Does stroke volume increase after a fluid challenge? A study on the management of patients undergoing major head and neck free flap surgery: preliminary data

Wijayasiri, Lara; Garewal, Davinder S.; Khpal, M; Rhodes, Andrew; Dewhurst, A; Cecconi, Maurizio

doi:10.1186/cc8351

Cited by 1 publication

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“…To reduce reporting bias, we attempted to identify, retrieve and include all reports, grey and published [ 75 ], that met predefined inclusion criteria, and to retrieve unpublished data by contacting the authors of the included studies. No unpublished results were retrieved, and two abstracts [ 76 , 77 ] were identified, but they did not report the incidence of postoperative infections. Therefore, we cannot exclude the possible existence of any publication bias, and available statistical tests are not accurate enough to detect it [ 78 ].…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic goal-directed therapy and postoperative infections: earlier is better. a systematic review and meta-analysis

et al. 2011

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IntroductionInfectious complications are the main causes of postoperative morbidity. The early timing of their promoting factors is the rationale for perioperative strategies attempting to reduce them. Our aim was to determine the effects of perioperative haemodynamic goal-directed therapy on postoperative infection rates.MethodsWe performed a systematic review and meta-analysis. MEDLINE, EMBASE, The Cochrane Library and the DARE databases were searched up to March 2011. Randomised, controlled trials of major surgery in adult patients managed with perioperative goal-directed therapy or according to routine haemodynamic practice were included. Primary outcome measure was specific type of infection.ResultsTwenty-six randomised, controlled trials with a combined total of 4,188 participants met our inclusion criteria. Perioperative goal-directed therapy significantly reduced surgical site infections (pooled OR 0.58, 95% CI 0.46 to 0.74; P < 0.0001), pneumonia (pooled OR 0.71, 95% CI 0.55 to 0.92; P = 0.009), and urinary tract infections (pooled OR 0.44, 95% CI 0.22 to 0.84; P = 0.02). A significant benefit was found regarding total infectious episodes (OR 0.40, 95% CI 0.28 to 0.58; P < 0.00001).ConclusionsFlow-directed haemodynamic therapy designed to optimise oxygen delivery protects surgical patients against postoperative hospital-acquired infections and must be strongly encouraged, particularly in the high-risk surgical population.

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Section: Discussionmentioning

confidence: 99%