Javier Ripollés-Melchor1, Ángel Espinosa2, Eugenio Martínez-Hurtado3, Alfredo Abad-Gurumeta4, Rubén Casans-Francés5, Cristina Fernández-Pérez6, Francisco López-Timoneda7, José María Calvo-Vecino3. 1. Complutense University of Madrid and Department of Anesthesia, Hospital Universitario Infanta Leonor, Gran Vía del Este 80, 28031 Madrid, Spain; EAR (Evidence Anesthesia Review) Group. Electronic address: ripo542@gmail.com. 2. Department of Anesthesia, Center of Vascular and Thoracic Surgery and Intensive Care, Örebro University Hospital, Sweden; EAR (Evidence Anesthesia Review) Group. 3. Complutense University of Madrid and Department of Anesthesia, Hospital Universitario Infanta Leonor, Gran Vía del Este 80, 28031 Madrid, Spain; EAR (Evidence Anesthesia Review) Group. 4. Department of Anesthesia, Hospital Universitario la Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain; EAR (Evidence Anesthesia Review) Group. 5. Zaragoza University and Department of Anesthesia, Hospital Clínico Universitario Lozano Blesa, Avenida San Juan Bosco, 15, 50009 Zaragoza, Spain; EAR (Evidence Anesthesia Review) Group. 6. Complutense University of Madrid and Department of Preventive Medicine and Public Health, Hospital Clinico San Carlos, Prof Martin Lagos s/n, 28040 Madrid, Spain; EAR (Evidence Anesthesia Review) Group. 7. Complutense University of Madrid and Department of Anesthesia, Hospital Clinico San Carlos, Prof Martin Lagos s/n, 28040 Madrid, Spain; EAR (Evidence Anesthesia Review) Group.
Abstract
STUDY OBJECTIVE: Goal-directed fluid therapy (GDHT) has been proposed as a method to reduce complications and mortality. DESIGN: Meta-analysis of the effects of perioperative GDHT in adult noncardiac surgery on mortality and postoperative complications was performed using the PRISMA methodology. A systematic search was performed in MEDLINE, PubMed, EMBASE, and the Cochrane Library (last update, October 2014). Inclusion criteria were as follows: randomized clinical trials (RCTs) in which perioperative GDHT was compared with conventional fluid management in noncardiac surgery. Exclusion criteria were as follows: trauma and pediatric surgery studies. End points were mortality and number of patients with complications. SETTING: District general hospital. PATIENTS: Thirty-nine RCTs were initially identified, with 8 fulfilling the inclusion criteria. Two RCTs were added by manual search, resulting in 10 RCTs in the final analysis, including 1527 patients. MEASUREMENTS: Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by supraphysiological or physiological hemodynamic goal and by time the intervention was carried out, perioperative or postoperative), and predefined sensitivity analysis. MAIN RESULTS: A significant reduction was observed in mortality associated with GDHT compared with conventional fluid therapy (risk ratio, 0.63; 95% confidence interval, 0.42-0.94; P = .02). However, no differences were found in the number of patients with complications (risk ratio, 0.75; 95% confidence interval, 0.50-1.17; P = .21), and the sensitivity analysis did not confirm the results. CONCLUSIONS: This meta-analysis, with its limitations, shows that the use of perioperative GDHT may reduce postoperative mortality, but it is unable to show a reduction in the number of patients with complications.
STUDY OBJECTIVE: Goal-directed fluid therapy (GDHT) has been proposed as a method to reduce complications and mortality. DESIGN: Meta-analysis of the effects of perioperative GDHT in adult noncardiac surgery on mortality and postoperative complications was performed using the PRISMA methodology. A systematic search was performed in MEDLINE, PubMed, EMBASE, and the Cochrane Library (last update, October 2014). Inclusion criteria were as follows: randomized clinical trials (RCTs) in which perioperative GDHT was compared with conventional fluid management in noncardiac surgery. Exclusion criteria were as follows: trauma and pediatric surgery studies. End points were mortality and number of patients with complications. SETTING: District general hospital. PATIENTS: Thirty-nine RCTs were initially identified, with 8 fulfilling the inclusion criteria. Two RCTs were added by manual search, resulting in 10 RCTs in the final analysis, including 1527 patients. MEASUREMENTS: Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by supraphysiological or physiological hemodynamic goal and by time the intervention was carried out, perioperative or postoperative), and predefined sensitivity analysis. MAIN RESULTS: A significant reduction was observed in mortality associated with GDHT compared with conventional fluid therapy (risk ratio, 0.63; 95% confidence interval, 0.42-0.94; P = .02). However, no differences were found in the number of patients with complications (risk ratio, 0.75; 95% confidence interval, 0.50-1.17; P = .21), and the sensitivity analysis did not confirm the results. CONCLUSIONS: This meta-analysis, with its limitations, shows that the use of perioperative GDHT may reduce postoperative mortality, but it is unable to show a reduction in the number of patients with complications.
Authors: Marie K Jessen; Mikael F Vallentin; Mathias J Holmberg; Maria Bolther; Frederik B Hansen; Johanne M Holst; Andreas Magnussen; Niklas S Hansen; Cecilie M Johannsen; Johannes Enevoldsen; Thomas H Jensen; Lara L Roessler; Peter C Lind; Maibritt P Klitholm; Mark A Eggertsen; Philip Caap; Caroline Boye; Karol M Dabrowski; Lasse Vormfenne; Maria Høybye; Jeppe Henriksen; Carl M Karlsson; Ida R Balleby; Marie S Rasmussen; Kim Pælestik; Asger Granfeldt; Lars W Andersen Journal: Br J Anaesth Date: 2021-12-13 Impact factor: 11.719
Authors: Anna Wrzosek; Joanna Jakowicka-Wordliczek; Renata Zajaczkowska; Wojciech T Serednicki; Milosz Jankowski; Malgorzata M Bala; Mateusz J Swierz; Maciej Polak; Jerzy Wordliczek Journal: Cochrane Database Syst Rev Date: 2019-12-12
Authors: Gertrude J Nieuwenhuijs-Moeke; Tobias M Huijink; Robert A Pol; Mostafa El Moumni; Johannes Gm Burgerhof; Michel Mrf Struys; Stefan P Berger Journal: J Clin Med Date: 2019-10-02 Impact factor: 4.241