Intraoperative goal-directed hemodynamic therapy through fluid administration to optimize the stroke volume: A meta-analysis of randomized controlled trials.

J Ripollés-Melchor, Á V Espinosa, P Fernández-Valdes-Bango, R Navarro-Pérez, A Abad-Motos, J V Lorente, M J Colomina, E Sáez-Ruiz, A Abad-Gurumeta, M I Monge-García
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Abstract

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.

通过输液优化卒中量的术中目标导向血流动力学疗法:随机对照试验的 Meta 分析。
目的评估作为目标导向血液动力学疗法(GDHT)的一部分,通过输液优化搏出量(SV)对接受择期腹部大手术的成人患者的临床影响:本系统综述和荟萃分析根据系统综述和荟萃分析首选报告项目(PRISMA)声明进行,并于 2024 年 1 月在 PROSPERO 数据库中注册。干预被定义为术中 GDHT,其基础是通过液体挑战优化或最大化 SV,或使用液体反应性动态指数,包括与常规液体管理相比的每搏容量变化、脉压变化和胸透变化指数。主要结果是术后并发症。次要结果变量包括术后急性肾损伤(AKI)、住院时间(LOS)、术中输液量和 30 天死亡率:共有 29 项随机对照试验(RCT)符合纳入标准。术后并发症(RR 0.89;95% CI,0.78 至 1.00)、术后 AKI(OR 0.97;95% IC,0.55 至 1.70)和死亡率(OR 0.80;95% CI,0.50 至 1.29)的发生率无明显差异。与常规护理相比,GDHT 与缩短 LOS 相关(SMD:-0.17 [-0.32; - 0.03])。使用羟乙基淀粉优化血液动力学的亚组并发症较少(RR 0.79;95% CI,0.65 至 0.94),而使用晶体液的亚组患者术后并发症风险增加(RR 1.08;95% CI,1.04 至 1.12):对于接受大手术的成人患者,以优化液体搏出量为重点的目标导向血液动力学疗法并不能降低术后发病率和死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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