Doctors in Southampton are leading a national trial of a treatment approach that could improve survival from emergency bowel surgery by guiding the amount of fluid given to patients during their operations.
The protocol uses a heart monitoring device that tracks the amount of blood being pumped by the heart during and after surgery so that exact amounts of fluid can be given when required to improve blood flow.
Current monitoring methods, including blood pressure, heart rate and blood samples, are not always reliable in showing how much fluid patients need.
The study is being led by Dr Mark Edwards, part of the critical care team at the NIHR Southampton Biomedical Research Centre, which is a partnership between the University of Southampton and University Hospital Southampton NHS Foundation Trust (UHS).
Around 7,500 patients will be involved at 100 hospitals. The approach has already been subject to studies in patients undergoing planned bowel operations which suggest there may be a 15% reduction in deaths.
Around 30,000 people need emergency bowel surgery each year in the UK, often as a result of bowel cancer complications or infection. Many are elderly and have other health issues.
The operations are major interventions and patients are usually cared for on intensive care units after surgery – but one in 10 patients do not survive the immediate trauma.
The study, known as FLuid Optimisation in Emergency LAparotomy (FLO-ELA), will compare survival from operations that use the fluid protocol guided by a heart monitoring device during and shortly after surgery against standard care.
It will use data on emergency bowel surgery collected by the National Emergency Laparotomy Audit, which is part of the National Clinical Audit Programme and is hosted by the Royal College of Anaesthetists.
“This approach has the potential to improve survival from major emergency bowel surgery,” said Dr Edwards, who is a consultant anaesthetist at UHS.
“Maintaining patients’ blood fluid levels and flow is important for successful recovery from surgery and a more advanced approach could improve outcomes and survival.
“Early research into its effects for planned operations has shown promising results and we are hopeful it will prove as successful for emergencies.”
The study is being funded by the National Institute for Health Research Health Technology Assessment Programme. Further information can be found at www.floela.org and by following @FLOELAtrial on Twitter.
Posted on Thursday 20 July 2017