000070703 001__ 70703
000070703 005__ 20200221144303.0
000070703 0247_ $$2doi$$a10.1016/j.bjane.2015.02.001
000070703 0248_ $$2sideral$$a105949
000070703 037__ $$aART-2016-105949
000070703 041__ $$aeng
000070703 100__ $$aRipolles, J.
000070703 245__ $$aIntraoperative goal directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis
000070703 260__ $$c2016
000070703 5060_ $$aAccess copy available to the general public$$fUnrestricted
000070703 5203_ $$aBackground: The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates.
Methods: A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A systematic search was performed in Medline PubMed, Embase, and the Cochrane Library (last update, October 2014). Inclusion criteria were randomized clinical trials in which intraoperative goal directed hemodynamic therapy was compared to conventional fluid management in noncardiac surgery. Exclusion criteria were trauma and pediatric surgery studies and that using pulmonary artery catheter. End-points were postoperative complications (primary) and mortality (secondary). Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by type of monitor, therapy, and hemodynamic goal), and predefined sensitivity analysis.
Results: 51 RCTs were initially identified, 24 fulfilling the inclusion criteria. 5 randomized clinical trials were added by manual search, resulting in 29 randomized clinical trials in the final analysis, including 2654 patients. A significant reduction in complications for goal directed hemodynamic therapy was observed (RR: 0.70, 95% CI: 0.62-0.79, p < 0.001). No significant decrease in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p = 0.30). Quality sensitive analyses confirmed the main overall results.
Conclusions: Intraoperative goal directed hemodynamic therapy with minimally invasive monitoring decreases postoperative complications in noncardiac surgery, although it was not able to show a significant decrease in mortality rate.
000070703 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc-nd$$uhttp://creativecommons.org/licenses/by-nc-nd/3.0/es/
000070703 590__ $$a0.903$$b2016
000070703 591__ $$aANESTHESIOLOGY$$b30 / 31 = 0.968$$c2016$$dQ4$$eT3
000070703 592__ $$a0.309$$b2016
000070703 593__ $$aAnesthesiology and Pain Medicine$$c2016$$dQ3
000070703 655_4 $$ainfo:eu-repo/semantics/review$$vinfo:eu-repo/semantics/publishedVersion
000070703 700__ $$aEspinosa, A.
000070703 700__ $$aMartinez-Hurtado, E.
000070703 700__ $$aAbad-Gurumeta, A.
000070703 700__ $$aCasans-Frances, R.
000070703 700__ $$aFernandez-Perez, C.
000070703 700__ $$aLopez-Timoneda, F.
000070703 700__ $$aCalvo-Vecino, J.M.
000070703 773__ $$g66, 5 (2016), 513-528$$pRev. Bras. Anestesiol. (Impr.)$$tRevista Brasileira de Anestesiologia$$x0034-7094
000070703 8564_ $$s703478$$uhttps://zaguan.unizar.es/record/70703/files/texto_completo.pdf$$yVersión publicada
000070703 8564_ $$s82399$$uhttps://zaguan.unizar.es/record/70703/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000070703 909CO $$ooai:zaguan.unizar.es:70703$$particulos$$pdriver
000070703 951__ $$a2020-02-21-13:33:40
000070703 980__ $$aARTICLE