Clinical Papers

This is just a selection of the clinical studies that have been published.
For a full bibliography please download here

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

Patient Population
High-risk abdominal surgery.

LiDCO Monitor
LiDCOrapid.

Trial Design
The acute high-risk abdominal (AHA) study was a controlled single-centre intervention study in an unselected consecutive cohort undergoing AHA surgery.

Outcome Impact
The 30-day mortality rate was 15.5 per cent in the intervention cohort compared with 21.8 per cent in the control cohort (P=0.005; relative risk reduction 29 per cent). The 180-day mortality was 22.2 per cent in the intervention cohort compared with 29.5 per cent in the control cohort (P=0.004).

 

Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy

Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy

Patient Population
Emergency Laparotomy Surgery.

LiDCO Monitor
LiDCOrapid as part of an evidence-based care bundle.

Trial Design
Before v after a care bundle introduction.

Outcome Impact
Reduced mortality – 5.97 more lives per 100 patients were saved.

ERAS | Single surgeon’s experience with enhanced recovery after surgery

ERAS | Single surgeon’s experience with enhanced recovery after surgery

Patient Population
Elective abdominal procedures.

LiDCO Monitor
LiDCOrapid.

Trial Design
A retrospective chart review performed to identify all patients who underwent elective abdominal surgery at one US medical centre, between June 2013 and April 2015. An ERAS pathway was implemented in June 2014. Three patient groups were categorised based on Charlson comobidity index (CCI).

Outcome Impact
Univariate analysis revealed that the ERAS protocol was associated with shorter LOS, lower cost, and lower mortality.

RCT early GDT after major surgery reduces complications and LOS

RCT early GDT after major surgery reduces complications and LOS

Patient Population
Post-surgical intensive care.

LiDCO Monitor
LiDCOplus oxygen delivery (DO2) Early goal-directed therapy (EGDT) target.

Trial Design
Randomised LiDCOplus EGDT target vs usual care.

Outcome Impact
Fewer EGDT patients developed complications – 27 patients (44%) vs 41 patients (68%) LOS was significantly reduced (11 days vs 14 days) and the mean stay was reduced by 12 days (17.5 days versus 29.5 days) a 41% reduction. EGDT decreased costs by £2,631 per patient and by £2,134 per hospital survivor. EGDT was found to prolong quality-adjusted life expectancy (by 9.8 months) and to bring incremental cost savings of £1,285.

GDT following cardiac surgery and incidence of AKI

GDT following cardiac surgery and incidence of AKI

Patient Population
Cardiac surgery patients following coronary artery bypass grafting and/or aortic valve surgery.

LiDCO Monitor
LiDCOplus.

Trial Design
Prospective observational study in cardiothoracic ICU.

Outcome Impact
A nurse-led GDT protocol targeting maximum SV for 8hrs post surgery showed a reduction in the incidence of AKI and reduction in the number of patients requiring RRT.

Elevated PPV predicts increased LOS and morbidity in high risk abdominal surgery

Elevated PPV predicts increased LOS and morbidity in high risk abdominal surgery

Patient Population
High risk abdominal & bariatric surgery.

LiDCO Monitor
LiDCOrapid fluid optimisation.

Trial Design
Prospective observational study.  Maintaining a threshold of 13% for PPV% was deemed adequate fluid management.

Outcome Impact
Patients with PPV maintained at threshold had decreased LOS (10.1 to 6.1 days) and a reduction in postoperative complication rates.

SVV guide to fluid administration in laparoscopic bariatric surgery

SVV guide to fluid administration in laparoscopic bariatric surgery

Patient Population
Laparoscopic bariatric surgery.

LiDCO Monitor
LiDCOrapid fluid optimisation.

Trial Design
Maintaining SVV% was the goal for fluid optimisation.

Outcome Impact
Using SVV% as the target physicians successfully maintained hemodynamic parameters (cardiac output, stroke volume and heart rate) within 10% of the preoperative level control level.

Effects of sympthomimetric drugs on free flaps in head and neck surgery

Effects of sympthomimetric drugs on free flaps in head and neck surgery

Patient Population
Head & neck free flap reconstruction.

LiDCO Monitor
LiDCOrapid.

Trial Design
Prospective comparison of blood flow in free flap versus control tissue in 24 patients.

Outcome Impact
Norepinephrine most consistently elevated the mean arterial pressure and caused by far the largest increase in flap skin blood flow, making it the pressor agent of choice (of those studied), following free tissue transfer.

 

Optimisation of intra-operative hemodynamics in major head and neck surgery

Optimisation of intra-operative hemodynamics in major head and neck surgery

Patient Population
Head & neck surgery.

LiDCO Monitor
LiDCOrapid.

Abstract
Short communication describing the use of a protocol for intraoperative fluid management with early experience in patients having major head and neck surgery, where oesophageal Doppler ultrasound is impractical.

 

Haemodynamic optimisation in lower limb arterial surgery: Room for improvement?

Haemodynamic optimisation in lower limb arterial surgery: Room for improvement?

