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Haemodynamic goal-directed therapy in cardiac and vascular surgery. A systematic review and meta-analysis.
Interact Cardiovasc Thorac Surg. 2012 Nov; 15(5):878-87.IC

Abstract

In cardiovascular surgery, reduced organ perfusion and oxygen delivery contribute to increased postoperative morbidity and prolonged intensive care unit stay. Goal-directed therapy (GDT), a perioperative haemodynamic strategy aiming to increase cardiac output, is helpful in preventing postoperative complications, but studies in the context of cardiovascular surgery have produced conflicting results. The purpose of the present meta-analysis is to determine the effects of perioperative haemodynamic goal-directed therapy on mortality and morbidity in cardiac and vascular surgery. MEDLINE, EMBASE, The Cochrane Library and the DARE databases were searched until July 2011. Randomized controlled trials reporting on adult cardiac or vascular surgical patients managed with perioperative GDT or according to routine haemodynamic practice were included. Primary outcome measures were mortality and morbidity. Data synthesis was obtained by using odds ratio (OR) with 95% confidence interval (CI) by a random effects model. An OR <1 favoured GDT. Statistical heterogeneity was assessed by Q and I(2) statistics. Eleven articles (five cardiac surgery and six vascular procedures), enrolling a total sample of 1179 patients, were included in the analysis. As compared with routine haemodynamic practice, perioperative GDT did not reduce mortality in either cardiac or vascular surgery (pooled OR 0.87; 95% CI 0.37-2.02; statistical power 64%). GDT significantly reduced the number of cardiac patients with complications (OR 0.34; 95% CI 0.18-0.63; P = 0.0006), but no effect was observed in vascular patients (OR, 0.84; 95% CI 0.45-1.56; P = 0.58). Perioperative GDT prevents postoperative complications in cardiac surgery patients, while it has no effect in vascular surgery. The different characteristics and comorbidities of the population enrolled could explain these conflicting results. More trials conforming to the characteristics of low-risk-of-bias studies and enrolling a larger and well-defined population of patients are needed to better clarify the effect of GDT in the specific setting of cardiovascular surgery.

Authors+Show Affiliations

Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

22833509

Citation

Giglio, Mariateresa, et al. "Haemodynamic Goal-directed Therapy in Cardiac and Vascular Surgery. a Systematic Review and Meta-analysis." Interactive Cardiovascular and Thoracic Surgery, vol. 15, no. 5, 2012, pp. 878-87.
Giglio M, Dalfino L, Puntillo F, et al. Haemodynamic goal-directed therapy in cardiac and vascular surgery. A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2012;15(5):878-87.
Giglio, M., Dalfino, L., Puntillo, F., Rubino, G., Marucci, M., & Brienza, N. (2012). Haemodynamic goal-directed therapy in cardiac and vascular surgery. A systematic review and meta-analysis. Interactive Cardiovascular and Thoracic Surgery, 15(5), 878-87. https://doi.org/10.1093/icvts/ivs323
Giglio M, et al. Haemodynamic Goal-directed Therapy in Cardiac and Vascular Surgery. a Systematic Review and Meta-analysis. Interact Cardiovasc Thorac Surg. 2012;15(5):878-87. PubMed PMID: 22833509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Haemodynamic goal-directed therapy in cardiac and vascular surgery. A systematic review and meta-analysis. AU - Giglio,Mariateresa, AU - Dalfino,Lidia, AU - Puntillo,Filomena, AU - Rubino,Giovanni, AU - Marucci,Massimo, AU - Brienza,Nicola, Y1 - 2012/07/24/ PY - 2012/7/27/entrez PY - 2012/7/27/pubmed PY - 2013/4/12/medline SP - 878 EP - 87 JF - Interactive cardiovascular and thoracic surgery JO - Interact Cardiovasc Thorac Surg VL - 15 IS - 5 N2 - In cardiovascular surgery, reduced organ perfusion and oxygen delivery contribute to increased postoperative morbidity and prolonged intensive care unit stay. Goal-directed therapy (GDT), a perioperative haemodynamic strategy aiming to increase cardiac output, is helpful in preventing postoperative complications, but studies in the context of cardiovascular surgery have produced conflicting results. The purpose of the present meta-analysis is to determine the effects of perioperative haemodynamic goal-directed therapy on mortality and morbidity in cardiac and vascular surgery. MEDLINE, EMBASE, The Cochrane Library and the DARE databases were searched until July 2011. Randomized controlled trials reporting on adult cardiac or vascular surgical patients managed with perioperative GDT or according to routine haemodynamic practice were included. Primary outcome measures were mortality and morbidity. Data synthesis was obtained by using odds ratio (OR) with 95% confidence interval (CI) by a random effects model. An OR <1 favoured GDT. Statistical heterogeneity was assessed by Q and I(2) statistics. Eleven articles (five cardiac surgery and six vascular procedures), enrolling a total sample of 1179 patients, were included in the analysis. As compared with routine haemodynamic practice, perioperative GDT did not reduce mortality in either cardiac or vascular surgery (pooled OR 0.87; 95% CI 0.37-2.02; statistical power 64%). GDT significantly reduced the number of cardiac patients with complications (OR 0.34; 95% CI 0.18-0.63; P = 0.0006), but no effect was observed in vascular patients (OR, 0.84; 95% CI 0.45-1.56; P = 0.58). Perioperative GDT prevents postoperative complications in cardiac surgery patients, while it has no effect in vascular surgery. The different characteristics and comorbidities of the population enrolled could explain these conflicting results. More trials conforming to the characteristics of low-risk-of-bias studies and enrolling a larger and well-defined population of patients are needed to better clarify the effect of GDT in the specific setting of cardiovascular surgery. SN - 1569-9285 UR - https://www.unboundmedicine.com/medline/citation/22833509/Haemodynamic_goal_directed_therapy_in_cardiac_and_vascular_surgery__A_systematic_review_and_meta_analysis_ L2 - https://academic.oup.com/icvts/article-lookup/doi/10.1093/icvts/ivs323 DB - PRIME DP - Unbound Medicine ER -