Effect of perioperative goal-directed fluid therapy on postoperative complications after thoracic surgery with one-lung ventilation: a systematic review and meta-analysis

Abstract

Background An understanding of the impact of goal-directed fluid therapy (GDFT) on the outcomes of patients undergoing one-lung ventilation (OLV) for thoracic surgery remains incomplete and controversial. This meta-analysis aimed to assess the effect of GDFT compared to other fluid therapy strategies on the incidence of postoperative complications in patients with OLV. Methods The Embase, Cochrane Library, Web of Science, and MEDLINE via PubMed databases were searched from their inception to November 30, 2022. Forest plots were constructed to present the results of the meta-analysis. The quality of the included studies was evaluated using the Cochrane Collaboration tool and Risk Of Bias In Non-Randomized Study of Interventions (ROBINS-I). The primary outcome was the incidence of postoperative complications. Secondary outcomes were the length of hospital stay, PaO2/FiO2 ratio, total fluid infusion, inflammatory factors (TNF-α, IL-6), and postoperative bowel function recovery time. Results A total of 1318 patients from 11 studies were included in this review. The GDFT group had a lower incidence of postoperative complications [odds ratio (OR), 0.47; 95% confidence interval (95% CI), 0.29–0.75; P = 0.002; I2, 67%], postoperative pulmonary complications (OR 0.48, 95% CI 0.27–0.83; P = 0.009), and postoperative anastomotic leakage (OR 0.51, 95% CI 0.27–0.97; P = 0.04). The GDFT strategy reduces total fluid infusion. Conclusions GDFT is associated with lower postoperative complications and better survival outcomes after thoracic surgery for OLV.

Impact of fluid balance and opioid-sparing anesthesia within enchanced recovery pathway on postoperative morbidity after transthoracic esophagectomy for cancer

“…Intraoperative goal directed therapy may help anesthesiologist to administer fluid only when needed and start with vasopressors (norepinephrine) application early, but safely ( 22 , 23 ). One-lung ventilation (ischemia–reperfusion injury) and two-field lymphadenectomy in combination with fluid overload could increase the risk for interstitial pulmonary edema and lung injury ( 24 ). In early postoperative period (48–72 h), neuroendocrine and metabolic effects on surgical stress are the most pronounced.…”

Effect of flow-optimized pressure control ventilation-volume guaranteed (PCV-VG) on postoperative pulmonary complications: a consort study

“…The pulse pressure variation rate was maintained at ≥ 13% or the stroke volume variation (SVV) was at ≥ 12%, the patient should be rehydration. When using a tidal volume of 6 ml/kg, the pulse pressure variation rate was at ≥ 6% or the SVV at ≥ 8%, the patient should be rehydration [ 16 ]. The blood pressure was kept within ± 20% of the preoperative resting blood pressure fluctuation, while the heart rate ranged from 60 to 100 beats per minute during the procedure.…”