Premium
Perioperative goal‐directed therapy: A systematic review without meta‐analysis
Author(s) -
Kaufmann Thomas,
Clement Ramon P.,
Scheeren Thomas W. L.,
Saugel Bernd,
Keus Frederik,
Horst Iwan C. C.
Publication year - 2018
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13212
Subject(s) - medicine , perioperative , meta analysis , cochrane library , intensive care medicine , clinical trial , medline , randomized controlled trial , subgroup analysis , adverse effect , psychological intervention , surgery , psychiatry , political science , law
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 Pub MED , 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.