Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane systematic review
Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane systematic review
This systematic review and meta-analysis summarizes the clinical effects of increasing perioperative blood flow using fluids with or without inotropes/vasoactive drugs to explicit defined goals in adults. We included randomized controlled trials of adult patients (aged 16 years or older) undergoing surgery. We included 31 studies of 5292 participants. There was no difference in mortality at the longest follow-up: 282/2615 (10.8%) died in the control group and 238/2677 (8.9%) in the treatment group, RR of 0.89 (95% CI: 0.76-1.05; P=0.18). However, the results were sensitive to analytical methods and withdrawal of studies with methodological limitations. The intervention reduced the rate of three morbidities (renal failure, respiratory failure, and wound infections) but not the rates of arrhythmia, myocardial infarction, congestive cardiac failure, venous thrombosis, and other types of infections. The number of patients with complications was also reduced by the intervention. Hospital length of stay was reduced in the treatment group by 1.16 days. There was no difference in critical care length of stay.The primary analysis of this review showed no difference between groups but this result was sensitive to the method of analysis, withdrawal of studies with methodological limitations, and was dominated by a single large study. Patients receiving this intervention stayed in hospital 1 day less with fewer complications. It is unlikely that the intervention causes harm. The balance of current evidence does not support widespread implementation of this approach to reduce mortality but does suggest that complications and duration of hospital stay are reduced.
fluid therapy, perioperative care, surgery
535-548
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Dushianthan, A.
bbc28c98-a128-40f0-bfa9-2669740687cf
Hamilton, M.A.
902bd14a-7dab-44ca-ac07-d69bc7f368e7
Mythen, M.G.
c82ab585-86d5-44f8-bd3c-ead87c59d459
Harrison, D.
fd368c13-f185-41de-a326-e507b4366535
Rowan, K.
778120a7-037d-4397-8dab-1b9ff3d3fdc6
October 2013
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Dushianthan, A.
bbc28c98-a128-40f0-bfa9-2669740687cf
Hamilton, M.A.
902bd14a-7dab-44ca-ac07-d69bc7f368e7
Mythen, M.G.
c82ab585-86d5-44f8-bd3c-ead87c59d459
Harrison, D.
fd368c13-f185-41de-a326-e507b4366535
Rowan, K.
778120a7-037d-4397-8dab-1b9ff3d3fdc6
Grocott, M.P.W., Dushianthan, A., Hamilton, M.A., Mythen, M.G., Harrison, D. and Rowan, K.
(2013)
Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane systematic review.
British Journal of Anaesthesia, 111 (4), .
(doi:10.1093/bja/aet155).
(PMID:23661403)
Abstract
This systematic review and meta-analysis summarizes the clinical effects of increasing perioperative blood flow using fluids with or without inotropes/vasoactive drugs to explicit defined goals in adults. We included randomized controlled trials of adult patients (aged 16 years or older) undergoing surgery. We included 31 studies of 5292 participants. There was no difference in mortality at the longest follow-up: 282/2615 (10.8%) died in the control group and 238/2677 (8.9%) in the treatment group, RR of 0.89 (95% CI: 0.76-1.05; P=0.18). However, the results were sensitive to analytical methods and withdrawal of studies with methodological limitations. The intervention reduced the rate of three morbidities (renal failure, respiratory failure, and wound infections) but not the rates of arrhythmia, myocardial infarction, congestive cardiac failure, venous thrombosis, and other types of infections. The number of patients with complications was also reduced by the intervention. Hospital length of stay was reduced in the treatment group by 1.16 days. There was no difference in critical care length of stay.The primary analysis of this review showed no difference between groups but this result was sensitive to the method of analysis, withdrawal of studies with methodological limitations, and was dominated by a single large study. Patients receiving this intervention stayed in hospital 1 day less with fewer complications. It is unlikely that the intervention causes harm. The balance of current evidence does not support widespread implementation of this approach to reduce mortality but does suggest that complications and duration of hospital stay are reduced.
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e-pub ahead of print date: May 2013
Published date: October 2013
Keywords:
fluid therapy, perioperative care, surgery
Organisations:
Faculty of Medicine
Identifiers
Local EPrints ID: 354815
URI: http://eprints.soton.ac.uk/id/eprint/354815
ISSN: 0007-0912
PURE UUID: 3cb43ac9-3b79-4902-9bef-6b7f72a586ff
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Date deposited: 23 Jul 2013 11:03
Last modified: 15 Mar 2024 03:33
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Contributors
Author:
A. Dushianthan
Author:
M.A. Hamilton
Author:
M.G. Mythen
Author:
D. Harrison
Author:
K. Rowan
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