Patient Population
High-risk peripheral vascular surgery.

LiDCO Monitor
LiDCOplus oxygen delivery (DO2) GDT target.

Trial Design
Randomised GDT vs standard care.

Outcome Impact
Significantly less fluid or adjusted all complications in the IGFT group.

GDFT hemodynamic stability of parturient for cesarean delivery and newborn well-being

GDFT hemodynamic stability of parturient for cesarean delivery and newborn well-being

Patient Population
Hypertensive caesarean section.

LiDCO Monitor
LiDCOrapid fluid optimisation (GDFT).

Trial Design
Randomised SV as target for fluid optimisation vs. routine fluid care.

Outcome Impact
In the GDFT group: heart rate, incidences of hypotension & use of phenylephrine were all lower than in the control group.  In the fetus pH in umbilical artery/vein were significantly decreased, as were incidences of neonatal hypercapnia and hypoxemia.

Sepsis | Reduced mortality with noninvasive hemodynamic monitoring of shock

Sepsis | Reduced mortality with noninvasive hemodynamic monitoring of shock

Patient Population
ICU shock patients.

LiDCO Monitor
LiDCOplus.

Trial Design
Observational study comparing no hemodynamic monitoring vs pulmonary artery vs LiDCOplus managed shock patients.

Outcome Impact
Treatment of patients using the LiDCOplus monitor significantly reduced the observed mortality rate to 13% against 32% and 20% in the invasively monitored and 37% in the unmonitored patient groups.

Restrictive strategy of intra-operative fluid maintenance decreases major complications after high-risk surgery

Restrictive strategy of intra-operative fluid maintenance decreases major complications after high-risk surgery

Patient Population
High-risk general surgery.

LiDCO Monitor
LiDCOrapid fluid optimisation & oxygen delivery (DO2) GDT target.

Trial Design
Randomised GDT with fluid restriction vs GDT with liberal maintenance fluids.

Outcome Impact
Allowed GDT DO2 targeting while restricting maintenance fluids; reducing expected complications rate from 61.5% to 20%.

Perioperative goal-directed fluid therapy is in essential element of ERP

Perioperative goal-directed fluid therapy is in essential element of ERP

Editorial

This editorial debates the balance of evidence of fluid management in perioperative care.

“We believe that goal-directed therapy has the potential to reduce length of stay in the hospital and decrease post-operative complications in patients undergoing major and high-risk surgery. In fact, recent studies using goal-directed therapy in an ERAS setting have demonstrated a reduction in length of stay and complications.”

 

Application of LiDCO-Rapid in peri-operative fluid therapy for aged patients total hip replacement

Application of LiDCO-Rapid in peri-operative fluid therapy for aged patients total hip replacement

Patient Population
Total hip replacement.

LiDCO Monitor
LiDCOrapid fluid optimisation.

Trial Design
Randomised LiDCOrapid fluid optimisation vs conventional fluid management.

Outcome Impact
Lactate levels were significantly lower than seen in the conventionally managed subjects vasopressor requirements and complications were also significantly lower in the LiDCOrapid fluid optimized group.

Multimodal intraoperative monitoring: Observational case series in major peripheral vascular surgery

Multimodal intraoperative monitoring: Observational case series in major peripheral vascular surgery

Patient Population
High-risk peripheral vascular surgery.

LiDCO Monitor
LiDCOrapid as the hemodynamic part of a multimodal monitoring approach.

Trial Design
Actual mortality after multimodal approach vs predicted V-POSSUM.

Outcome Impact
30-day mortality at 0.8% significantly lower than the 9% mortality predicted by the V-POSSUM amputation rate less than 2% after one year. Post-operatively only 8% (10 patients) went to a high dependency unit (HDU).

RCT effect of peri-operative GDHT on cardiac surgery outcomes

RCT effect of peri-operative GDHT on cardiac surgery outcomes

Patient Population
Cardiac surgery.

LiDCO Monitor
LiDCOrapid goal-directed therapy (GDT) targeted cardiac index (CI).

Trial Design
Randomised GDT targeted cardiac index vs standard care.

Outcome Impact
Composite endpoint 30-day mortality and major postoperative complications reduced in the goal-directed therapy group (27.4% vs 45.3%) and GDT patients had less infections (12.9% vs 29.7%), a lower incidence of low cardiac output syndrome (6.5% vs 26.6%), reduced ICU (3 vs 5 days) and hospital stay (9 vs 12 days).

Propensity score analysis of ERP in upper gastrointestinal cancer surgery

Propensity score analysis of ERP in upper gastrointestinal cancer surgery

Patient Population
Oesophagectomy & Gastrectomy.

LiDCO Monitor
LiDCOrapid as part of an enhanced recovery program (ERP).

Trial Design
Before vs after ERP (propensity score-matched analysis).

Outcome Impact
ICU stay reduced and LOS reduced by 3 days.

Impact of multidisciplinary SOCP on perioperative oesophageal cancer outcomes

Impact of multidisciplinary SOCP on perioperative oesophageal cancer outcomes

Patient Population
Oesophagectomy.

