New journal Perioperative Medicine launches on 27th June 2012 with important guidelines for fluid management during surgery. The Consensus Statement was agreed by the Clinical Leaders of the English Enhanced Recovery Partnership, set up by the UK Department of Health to improve recovery after major surgery.
The statement provides important evidence-based guidelines for fluid management in high-risk patients, including the training of all anaesthetists in the use of cardiac output measuring technologies. These technologies, such as the Oesophageal Doppler, are rarely used in high risk NHS patients, despite clear evidence that inadequate fluid management increases mortality after surgery by up to three-fold (the recent NCEPOD report found that arterial lines, central lines and cardiac output monitoring were only used in 27%, 14% and 5% of the high risk group). The consensus statement is backed up by evidence from NICE, GIFTASUP and the Department of Health.
The authors state that “perceived lack of resources is not a viable excuse. NICE have concluded that we can’t afford NOT to use intra-operative fluid management technologies where indicated. Practitioners should not be constrained by lack of availability of such technology.” Crucially, the authors also recommends a regular audit of compliance with these guidelines.
In the launch editorial of Perioperative Medicine, Editors-in-Chief Monty Mythen and Mark Hamilton state that “cardiac output monitoring was rarely used in high-risk patients and inadequate intra-operative monitoring was associated with a three-fold increase in mortality”. They add that “achieving superior outcomes in surgery may require that hospitals invest in expensive resources, such as intensivist-staffed intensive care units, high nurse-to-bed ratios, advanced technology, and specialist services.”
“Perioperative Fluid Management: Consensus statement from the Enhanced Recovery Partnership” Monty G Mythen, Michael Swart, Nigel Acheson, Robin Crawford, Kerri Jones, Martin Kuper, John S McGrath and Alan Horgan.Perioperative Medicine 2012, 1:5.