Perioperative goal-directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis

• Published in: Journal of clinical anesthesia Vol. 28; pp. 105 - 115
• Main Authors: Ripollés-Melchor, Javier, MD, Espinosa, Ángel, MD, Martínez-Hurtado, Eugenio, MD, Abad-Gurumeta, Alfredo, PhD, Casans-Francés, Rubén, PhD, Fernández-Pérez, Cristina, López-Timoneda, Francisco, Calvo-Vecino, José María
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2016; Elsevier Limited
• Subjects: Algorithms; Anesthesia & Perioperative Care; Bias; Catheters; Clinical outcomes; Clinical trials; Confidence intervals; Fluid Therapy; Fluids; Goal-directed fluid therapy; Goals; Hemodynamic goal; Hemodynamics; Humans; Intensive care; Meta-analysis; Mortality; Noncardiac surgery; Pain Medicine; Perioperative care; Perioperative Care - methods; Postoperative period; Pulmonary arteries; Quality; Randomized Controlled Trials as Topic; Statistical analysis; Studies; Surgery; Surgical Procedures, Operative - methods; Surgical Procedures, Operative - mortality; Urine; Hemodynamic goal; Noncardiac surgery; Perioperative care; Goal-directed fluid therapy; Meta-analysis
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2015.08.004

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.