A Systematic Review and Meta-Analysis of Intraoperative Goal Directed Fluid and Haemodynamic Therapy in Children and Postoperative Outcome

Abstract

Introduction:In adults, studies have shown that when goal directed fluid and haemodynamic therapy was applied in the perioperative period, morbi-mortality was reduced. In children the impact on postoperative outcome of this therapy is not clear.Objective: To determine the impact of intraoperative goal directed fluid and haemodynamic therapy on postoperative morbimortality in children less than 18 years old.Methods: Systematic review and meta-analysis of randomised and non randomised studies.RevMan 5.3 sofware was used for statistic analysis.Results: 23 studies were included with 3389 children among which 21 trials concerned cardiac surgical children and two concerned non cardiac patients: 1° In 3290 children in 21 studies included, mortality was significantly lower in the experimental group (the group with higher above baseline values of regional oxygen saturation, of mixed central venous oxygen saturation, and lower lactate levels) (odds ratio=0.03 [0.01, 0.14], p<0.00001). The quality of evidence (GRADE) was low.2° In 14 studies with 2347 children included, organ dysfunction was significantly lower in the experimental group (odds ratio = 0.02 [0.00, 0.08], p <0.00001). The quality of evidence (GRADE) was low.3° in 8 studies length of hospital stay was significantly lower in the experimental group (p=0.018). The quality of evidence (GRADE) was very low. Conclusions:Intraoperative goal directed fluid and haemodynamic therapy is not developed in children, there are biomarkers of postoperative adverse outcome in pediatric cardiac surgery.Research is to be developed in children to clarify the impact of goal directed fluid and hemodynamic therapy on postoperative outcome.

Major Abdominal Surgery, Neurosurgery, Orthopedic Surgery in Children aged between 10 and 18 years and Postoperative Outcome

“…In-hospital mortality rate was 0.45% in 1 trauma patient who underwent a decompressive craniectomy and presented postoperative multiple organ failure and died on postoperative day 7 (table 3). Median total length of hospital stay was 9 days [5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Postoperative Outcome in Children aged between 6 and 10 years in Major Abdominal Surgery, Neurosurgery and Orthopedic Surgery

“…Integrating goal directed therapies for intra-operative management in these patients is a necessary implementation to improve postoperative outcome in pediatric surgical patients. Goal directed therapies include intra-operative uid and hemodynamic goal directed therapy with validated tools in children, intra-operative transfusion goal directed protocols with point of care devices to guide blood product administration and enhanced recovery after surgery (5,6,7,8,9,10,11,12,13). All these therapies have the same aim which is to optimize intra-operative patient status which contributes to a favorable postoperative evolution.…”

“…For a better postoperative outcome, anticipating patient's management optimization begins preoperatively, continues intra-operatively and postoperatively. Intra-operative patient optimization includes uid and hemodynamic goal directed therapy with tools validated in children, blood patient transfusion protocols guided with point of care tests in hemorrhagic surgery and enhanced recovery after surgery protocols (5,6,7,8,9,10,11,12,13). These goal directed therapies have been shown in adults to improve postoperative outcome.…”

“…42(47.7%) patients had intra-operative transfusion.There was 1 in-hospital death (1.1%). Median total length of hospital stay was 9 days [5][6][7][8][9][10][11][12][13][14][15][16].…”

Postoperative Outcome in Non-Preterm Infants Under One Year Old in Non-Cardiac Surgery

“…One third of the patients in this cohort presented intra-operative and or postoperative complications and patients with fatal outcome were all ASA 3 or more. It is time to reconsider the integration of uid and hemodynamic goal directed therapy in these patients with the aim to improve postoperative evolution since these protocols are not yet a routine practice in our Hospital (24,25,26,27,28,29,30,31).…”