Perioperative goal‐directed therapy: A systematic review without meta‐analysis

Kaufmann, Thomas; Clement, Ramon P.; Scheeren, Thomas; Saugel, Bernd; Keus, Frederik; Horst, Iwan C. C. van der

doi:10.1111/aas.13212

Cited by 40 publications

(34 citation statements)

References 128 publications

(136 reference statements)

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“…either a superiority [44] or non-superiority of EGDT [45, 46]. Of note, a recent systematic review from the perioperative setting refrained from pooling the data of the single studies to perform a meta-analysis due to significant heterogeneity in patients, interventions and outcomes between the different studies [47]. …”

Section: Perioperative Outcomementioning

confidence: 99%

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management

Saugel

Flick

Bendjelid

et al. 2019

J Clin Monit Comput

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Hemodynamic management is a mainstay of patient care in the operating room and intensive care unit (ICU). In order to optimize patient treatment, researchers investigate monitoring technologies, cardiovascular (patho-) physiology, and hemodynamic treatment strategies. The Journal of Clinical Monitoring and Computing (JCMC) is a well-established and recognized platform for publishing research in this field. In this review, we highlight recent advancements and summarize selected papers published in the JCMC in 2018 related to hemodynamic monitoring and management.

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Section: Perioperative Outcomementioning

confidence: 99%

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management

Saugel

Flick

Bendjelid

et al. 2019

J Clin Monit Comput

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“…Despite such recommendations, pGDT is not yet routinely implemented in clinical practice [11]. One explanatory factor for this discrepancy might be that clinical heterogeneity among trials troubles a clear interpretation of trials evaluating pGDT protocols [12]. Additionally, the term "goal-directed therapy" is poorly defined and is used to describe different treatment strategies in studies with varying degrees of complexity [13].…”

Section: Introductionmentioning

confidence: 99%

The effect of compliance with a perioperative goal-directed therapy protocol on outcomes after high-risk surgery: a before-after study

Boekel

Venema

Kaufmann

et al. 2020

J Clin Monit Comput

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Perioperative goal-directed therapy is considered to improve patient outcomes after high-risk surgery. The association of compliance with perioperative goal-directed therapy protocols and postoperative outcomes is unclear. The purpose of this study is to determine the effect of protocol compliance on postoperative outcomes following high-risk surgery, after implementation of a perioperative goal-directed therapy protocol. Through a before-after study design, patients undergoing elective high-risk surgery before (before-group) and after implementation of a perioperative goal-directed therapy protocol (after-group) were included. Perioperative goal-directed therapy in the after-group consisted of optimized stroke volume variation or stroke volume index and optimized cardiac index. Additionally, the association of protocol compliance with postoperative complications when using perioperative goal-directed therapy was assessed. High protocol compliance was defined as ≥ 85% of the procedure time spent within the individual targets. The difference in complications during the first 30 postoperative days before and after implementation of the protocol was assessed. In the before-group, 214 patients were included and 193 patients in the after-group. The number of complications was higher in the before-group compared to the after-group (n = 414 vs. 282; p = 0.031). In the after-group, patients with high protocol compliance for stroke volume variation or stroke volume index had less complications compared to patients with low protocol compliance for stroke volume variation or stroke volume index (n = 187 vs. 90; p = 0.01). Protocol compliance by the attending clinicians is essential and should be monitored to facilitate an improvement in postoperative outcomes desired by the implementation of perioperative goal-directed therapy protocols.

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“…The important cofactor that may interfere with results of studies is different anaesthetic technique used in patients included in the studies (presence or absence of epidural catheter, different anaesthetics used) (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Multimodal Monitoring With Haemodynamic Optimisations May Offer Some Benefit for Patients Undergoing Major Abdominal Surgery. A Randomised, Controlled Trial.

Jenko¹,

Mencin²,

Novak-Jankovič³

et al. 2020

Preprint

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Background: Combined monitoring of blood flow with assessment of fluid status and cerebral tissue oxygenation improve perioperative management and outcome of high-risk surgical patients. The study tests if intraoperative multimodal monitoring reduces postoperative morbidity and duration of hospitalisation in patients undergoing major abdominal surgery managed by same anaesthetic protocols with epidural analgesia.Methods: Prospective study was conducted in 2 parallel groups. High risk surgical patients undergoing major abdominal surgery were randomised in control group (CG), where standard monitoring was applied and protocol group (PG), where cerebral oxygenation and haemodynamic monitoring were used with protocol for intraoperative interventions.Results: There was no difference in median length of hospital stay, CG 9 days (IQR 8 days), PG 9 (5.5), p= 0.851. There was no difference in postoperative renal of cardiac impairment. Procalcitonin was significantly higher (highest postoperative value in first 3 days) in CG, 0.75 mcg/L (IQR 3.19mcg/L), than in PG 0.3 mcg/L (0.88 mcg/L), p= 0.001. Patents in PG received larger intraoperative amount of fluids; median intraoperative fluid balance +1300 ml (IQR 1063ml) than CG; +375 ml (IQR 438ml), p<0.00.Conclusions: There was no difference in postoperative morbidity or hospital stay. Median postoperative value of procalcitonin was significantly higher in CG and was above laboratory reference range. There were significant differences in intraoperative fluid management.Trial registration: ClinicalTrials.gov, NCT02293473, Registered June 10, 2014, https://clinicaltrials.gov/

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Perioperative goal‐directed therapy: A systematic review without meta‐analysis

Cited by 40 publications

References 128 publications

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management

Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management

The effect of compliance with a perioperative goal-directed therapy protocol on outcomes after high-risk surgery: a before-after study

Multimodal Monitoring With Haemodynamic Optimisations May Offer Some Benefit for Patients Undergoing Major Abdominal Surgery. A Randomised, Controlled Trial.

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