Development of an Algorithm for Goal-Directed Fluid Therapy in Colorectal Surgery

Abstract

Many anesthesia providers rely on traditional theories and methods for the management of perioperative fluid resuscitation in colorectal surgery (Bamboat & Bordeianou, 2009). Historically, prior training favored liberal intraoperative fluid replacement, particularly after bowel or emergent colorectal surgeries. In the 2000s, data supported the use of restrictive approaches to perioperative fluid administration, especially with goal-directed fluid therapy (GDFT). Within the past two years, current evidence shows that GDFT is appropriate in some populations and colorectal procedures but not beneficial for others. This Doctor of Nursing Practice (DNP) project provides evidence-based recommendations on suggested intraoperative fluid replacement therapy in colorectal surgery in the form of an algorithm that is based on a modified clinical practice guideline. The algorithm was developed for anesthesia providers at a Level 3 hospital in Mesa, Arizona. The Iowa Model was the conceptual framework, which guided this project by making recommendations to change current practice. An algorithm guided by the “2018 ERAS CPG for Colorectal Surgery Recommendation 13” was developed by the principal investigator (PI). Prior to developing the algorithm, participants (n=3) included DNP-Certified Registered Nurse Anesthetists (CRNAs) who used the “Appraisal of Guidelines for Research and Evaluation II” (AGREE II) tool to determine the quality of the guideline. Results determined that these guidelines were of good quality. The GDFT algorithm was presented to anesthesia providers during a monthly staff meeting. Ultimately, the anesthesia providers (N=4) filled out the Stakeholder Feedback Form and confirmed it was a quality algorithm, and that they would adopt it into their own practice. Anesthesia providers must change practice as evidence-based research provides current evidence to guide practice in improving patient outcomes.