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Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review.
Ann Med. 2017 06; 49(4):343-351.AM

Abstract

PURPOSE

Goal-directed hemodynamic therapy (GDT) is used to prevent hypoperfusion resulting from surgery. The objective of this study was to analyze the efficacy and importance of perioperative GDT.

METHODS

PUBMED, MEDLINE, CENTRAL, and Google Scholar databases were searched until 17 June 2016 using the search terms: cardiac output, cardiac surgical procedures, hemodynamics, goal-directed therapy, and intraoperative. Randomized-controlled trials with pre-emptive hemodynamic intervention for cardiac surgical population versus standard hemodynamic therapy were included.

RESULTS

Nine studies were included with a total of 1148 patients. The overall analysis revealed no significant difference in the all-cause mortality (pooled peto OR =0.58, 95%CI =0.27-1.525, p = 0.164), duration of mechanical ventilation (pooled difference in mean= -1.48, 95%CI= -3.24 to 0.28, p = 0.099), or length of intensive care unit (ICU) stay (pooled difference in mean= -9.10, 95%CI= -20.14 to 1.93, p = 0.106) between patients in the GDT and control groups. Patients in the GDP group were associated with shorter hospital stay than those in the control group (pooled difference in mean= -1.52, 95%CI= -2.31 to -0.73, p < 0.001).

CONCLUSION

GDT reduces the length of hospital stay compared with the standard of care. Further studies are necessary to continually assess the benefit of GDT following major surgery. Key Messages The results of this analysis revealed no significant difference between cardiac surgery patients receiving goal-directed hemodynamic therapy (GDT) or conventional fluid therapy in terms of the all-cause mortality, duration of mechanical intervention, and length of ICU-stay. The length of hospital stay was significantly reduced in patients treated with GDT compare to conventional fluid therapy. GDT may have limited benefit in reducing mortality; however, the association to shorter length of hospital stay may suggest that better hemodynamic balance can facilitate postoperative recovery.

Authors+Show Affiliations

a Department of Nephrology , Yantai Yuhuangding Hospital , Yantai , Shandong , China.b Department of Obstetrics , Yantai Yuhuangding Hospital , Yantai , Shandong , China.a Department of Nephrology , Yantai Yuhuangding Hospital , Yantai , Shandong , China.c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China. d Kidney and Dialysis Institute of Shanghai , Shanghai , China.c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China. d Kidney and Dialysis Institute of Shanghai , Shanghai , China.c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China. d Kidney and Dialysis Institute of Shanghai , Shanghai , China.c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China. d Kidney and Dialysis Institute of Shanghai , Shanghai , China.c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China. d Kidney and Dialysis Institute of Shanghai , Shanghai , China.c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China. d Kidney and Dialysis Institute of Shanghai , Shanghai , China. e Shanghai Key Laboratory of Kidney and Blood Purification , Shanghai , China.c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China. d Kidney and Dialysis Institute of Shanghai , Shanghai , China. e Shanghai Key Laboratory of Kidney and Blood Purification , Shanghai , China.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27936959

Citation

Li, Peng, et al. "Significance of Perioperative Goal-directed Hemodynamic Approach in Preventing Postoperative Complications in Patients After Cardiac Surgery: a Meta-analysis and Systematic Review." Annals of Medicine, vol. 49, no. 4, 2017, pp. 343-351.
Li P, Qu LP, Qi D, et al. Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review. Ann Med. 2017;49(4):343-351.
Li, P., Qu, L. P., Qi, D., Shen, B., Wang, Y. M., Xu, J. R., Jiang, W. H., Zhang, H., Ding, X. Q., & Teng, J. (2017). Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review. Annals of Medicine, 49(4), 343-351. https://doi.org/10.1080/07853890.2016.1271956
Li P, et al. Significance of Perioperative Goal-directed Hemodynamic Approach in Preventing Postoperative Complications in Patients After Cardiac Surgery: a Meta-analysis and Systematic Review. Ann Med. 2017;49(4):343-351. PubMed PMID: 27936959.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review. AU - Li,Peng, AU - Qu,Li-Ping, AU - Qi,Dong, AU - Shen,Bo, AU - Wang,Yi-Mei, AU - Xu,Jia-Rui, AU - Jiang,Wu-Hua, AU - Zhang,Hao, AU - Ding,Xiao-Qiang, AU - Teng,Jie, Y1 - 2017/02/02/ PY - 2016/12/13/pubmed PY - 2017/10/11/medline PY - 2016/12/13/entrez KW - Cardiac output KW - cardiac surgical procedures KW - goal-directed therapy KW - hemodynamics KW - intraoperative SP - 343 EP - 351 JF - Annals of medicine JO - Ann. Med. VL - 49 IS - 4 N2 - PURPOSE: Goal-directed hemodynamic therapy (GDT) is used to prevent hypoperfusion resulting from surgery. The objective of this study was to analyze the efficacy and importance of perioperative GDT. METHODS: PUBMED, MEDLINE, CENTRAL, and Google Scholar databases were searched until 17 June 2016 using the search terms: cardiac output, cardiac surgical procedures, hemodynamics, goal-directed therapy, and intraoperative. Randomized-controlled trials with pre-emptive hemodynamic intervention for cardiac surgical population versus standard hemodynamic therapy were included. RESULTS: Nine studies were included with a total of 1148 patients. The overall analysis revealed no significant difference in the all-cause mortality (pooled peto OR =0.58, 95%CI =0.27-1.525, p = 0.164), duration of mechanical ventilation (pooled difference in mean= -1.48, 95%CI= -3.24 to 0.28, p = 0.099), or length of intensive care unit (ICU) stay (pooled difference in mean= -9.10, 95%CI= -20.14 to 1.93, p = 0.106) between patients in the GDT and control groups. Patients in the GDP group were associated with shorter hospital stay than those in the control group (pooled difference in mean= -1.52, 95%CI= -2.31 to -0.73, p < 0.001). CONCLUSION: GDT reduces the length of hospital stay compared with the standard of care. Further studies are necessary to continually assess the benefit of GDT following major surgery. Key Messages The results of this analysis revealed no significant difference between cardiac surgery patients receiving goal-directed hemodynamic therapy (GDT) or conventional fluid therapy in terms of the all-cause mortality, duration of mechanical intervention, and length of ICU-stay. The length of hospital stay was significantly reduced in patients treated with GDT compare to conventional fluid therapy. GDT may have limited benefit in reducing mortality; however, the association to shorter length of hospital stay may suggest that better hemodynamic balance can facilitate postoperative recovery. SN - 1365-2060 UR - https://www.unboundmedicine.com/medline/citation/27936959/Significance_of_perioperative_goal_directed_hemodynamic_approach_in_preventing_postoperative_complications_in_patients_after_cardiac_surgery:_a_meta_analysis_and_systematic_review_ L2 - http://www.tandfonline.com/doi/full/10.1080/07853890.2016.1271956 DB - PRIME DP - Unbound Medicine ER -