J Ripollés-Melchor1, R Casans-Francés2, A Espinosa3, A Abad-Gurumeta4, A Feldheiser5, F López-Timoneda6, J M Calvo-Vecino7. 1. Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid. Servicio de Anestesia, Hospital Universitario Infanta Leonor, Madrid, España. Electronic address: ripo542@gmail.com. 2. Facultad de Medicina, Universidad de Zaragoza. Servicio de Anestesia, Hospital Universitario Lozano Blesa, Zaragoza, España. 3. Department of Anesthesia, Center of Vascular and Thoracic Surgery and Intensive Care, Örebro University Hospital, Örebro, Suecia. 4. Servicio de Anestesia, Hospital Universitario La Paz, Madrid, España. 5. Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte and Campus Charité Virchow-Klinikum, Berlín, Alemania. 6. Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid. Servicio de Anestesia, Hospital Clínico Universitario San Carlos, Madrid, España. 7. Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid. Servicio de Anestesia, Hospital Universitario Infanta Leonor, Madrid, España.
Abstract
BACKGROUND: Numerous studies have compared perioperative esophageal doppler monitoring (EDM) guided intravascular volume replacement strategies with conventional clinical volume replacement in surgical patients. The use of the EDM within hemodynamic algorithms is called 'goal directed hemodynamic therapy' (GDHT). METHODS: Meta-analysis of the effects of EDM guided GDHT in adult non-cardiac surgery on postoperative complications and mortality using PRISMA methodology. A systematic search was performed in Medline, PubMed, EMBASE, and the Cochrane Library (last update, March 2015). INCLUSION CRITERIA: Randomized clinical trials (RCTs) in which perioperative GDHT was compared to other fluid management. PRIMARY OUTCOMES: Overall complications. SECONDARY OUTCOMES: Mortality; number of patients with complications; cardiac, renal and infectious complications; incidence of ileus. Studies were subjected to quantifiable analysis, pre-defined subgroup analysis (stratified by surgery, type of comparator and risk); pre-defined sensitivity analysis and trial sequential analysis (TSA). RESULTS: Fifty six RCTs were initially identified, 15 fulfilling the inclusion criteria, including 1,368 patients. A significant reduction was observed in overall complications associated with GDHT compared to other fluid therapy (RR=0.75; 95%CI: 0.63-0.89; P=0.0009) in colorectal, urological and high-risk surgery compared to conventional fluid therapy. No differences were found in secondary outcomes, neither in other subgroups. The impact on preventing the development of complications in patients using EDM is high, causing a relative risk reduction (RRR) of 50% for a number needed to treat (NNT)=6. CONCLUSIONS: GDHT guided by EDM decreases postoperative complications, especially in patients undergoing colorectal surgery and high-risk surgery. However, no differences versus restrictive fluid therapy and in intermediate-risk patients were found.
BACKGROUND: Numerous studies have compared perioperative esophageal doppler monitoring (EDM) guided intravascular volume replacement strategies with conventional clinical volume replacement in surgical patients. The use of the EDM within hemodynamic algorithms is called 'goal directed hemodynamic therapy' (GDHT). METHODS: Meta-analysis of the effects of EDM guided GDHT in adult non-cardiac surgery on postoperative complications and mortality using PRISMA methodology. A systematic search was performed in Medline, PubMed, EMBASE, and the Cochrane Library (last update, March 2015). INCLUSION CRITERIA: Randomized clinical trials (RCTs) in which perioperative GDHT was compared to other fluid management. PRIMARY OUTCOMES: Overall complications. SECONDARY OUTCOMES: Mortality; number of patients with complications; cardiac, renal and infectious complications; incidence of ileus. Studies were subjected to quantifiable analysis, pre-defined subgroup analysis (stratified by surgery, type of comparator and risk); pre-defined sensitivity analysis and trial sequential analysis (TSA). RESULTS: Fifty six RCTs were initially identified, 15 fulfilling the inclusion criteria, including 1,368 patients. A significant reduction was observed in overall complications associated with GDHT compared to other fluid therapy (RR=0.75; 95%CI: 0.63-0.89; P=0.0009) in colorectal, urological and high-risk surgery compared to conventional fluid therapy. No differences were found in secondary outcomes, neither in other subgroups. The impact on preventing the development of complications in patients using EDM is high, causing a relative risk reduction (RRR) of 50% for a number needed to treat (NNT)=6. CONCLUSIONS: GDHT guided by EDM decreases postoperative complications, especially in patients undergoing colorectal surgery and high-risk surgery. However, no differences versus restrictive fluid therapy and in intermediate-risk patients were found.
Authors: Thomas S Metkus; Dylan Thibault; Michael C Grant; Vinay Badhwar; Jeffrey P Jacobs; Jennifer Lawton; Sean M O'Brien; Vinod Thourani; Zachary K Wegermann; Brittany Zwischenberger; Robert Higgins Journal: J Am Coll Cardiol Date: 2021-05-03 Impact factor: 27.203
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: Javier Ripollés-Melchor; María Luisa de Fuenmayor-Varela; Susana Criado Camargo; Pablo Jerez Fernández; Álvaro Contreras Del Barrio; Eugenio Martínez-Hurtado; Rubén Casans-Francés; Alfredo Abad-Gurumeta; José Manuel Ramírez-Rodríguez; José María Calvo-Vecino Journal: Braz J Anesthesiol Date: 2018-03-31