Goal directed fluid therapy in colorectal surgery : strategies for the low risk patient

Warnakulasuriya, Samantha Roshini

September 2014

Thesis or dissertation

© 2014 Samantha Roshini Warnakulasuriya. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Morbidity and mortality following major surgery has considerable variation both nationally and globally, and hence considerable research has been focused on how post operative outcomes can be improved. In order to achieve improvement it is essential to be able to stratify a patient’s risk, and hence direct appropriate therapy and interventions to those who will benefit.

Fluid therapy is used peri‐operatively to expand the circulating volume to optimise cardiac output, and hence increasing oxygen delivery to tissues, allowing the patient to meet the metabolic demands of surgery. There has been considerable debate on the optimal fluid regime for major surgery. Goal directed fluid therapy utilises cardiac output monitoring to optimise haemodynamic status on an individualised basis. Various protocols have shown improved post‐operative outcomes, and new non-invasive technologies are emerging which will allow uptake of targeted fluid therapy to be extended within the surgical population.

The oesophageal Doppler is an established technology used to target fluid therapy, and various studies have shown reduced morbidity when it is used in patients undergoing major abdominal surgery. Plethysmograph variability index (PVI) is a non‐invasive technology, which evaluates variations in the plethysmographic waveform with the respiratory cycle indicating fluid responsiveness. However, currently there are no published outcome studies of its use for intra‐operative goal directed fluid therapy.

The aim of this thesis is to examine the use of PVI in low-risk colorectal surgery patients, primarily investigating if similar volumes of fluids are administered when goal directed therapy is targeted using PVI or oesophageal Doppler. Fluid balance, post-operative morbidity and length of hospital stay are also compared to evaluate if PVI can be used as an alternative target for intra-operative goal-directed fluid therapy in this patient group.

Hull York Medical School, The University of Hull and the University of York
Davies, Simon
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