Professor Monty Mythen with the ODM probe
Oesophageal Doppler monitoring (ODM) is a minimally-invasive technology used in major surgery and in acutely ill patients which involves a thin ultrasound probe being placed down a patient's food pipe.
ODM accurately measures the patient's blood flow, which affects the delivery of oxygen - if the flow drops, the clinician can then accurately measure how much fluid and drugs need to be given to ensure optimum flow. It means adequate oxygen supplies to vital tissues and organs are maintained or quickly restored during critical illness or in general, vascular, urology and renal, orthopaedic and gynaecological surgery.
As a result, in operative cases, patients recover from their surgery more quickly, are mobile and can be discharged sooner, and have fewer complications. There is also evidence that ODM saves lives.
Guidance published today by the National Institute for Health and Clinical Excellence (NICE) supports the use of ODM during surgery. It could be used in over 800,000 surgeries a year but is currently used to treat only one in 20 eligible patients across the NHS.
Two consultants have been crucial to the development of ODM, which has been used at the Trust for the last 20 years. Professor Mervyn Singer, Professor of Intensive Care Medicine at UCL/UCLH, invented the device. Professor Monty Mythen, consultant in anaesthesia and critical care and director of research and development at UCLH, carried out the first clinical trial in patients undergoing heart surgery.
Professor Mythen, who is also clinical lead for the Department of Health's Enhanced Recovery Partnership Programme, said: "UCLH can be rightly proud of its role in developing ODM which has culminated in the guidance published today. I have worked with ODM for over 20 years and my patients have enjoyed the benefits from better management of their fluid levels during surgery.
"As part of a wider enhanced recovery programme, ODM significantly improves patient outcomes, as well as saving money for the NHS. I am delighted that this guidance has highlighted the advantages of this technology, and I hope that it gives the NHS the impetus it needs to ensure better access for all."
Professor Singer, a National Institute for Health Research UCLH/UCL Comprehensive Biomedical Research Centre senior investigator, added: “UCLH has the lowest standardised mortality rates of any hospital in the country. An important addition such as the ODM device, that can detect clinical deterioration at an early stage and can guide treatment more accurately than conventional methods, is likely to have been a major contributor to this success.”
The official NICE guidance states that oesophageal Doppler monitoring (ODM), which measures blood flow during surgery, also:
- reduces average length of hospital stay by two days per patient
- results in fewer complications
- reduces use of critical care facilities
- results in fewer hospital readmissions
ODM is one of three strands which make up UCLH's Enhanced Surgical Treatment and Recovery Programme (ESTReP) which was implemented in 2007.
The fundamental principle underlying ESTReP is that patients recover more rapidly and are fit for discharge earlier. It can halve the length of time patients spend recovering in hospital. The three strands are:
ESTREP involves three key processes:
A comprehensive preparation of the patient prior to admission including a package of education to better inform them about their 'surgical journey' and an objective assessment of their fitness to undergo the required operation
The use of minimally invasive surgical techniques (key hole surgery) and precise anaesthetic care with specialist cardiac and fluid monitoring during the operation. This specialist monitoring utilises the oesophageal Doppler monitoring (ODM) technique that is accepted as being 'best practice’ by the National Institute of Clinical Excellence (NICE) but is currently used in less than 5% of major operations nationwide
A defined postoperative programme including rapid mobilisation and early return to eating and drinking that minimises surgical complications while encouraging patient recovery and discharge.