Goal‐Directed Fluid Therapy in Gastrointestinal Surgery in Older Coronary Heart Disease Patients: Randomized Trial

Abstract

GDT was associated with shorter ICU stay and time to discharge and faster return of GI function compared to traditional fluid therapy. The number of adverse cardiac events was similar in the two groups.

Effect of perioperative goal-directed hemodynamic therapy on postoperative recovery following major abdominal surgery—a systematic review and meta-analysis of randomized controlled trials

“…2) and table (Additional file 1). A total of 26 studies (58%) [1, 3, 11–13, 27, 28, 31, 32, 36–38, 40, 43, 45–47, 50, 51, 57–59, 61, 62, 64, 65] were judged to carry a low risk of bias (Table 1). Weighted kappa was calculated to examine agreement for each component and overall risk of bias assessment.…”

“…Eight trials [26, 29, 30, 46, 50, 53, 54, 56] used pulmonary arterial catheters for monitoring; fourteen trials [3, 11, 14, 32, 33, 36, 42, 44, 48, 49, 51, 55, 62, 64] used esophageal Doppler monitoring; fifteen trials [3, 12, 27, 28, 31, 38, 39, 41, 43, 45, 52, 59–61, 65] used self-calibrating/calibrated pulse contour analysis monitoring; and the remaining eight trials used other monitors, including arterial lines plus monitoring equipment [40], central lines and arterial line sampling [34, 37, 57], pulse oximeters [35, 58], and other noninvasive monitors [13, 47]. Three types of goals were used in the majority of included trials, including DO 2 I and/or cardiac index [13, 26, 29, 30, 43, 46, 50, 53, 54, 56, 59], optimal SV [1, 11, 28, 32, 33, 36, 38, 39, 42, 44, 48, 49, 51, 55], and dynamic measures of preload responsiveness (e.g., PPV, SVV, PVI) [12, 27, 31, 35, 40, 41, 45, 52, 58, 60, 61, 65].…”

“…Three types of goals were used in the majority of included trials, including DO 2 I and/or cardiac index [13, 26, 29, 30, 43, 46, 50, 53, 54, 56, 59], optimal SV [1, 11, 28, 32, 33, 36, 38, 39, 42, 44, 48, 49, 51, 55], and dynamic measures of preload responsiveness (e.g., PPV, SVV, PVI) [12, 27, 31, 35, 40, 41, 45, 52, 58, 60, 61, 65]. …”

“…Perioperative GDHT shortened the time to first flatus (WMD −0.40 days, 95% CI −0.72 to −0.08, p  < 0.0001; I 2  = 74%; n  = 10 [13, 32, 42, 44, 55, 58–61, 64]) and time to toleration of an oral diet (WMD −0.74 days, 95% CI −1.44 to −0.03, p  < 0.0001; I 2  = 92%; n  = 9 [32, 36, 42, 44, 45, 55, 59, 62, 64]), but it did not shorten the time to first bowel movement (Fig. 6).…”

“…A statistically significant effect of GDHT was observed on time to toleration of an oral diet when we pooled studies for non-high-risk patients (WMD −0.83 days, 95% CI −1.51 to −0.14, p  = 0.03; I 2  = 59%; n  = 6 [42, 44, 45, 55, 62, 64]) and on time to first flatus pass for non-high-risk patients (WMD −0.41 days, 95% CI −0.80 to −0.01, p  = 0.04; I 2  = 71%; n  = 8 [13, 42, 44, 55, 58, 60, 61, 64]) and patients using fluids and inotropes as interventions (WMD −0.45 days, 95% CI −0.83 to −0.06, p  < 0.0001; I 2  = 64%; n  = 4 [13, 59–61]). No significant difference between the GDHT and control groups was found by sensitivity analysis restricting studies for colorectal surgical procedures, studies randomizing large-sample-size patients, and studies carrying a low risk of bias.…”