Goal directed fluid therapy using transoesophageal Doppler in patients undergoing elective colorectal surgery: A meta-analysis of randomised controlled trials

2019 ◽  
Vol 31 ◽  
pp. 103
Author(s):  
K.E. Rollins ◽  
N.C. Mathias ◽  
D.N. Lobo
Keyword(s):  
Colorectal Surgery ◽  
Fluid Therapy ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Elective Colorectal Surgery ◽  
Goal Directed Fluid Therapy ◽  
Randomised Controlled

scholarly journals A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right

2010 ◽  
Vol 69 (4) ◽  
pp. 488-498 ◽  
Author(s):  
Krishna K. Varadhan ◽  
Dileep N. Lobo
Keyword(s):  
Abdominal Surgery ◽  
Fluid Balance ◽  
Fluid Therapy ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Intravenous Fluid ◽  
Controlled Trials ◽  
Intravenous Fluid Therapy ◽  
Open Abdominal Surgery ◽  
Randomised Controlled

The terminology used for describing intervention groups in randomised controlled trials (RCT) on the effect of intravenous fluid on outcome in abdominal surgery has been imprecise, and the lack of standardised definitions of the terms ‘standard’, ‘restricted’ and ‘liberal’ has led to some confusion and difficulty in interpreting the literature. The aims of this paper were to clarify these definitions and to use them to perform a meta-analysis of nine RCT on primarily crystalloid-based peri-operative intravenous fluid therapy in 801 patients undergoing elective open abdominal surgery. Patients who received more or less fluids than those who received a ‘balanced’ amount were considered to be in a state of ‘fluid imbalance’. When ‘restricted’ fluid regimens were compared with ‘standard or liberal’ fluid regimens, there was no difference in post-operative complication rates (risk ratio 0·96 (95% CI 0·56, 1·65), P=0·89) or length of hospital stay (weighted mean difference (WMD) −1·77 (95% CI −4·36, 0·81) d, P=0·18). However, when the fluid regimens were reclassified and patients were grouped into those who were managed in a state of fluid ‘balance’ or ‘imbalance’, the former group had significantly fewer complications (risk ratio 0·59 (95% CI 0·44, 0·81), P=0·0008) and a shorter length of stay (WMD −3·44 (95% CI −6·33, −0·54) d, P=0·02) than the latter. Using imprecise terminology, there was no apparent difference between the effects of fluid-restricted and standard or liberal fluid regimens on outcome in patients undergoing elective open abdominal surgery. However, patients managed in a state of fluid balance fared better than those managed in a state of fluid imbalance.

scholarly journals The Impact of Sham Feeding with Chewing Gum on Postoperative Ileus Following Colorectal Surgery: a Meta-Analysis of Randomised Controlled Trials

2020 ◽  
Vol 24 (11) ◽  
pp. 2643-2653 ◽  
Author(s):  
Farah Roslan ◽  
Anisa Kushairi ◽  
Laura Cappuyns ◽  
Prita Daliya ◽  
Alfred Adiamah
Keyword(s):  
Colorectal Surgery ◽  
Standard Care ◽  
Randomised Controlled Trials ◽  
Postoperative Ileus ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Controlled Trials ◽  
Sham Feeding ◽  
Randomised Controlled

Abstract Background Chewing gum as a form of sham feeding is an inexpensive and well-tolerated means of promoting gastrointestinal motility following major abdominal surgery. Although recognised by the Enhanced Recovery After Surgery (ERAS) Society as one of the multimodal approaches to expedite recovery after surgery, strong evidence to support its use in routine postoperative practice is lacking. Methodology A comprehensive literature review of all randomised controlled trials (RCTs) was performed in the Medline and Embase databases between 2000 and 2019. Studies were selected to compare the use of chewing gum versus standard care in the management of postoperative ileus (POI) in adults undergoing colorectal surgery. The primary outcome assessed was the incidence of POI. Secondary outcomes included time to passage of flatus, time to defecation, total length of hospital stay and mortality. Results Sixteen RCTs were included in the systematic review, of which ten (970 patients) were included in the meta-analysis. The incidence of POI was significantly reduced in patients utilising chewing gum compared to those having standard care (RR 0.55, 95% CI 0.39, 0.79, p = 0.0009). These patients also had a significant reduction in time to passage of flatus (WMD − 0.31, 95% CI − 0.36, − 0.26, p < 0.00001) and time to defecation (WMD − 0.47, 95% CI − 0.60, − 0.34, p < 0.00001), without significant differences in the total length of hospital stay or mortality. Conclusion The use of chewing gum after colorectal surgery is a safe and effective intervention in reducing the incidence of POI and merits routine use alongside other ERAS pathways in the postoperative setting.

scholarly journals 821 Comparative Effectiveness of Interventions to Reduce Ileus After Colorectal Surgery: A Network Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Ashcroft ◽  
A A Singh ◽  
B Ramachandran ◽  
A Habeeb ◽  
V Hudson ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Outcome Measures ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Relative Effectiveness ◽  
Mean Difference ◽  
Controlled Trials ◽  
Early Feeding ◽  
Solid Diet ◽  
Randomised Controlled

Abstract Aim Several treatment strategies for post-operative ileus have been evaluated in randomised controlled trials. This network meta-analysis aimed to explore the relative effectiveness of these different therapies on their impact on ileus outcome measures. Method A systematic review was conducted to identify randomised controlled trials reported up to 23rd April 2020. Indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analysis. Results A total of 48 randomised controlled trials, reporting any combination of five different outcome measures of time to flatus, stool, and solid diet tolerance, or nasogastric tube post-operative insertion, or length of stay following colorectal surgery were identified. In this network meta-analysis, early feeding was ranked first for time to solid diet tolerance (Mean Difference (hours) -58.845 CrI (-73.414, -43.150; rank 1 p = 0.960) and length of hospital stay (Mean Difference (hours) -2.326; CrI -3.510, -1.184; rank 1 p = 0.465) with high probability of first rank in the remainder of measures. Epidural analgesia was ranked first for time to flatus (Mean Difference (hours) -18.882; CrI -33.673, -3.435; rank 1 p = 0.286) and time to stool (Mean Difference (hours) -26.054; 95% CrI -66.417, 15.645; rank 1 p = 0.268). Conclusions This network meta-analysis identified early feeding as the most efficacious therapeutic to reduce post-operative ileus in patients undergoing colorectal surgery. High quality studies of the efficacious therapeutics to reduce ileus following colorectal surgery highlighted in this review are required with established core outcome measures of gastrointestinal mobility.

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