Conventional monitoring and intravascular volume measurement can lead to different therapy after upper gastrointestinal tract surgery

Abstract

Objective. The purpose of this study was to compare the judgment of intravascular volume based either on conventional monitoring or on the data of COLD measurement.

Design: Single-blinded, observational study.

Setting: Intensive care unit (ICU).

Patients: Ten consecutive patients after upper gastrointestinal tract surgery for carcinoma.

Measurements and results: Judgments (n=59) about intravascular volume (hypo-, iso- or hypervolemic) were given twice a day until the 2nd postoperative day by two physicians. Physician A's judgment was based on conventional monitoring and physician B's judgment on COLD monitoring. Both were blinded for each other's judgment. The inter-rater agreement between A and B was analyzed using the weighted kappa statistic. Both physicians gave a recommendation about the volume therapy during the following 12 h. The therapeutic regimen, including volume therapy, was defined by physician A. The inter-rater-agreement regarding intravascular volume was poor (overall weighted kappa =0.095). The sum of absolute differences between A and B in their recommendation about infusion administration reached a median of 4,875 ml per patient.

Conclusions: The poor inter-rater agreement between the two physicians and the consecutive difference in the infusion therapy may have clinical consequences and should be evaluated in further studies. These data cannot confirm which decision strategy should be preferred.