Goal-directed fluid restriction using stroke volume variation and cardiac index during one-lung ventilation: a randomized controlled trial

Abstract

Chinese Clinical Trials Register ChiCTR-INR-16008288, Registered 20 April, 2016.

Effects of perioperative goal-directed fluid therapy combined with the application of alpha-1 adrenergic agonists on postoperative outcomes: a systematic review and meta-analysis

“…Seventeen trials [ 28 , 29 , 31 – 33 , 35 , 36 , 39 , 41 , 43 , 45 – 51 ] included patients who were less than 65 years old, and 14 trials [ 3 , 9 , 24 – 27 , 30 , 34 , 37 , 38 , 40 , 42 , 44 , 52 ] included patients who were more than 65 years old. As for the type of alpha-1 adrenergic agonists used in studies, 17 studies [ 3 , 25 , 27 – 30 , 34 – 38 , 40 , 44 , 45 , 49 – 52 ] selected norepinephrine, 11 studies [ 24 , 26 , 31 – 33 , 39 , 41 , 42 , 50 , 52 ] considered phenylephrine, 2 studies [ 43 , 46 ] used norepinephrine and phenylephrine, and 1 study [ 9 ] used metaraminol. Additionally, 18 trials [ 3 , 27 – 29 , 31 , 32 , 35 , 37 , 38 , 40 – 45 , 47 , 48 , 52 ] involved abdominal surgery.…”

“…Additionally, 18 trials [ 3 , 27 – 29 , 31 , 32 , 35 , 37 , 38 , 40 – 45 , 47 , 48 , 52 ] involved abdominal surgery. Four trials [ 34 , 46 , 50 , 51 ] were related to thoracic surgery. Three trials [ 9 , 24 , 25 ] were about orthopedic surgery.…”

“…Twenty-eight studies [ 9 , 24 – 43 , 45 – 50 , 52 ] provided data for analysis. Perioperative GDFT combined with alpha-1 adrenergic agonists shortened the LOS [weighted mean difference (WMD) –0.92 days; 95% confidence interval (CI) –1.50 to − 0.34; P = 0.002; I 2 = 69%] (Fig.…”

“…The subgroup analyses revealed that GDFT combined with alpha-1 adrenergic agonists significantly reduced LOS associated with abdominal surgery (WMD − 1.20 days; 95% CI –2.12 to − 0.28; P = 0.01; I 2 = 71%; n = 16 [ 3 , 27 – 29 , 31 , 32 , 35 , 38 , 40 – 45 , 48 , 52 ]), norepinephrine as interventions (WMD − 1.46 days; 95% CI –2.29 to − 0.64; P = 0.0005; I 2 = 62%; n = 16 [ 3 , 25 , 27 – 30 , 34 – 36 , 38 , 40 , 44 , 45 , 48 , 50 , 52 ]) (Fig. 5 ) and low risk of bias (WMD − 0.98 days; 95% CI –1.58 to − 0.38; P = 0.001; I 2 = 56%; n = 16 [ 25 , 26 , 28 – 30 , 32 , 34 , 36 , 38 , 40 , 42 , 45 , 48 – 50 , 52 ]) (Additional file 7 ).

Fig.

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“…Neither the Egger’s regression asymmetry test ( P = 0.274) nor the Begg’s adjusted rank correlation test ( P = 0.452) showed evidence of publication bias. Postoperative heart failure [ 36 , 40 , 54 ], arrhythmia [ 26 , 30 , 34 – 36 , 38 , 40 , 48 , 49 , 52 ], and hypotension [ 35 , 38 – 40 , 43 , 45 , 49 , 50 ] showed no significant difference between the intervention and control groups.

Fig.

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