Details of HTA project
Last updated: 15 July 2008 - Next update due: 22 July 2008
Research type: |
HTA Technology Assessment Report |
Project title: |
Systematic review of the clinical effectiveness and cost-effectiveness of oesophageal Doppler monitoring in critically ill and high risk surgical patients |
Project ref: |
07/20/01 |
Cost: |
This project has been commissioned by the HTA programme on a call-off contract basis. |
Chief Investigator : |
Aberdeen HTA Group, University of Aberdeen |
Start Date: |
March 2007. |
Publication date: |
December 2008. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
It is believed that measuring heart function during critical illness or during surgery can improve patient outcomes. Until recently the main method used to measure heart function has been pulmonary artery catheterisation (PAC), although for people undergoing surgery even this approach is uncommon. Whilst providing useful information, PACs have not been shown to improve mortality. This coupled with concerns over procedural complications associated with the use of these catheters, along with the development of less complex heart monitors, has resulted in a global decline in the usage of PACs over recent years. This review will assess the effectiveness and cost-effectiveness of oesophageal Doppler monitoring (ODM) when used for monitoring heart function in comparison with (i) standard care (i.e. no cardiac output monitor perioperatively amongst patients undergoing major surgery; and (ii) other methods of monitoring heart function such as pulmonary artery catheterisation or pulse contour monitoring devices in critically ill patients or in patients undergoing major surgery. The analysis will focus on outcomes of most importance to patients (e.g. mortality, length of hospitalisation, length of stay in critical care, days of organ support in ICU and complications). Cost-effectiveness will be assessed from the perspective of the NHS and personal social services. Information of the relative effectiveness of the alternative interventions will be derived by systematically reviewing relevant randomised controlled trials (RCTs) comparing ODM with: (i) standard care (i.e. no cardiac output monitor perioperatively amongst patients undergoing major surgery); and (ii) other methods of monitoring heart function as outlined above. Information on cost-effectiveness will initially be assessed using a systematic review of economic evaluations comparing ODM to the relevant comparators for the two patient groups specified. |
Abstract: |
Optimal management of cardiac output and haemodynamic status have long been considered as key to improving outcome in critically ill patients and in high risk patients undergoing major surgery. Traditionally pulmonary artery catheters (PAC) have been used to monitor cardiac output and haemodynamic status and to guide treatment. A recent HTA Programme funded study demonstrated that PAC insertion and management of critically ill patients using the parameters monitored by PAC fails to infer an outcome benefit. Further studies have also cast doubt on the value of PAC in high risk major surgery. This coupled with concerns related to procedural complications associated with the insertion and use of the PAC, along with the development and assimilation of less invasive cardiac output monitors into clinical practice, has resulted in a global decline in the usage of the PAC in recent years. Less invasive technologies to monitor cardiac output and other haemodynamic parameters include Oesophageal Doppler Monitoring (ODM) and systems based upon pulse contour analysis and dye dilution methods. The ODM measures blood flow velocity in the descending thoracic aorta using a flexible ultrasonic probe inserted into the patient's oesophagus. This information is combined with an estimate of aortic cross sectional area (derived from the patient's age, height, and weight) allowing haemodynamic variables to be calculated. Pulse contour analysis devices employ algorithms to perform real-time continuous monitoring of cardiac output through arterial pulse contour analysis. There are several types of devices available, but all require initial calibration which may be either via transpulmonary thermodilution or lithium dilution techniques. Information on the relative effectiveness of the alternative interventions will be derived by systematically reviewing relevant randomised controlled trials (RCTs). Information on cost-effectiveness will be assessed using a systematic review of economic evaluations of the alternative methods. THE NATIONAL COORDINATING CENTRE FOR HTA COMMISSIONED THIS TECHNOLOGY ASSESSMENT REPORT ON BEHALF OF THE HTA PROGRAMME DIRECTOR IN COLLABORATION WITH THE NHS CENTRE FOR EVIDENCE-BASED PURCHASING (CEP) |
NRR* number, if applicable: |
N0484193513 (*National Research Register) |
Project Protocol: |
Project protocol (pdf format, 139 kbytes) |
URL of this page: |
http://www.hta.ac.uk/1633 |
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