Meta‐analysis of goal‐directed fluid therapy using transoesophageal Doppler monitoring in patients undergoing elective colorectal surgery

Abstract

Background Intraoperative goal‐directed fluid therapy (GDFT) is recommended in most perioperative guidelines for intraoperative fluid management in patients undergoing elective colorectal surgery. However, the evidence in elective colorectal surgery alone is not well established. The aim of this meta‐analysis was to compare the effects of GDFT with those of conventional fluid therapy on outcomes after elective colorectal surgery. Methods A meta‐analysis of RCTs examining the role of transoesophageal Doppler‐guided GDFT with conventional fluid therapy in adult patients undergoing elective colorectal surgery was performed in accordance with PRISMA methodology. The primary outcome measure was overall morbidity, and secondary outcome measures were length of hospital stay, time to return of gastrointestinal function, 30‐day mortality, acute kidney injury, and surgical‐site infection and anastomotic leak rates. Results A total of 11 studies were included with a total of 1113 patients (556 GDFT, 557 conventional fluid therapy). There was no significant difference in any clinical outcome measure studied between GDFT and conventional fluid therapy, including overall morbidity (risk ratio (RR) 0·90, 95 per cent c.i. 0·75 to 1·08, P = 0·27; I2 = 47 per cent; 991 patients), 30‐day mortality (RR 0·67, 0·23 to 1·92, P = 0·45; I2 = 0 per cent; 1039 patients) and length of hospital stay (mean difference 0·01 (95 per cent c.i. −0·92 to 0·94) days, P = 0·98; I2 = 34 per cent; 1049 patients). Conclusion This meta‐analysis does not support the perceived benefits of GDFT guided by transoesophageal Doppler monitoring in the setting of elective colorectal surgery.