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

Abstract

Intraoperative goal directed hemodynamic therapy with minimally invasive monitoring decreases postoperative complications in noncardiac surgery, although it was not able to show a significant decrease in mortality rate.

Clinical guidelines for perioperative hemodynamic management of non cardiac surgical adult patients

“…Although results present low statistical heterogeneity, they derive from high risk of bias studies and clinical heterogeneity with regard to type of surgery, patients, and protocols, reducing the strenght of evidence. Other meta-analyses including only abominal surgical patients 52,53,54 report contrasting results contributing to increase uncertainty of evidence. Therefore, there is not enough evidence to propose any recommendation in favour or against adoption of GDT protocol to reduce mortality in a population of adult non cardiac surgical patients.…”

Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery: a systematic review and meta-analysis

“…Goal-directed haemodynamic therapy (GDHT) – sometimes just called goal-directed therapy 6 – is the use of a protocol to standardise haemodynamic targets and the treatments used to reach these targets. GDHT most often refers to optimisation of flow-related parameters such as cardiac output or stroke volume, 7 , 8 and optimisation will most often involve fluid therapy and the term goal-directed fluid therapy is therefore also used. 9 , 10 , 11 Systematic reviews have generally found that GDHT reduces hospital length of stay 9 , 12 , 13 , 14 , 15 , 16 , 17 and overall postoperative complication rate, 7 , 9 , 14 , 15 , 16 , 18 , 19 , 20 whereas estimates on mortality 7 , 12 , 13 , 16 , 18 , 19 , 21 , 22 , 23 and organ-specific complications 9 , 13 , 14 , 16 , 20 , 22 , 23 , 24 , 25 , 26 tend to favour GDHT with varying precision.…”

“…GDHT most often refers to optimisation of flow-related parameters such as cardiac output or stroke volume, 7 , 8 and optimisation will most often involve fluid therapy and the term goal-directed fluid therapy is therefore also used. 9 , 10 , 11 Systematic reviews have generally found that GDHT reduces hospital length of stay 9 , 12 , 13 , 14 , 15 , 16 , 17 and overall postoperative complication rate, 7 , 9 , 14 , 15 , 16 , 18 , 19 , 20 whereas estimates on mortality 7 , 12 , 13 , 16 , 18 , 19 , 21 , 22 , 23 and organ-specific complications 9 , 13 , 14 , 16 , 20 , 22 , 23 , 24 , 25 , 26 tend to favour GDHT with varying precision. Yet, there may be problems with heterogeneity in outcome definitions: although one review did select studies for meta-analyses based on specific definitions of pulmonary outcomes, 17 other reviews included all outcome definitions.…”

Goal-Directed Fluid Therapy and Postoperative Outcomes in an Enhanced Recovery Program for Colorectal Surgery: A Propensity Score-Matched Multicenter Study

“…This was highlighted in the OPTIMSE study, in which results became significant with GDFT leading to fewer postoperative complications than the control group after adjusting for protocol adherence. In addition, despite the fact that the different dynamic parameters of fluid responsiveness used in patients undergoing low- to moderate-risk abdominal surgery (eg, pulse pressure variation, stroke volume variation, or plethysmography variation index) could be considered equivalents in terms of efficacy to prevent postoperative complications, 27 we do not know if GDFT based on these monitoring methods was performed adequately in this study, given the observational nature of its design. Moreover, the other area of variability includes the monitors used to guide fluid therapy.…”