Background: Perioperative goal-directed therapy aims to optimise haemodynamics by titrating fluids, vasopressors and/or inotropes to predefined haemodynamic targets. Perioperative goal-directed therapy is a complex intervention composed of several independent component interventions. Trials on perioperative goal-directed therapy show conflicting results. We aimed to conduct a systematic review and meta-analysis to investigate the benefits and harms of perioperative goal-directed therapy.
Methods: PubMED, EMBASE, Web of Science and Cochrane Library were searched. Trials were included if they had a perioperative goal-directed therapy protocol. The primary outcome was all-cause mortality. The first secondary outcome was serious adverse events excluding mortality. Risk of bias was assessed, and GRADE was used to evaluate quality of evidence.
Results: One hundred and twelve randomised trials were included of which one trial (1%) had low risk of bias. Included trials varied in patients: types of surgery which was expected due to inclusion criteria; in intervention and comparison: timing of intervention, monitoring devices, haemodynamic variables, target values, use of fluids, vasopressors and/or inotropes as well as combinations of these within protocols; and in outcome: mortality was reported in 87 trials (78%). Due to substantial clinical heterogeneity also within the various types of surgery a meta-analysis of data, including subgroup analyses, as defined in our protocol was considered inappropriate.
Conclusion: Clinical heterogeneity in patients, interventions and outcomes in perioperative goal-directed therapy trials is too large to perform meta-analysis on all trials. Future trials and meta-analyses highly depend on universally agreed definitions on aspects beyond type of surgery of the complex intervention and its evaluation.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1111/aas.13212 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Decision support guided fluid challenges and stroke volume response during high-risk surgery: a post hoc analysis of a randomized controlled trial.
J Clin Monit Comput
January 2025
Department of Anaesthesiology and Intensive Care, Bicetre hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin Bicetre, France.
Intravenous fluid is administered during high-risk surgery to optimize stroke volume (SV). To assess ongoing need for fluids, the hemodynamic response to a fluid bolus is evaluated using a fluid challenge technique. The Acumen Assisted Fluid Management (AFM) system is a decision support tool designed to ease the application of fluid challenges and thus improve fluid administration during high-risk surgery.
View Article and Find Full Text PDF[Clinical practice guidelines for perioperative fluid therapy in Chinese adult patients (2025 edition)].
Zhonghua Yi Xue Za Zhi
January 2025
Perioperative fluid therapy is a pivotal component of surgical patient management, as appropriate fluid administration can significantly enhance postoperative recovery. To standardize perioperative fluid therapy for adult patients in China, the Geriatric Anesthesia and Perioperative Management Group of the Chinese Society of Anesthesiology has developed the "Clinical Practice Guidelines for Perioperative Fluid Therapy in Chinese Adult Patients". Based on current clinical status in China, this guideline addressed 11 key areas based on clinical evidence, more than 30% of which is from China researchers, including principles for the selection of common fluid types, preoperative fasting and hydration following enhanced recovery after surgery (ERAS) protocols, intraoperative fluid requirements for adult patients, perioperative volume assessment, perioperative evaluation of volume overload/insufficiency, goal-directed fluid therapy, restrictive fluid therapy, perioperative fluid therapy strategies for high-risk patients, fluid resuscitation for massive blood loss, the relationship between perioperative fluid therapy and postoperative complications, and the relationship between perioperative fluid therapy and ERAS.
View Article and Find Full Text PDFUtility of ultrasound in thoracic anesthesia.
Best Pract Res Clin Anaesthesiol
March 2024
Department of Anaesthesiology, Intensive care and Emergency Medicine, OLV Clinic, Aalst, Belgium. Electronic address:
The use of ultrasound (US) in the perioperative clinical management should be goal-directed, rapid, and reproducible. Thoracic US enables detailed examinations of vital structures, such as the airway, lung, pleural space, diaphragm, and heart. This chapter focuses on the value of US as a bedside tool to assess anatomy, guide procedures, and monitor vital organ function in patients undergoing thoracic surgery.
View Article and Find Full Text PDFAssessing Use and Familiarity of Enhanced Recovery After Surgery Elements in Pediatric Orthognathic Surgery.
J Craniofac Surg
January 2025
Department of Plastic Surgery, University of California, Irvine.
Enhanced recovery after surgery (ERAS) protocols have informed perioperative care across multiple surgical specialties, optimizing patient outcomes through surgical stress management and accelerated recovery. This study evaluates the familiarity and adoption of ERAS elements among craniofacial and oral and maxillofacial surgeons in pediatric orthognathic surgery, a field where a formal ERAS protocol has not been established. A closed-ended survey of 102 surgeons was conducted to assess familiarity with and utilization of 14 ERAS elements.
View Article and Find Full Text PDFTo: Goal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis.
Crit Care Sci
December 2024
Faculty of Medicine and Surgery, University "Kore" - Enna, Italy.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!