LiDCO Monitor
LiDCOrapid + standardised oesophagectomy pathway (SOCP).

Trial Design
Before vs after SOCP introduction.

Outcome Impact
Lower complications, ICU stay reduced by 1 day, LOS reduced by 10 days (17 to 7 days).

RCT effect of peri-operative hemodynamic therapy algorithm major gastrointestinal surgery outcomes

RCT effect of peri-operative hemodynamic therapy algorithm major gastrointestinal surgery outcomes

Patient Population
OPTIMISE – High-risk gastrointestinal surgery.

LiDCO Monitor
LiDCOrapid guided hemodynamic algorithm with dopexamine infusion vs usual care.

Trial Design
Prospective multi-centre randomised.

Outcome Impact
Lower, compound complications (36.6% v 43.4% n.s.) The inclusion of results in a meta-analysis indicates intervention was associated with a clinically significant lower level of complications.

GDFT hemodynamic stability in parturient women under spinal epidural

GDFT hemodynamic stability in parturient women under spinal epidural

Patient Population
Cesarean.

LiDCO Monitor
LiDCOrapid.

Trial Design
100 term parturient women scheduled for elective cesarean section randomly allocated to GDFT or a control group.

Outcome Impact
The incidence of hypotension and mean phenylephrine dose administered prior to delivery were significantly higher in the control group than in the GDFT group (P < 0.01).

Hemodynamic effects during spinal anesthesia for elective cesarean delivery

Hemodynamic effects during spinal anesthesia for elective cesarean delivery

Patient Population
Cesarean.

LiDCO Monitor
LiDCOplus.

Trial Design
Prospective, randomised and double-blind among 40 patients.

Outcome Impact
Bolus phenylephrine reduced maternal CO and decreased CO when compared with ephedrine during elective spinal anesthesia for Cesarean delivery.

Surviving Sepsis campaign | 2016

Surviving Sepsis campaign | 2016

Guidelines
Management of sepsis and septic shock.

Purpose
To provide an update to the Surviving Sepsis Campaign guidelines for Management of Sepsis and Septic Shock: 2012.

Appendices
Appendix 1. Recommendations and Best Practice Statement
Appendix 2. Comparison of Recommendations from 2012 to 2016

A rational approach to fluid therapy in sepsis

A rational approach to fluid therapy in sepsis

Patient population
Severe sepsis and septic shock.

Purpose
The purpose of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock.

 

 

Consensus on circulatory shock and hemodynamic monitoring

Consensus on circulatory shock and hemodynamic monitoring

Consensus
Circulatory shock and hemodynamic monitoring.

Purpose
The purpose of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock.

 

 

Practice guidelines for obstetric anesthesia

Practice guidelines for obstetric anesthesia

Guideline
Obstetric Anesthesia.

Purpose
The purpose of these guidelines are to enhance the quality of anesthetic care for obstetric patients, improve patient safety by reducing the incidence and severity of anesthesia-related complications, and increase patient satisfaction.

ESA | Peri-operative GDT protocol summary

ESA | Peri-operative GDT protocol summary

Protocol Summary
ESA – Perioperative goal-directed therapy

Purpose
This protocol summary produced by the European Society of Anaesthesiology (ESA) describes three main perioperative GDT strategies.

Reduced LOS in colorectal surgery after ERP implementation

Reduced LOS in colorectal surgery after ERP implementation

Patient Population
Open or laparoscopic colorectal surgery.

LiDCO Monitor*
LiDCOrapid as part of an enhanced recovery program (ERAS).

Trial Design
Before vs after ERAS introduction.

Outcome Impact
LOS reduced by 2 days (7 to 5), lower urinary infections (13% v 24%) & 30 day readmission rates 9.8% v 20.2%.

Enhanced recovery in the resection of colorectal liver metastases

Enhanced recovery in the resection of colorectal liver metastases

Patient Population
Resection of colorectal liver metastases.

LiDCO Monitor
LiDCOrapid as part of an enhanced recovery program (ERAS).

Trial Design
Before v after an ERAS introduction.

Outcome Impact
The probability that LOS would be > 10 days decreased to 7% from 25% & ICU utilization reduced from 75.5% to 54.7%.

RCT enhanced recovery versus standard care following open liver resection

RCT enhanced recovery versus standard care following open liver resection

Patient population
Open Liver Surgery.

LiDCO Monitor
LiDCOrapid as part of an enhanced recovery program (ERP).

Trial Design
Randomised ERP vs standard care.

Outcome Impact
LOS reduced by 3 days. Complications reduced from 27% to 7%.

ERAS in a single high-volume surgical oncology unit

ERAS in a single high-volume surgical oncology unit

Patient Population
Mixed abdominal cancer surgery.

LiDCO Monitor
LiDCOrapid as part of an enhanced recovery program (ERAS).

Trial Design
Before vs after ERAS introduction.

Outcome Impact
LOS reduced by 2 days (8 to 6) & mortality reduced from 2.9% to 0%.