Intraoperative goal-directed hemodynamic therapy through fluid administration to optimize the stroke volume: A meta-analysis of randomized controlled trials. Rev Esp Anestesiol Reanim (Engl Ed) 2024 Dec;71(10):719-731
Date
09/08/2024Pubmed ID
39243815DOI
10.1016/j.redare.2024.09.004Abstract
OBJECTIVE: To evaluate the clinical impact of optimizing stroke volume (SV) through fluid administration as part of goal-directed hemodynamic therapy (GDHT) in adult patients undergoing elective major abdominal surgery.
METHODS: This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered in the PROSPERO database in January 2024. The intervention was defined as intraoperative GDHT based on the optimization or maximization of SV through fluid challenges, or by using dynamic indices of fluid responsiveness, including stroke volume variation, pulse pressure variation, and plethysmography variation index compared to usual fluid management. The primary outcome was postoperative complications. Secondary outcome variables included postoperative acute kidney injury (AKI), length of stay (LOS), intraoperative fluid administration, and 30-day mortality.
RESULTS: A total of 29 randomized controlled trials (RCTs) met the inclusion criteria. There were no significant differences in the incidence of postoperative complications (RR 0.89; 95% CI, 0.78-1.00), postoperative AKI (OR 0.97; (95% IC, 0.55-1.70), and mortality (OR 0.80; 95% CI, 0.50-1.29). GDHT was associated with a reduced LOS compared to usual care (SMD: -0.17 [-0.32; -0.03]). The subgroup in which hydroxyethyl starch was used for hemodynamic optimization was associated with fewer complications (RR 0.79; 95% CI, 0.65-0.94), whereas the subgroup of patients in whom crystalloids were used was associated with an increased risk of postoperative complications (RR 1.08; 95% CI, 1.04-1.12).
CONCLUSIONS: In adults undergoing major surgery, goal-directed hemodynamic therapy focused on fluid-based stroke volume optimization did not reduce postoperative morbidity and mortality.
Author List
Ripollés-Melchor J, Espinosa ÁV, Fernández-Valdes-Bango P, Navarro-Pérez R, Abad-Motos A, Lorente JV, Colomina MJ, Sáez-Ruiz E, Abad-Gurumeta A, Monge-García MIAuthor
Angel Vicente Espinosa MD Assistant Professor in the Anesthesiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AbdomenAcute Kidney Injury
Elective Surgical Procedures
Fluid Therapy
Hemodynamics
Humans
Hydroxyethyl Starch Derivatives
Intraoperative Care
Length of Stay
Postoperative Complications
Randomized Controlled Trials as Topic
Stroke Volume
