Goal-directed therapy during transthoracic oesophageal resection does not improve outcome

Bahlmann, Hans; Halldestam, Ingvar; Nilsson, Lena

doi:10.1097/eja.0000000000000908

Cited by 27 publications

(58 citation statements)

References 33 publications

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“…The total sample size was <100 participants for 33 studies (Bahlmann et al, 2019;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Cecconi et al, 2011;Colantonio et al, 2015;El Sharkawy et al, 2013;Funk et al, 2015;Han et al, 2016;Jammer et al, 2015;Joosten et al, 2019;Kaufmann et al, 2018;Kim et al, 2018;Kumar et al, 2016;Lobo et al, 2000;Mayer et al, 2010;Mikor et al, 2015;Mythen & Webb, 1995;Peng et al, 2014;Reisinger et al, 2017;Scheeren et al, 2013;Senagore et al, 2009;Shoemaker et al, 1988;Sinclair et al, 1997;Ueno et al, 1998;Van der Linden et al, 2010;Venn et al, 2002;Weinberg et al, 2017;Weinberg et al, 2019;Wu et al, 2017;Yin et al, 2018;Zakhaleva et al, 2013;Zeng et al, 2014;Zhang et al, 2013) (50%) and the majority (77%) were conducted in a single centre setting (Bartha et al, 2013;Bender et al, 1997;Benes et al, 2010;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Boyd et al, 1993;Cecconi et al, 2011;…”

Section: Resultsmentioning

confidence: 99%

“…The monitoring device for the majority of the studies was minimally invasive (33 studies) (Ackland et al, 2015;Bahlmann et al, 2019;Bartha et al, 2013;Benes et al, 2010;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Cecconi et al, 2011;Colantonio et al, 2015;Correa-Gallego et al, 2015;Funk et al, 2015;Gerent et al, 2018;Goepfert et al, 2013;Han et al, 2016;Jammer et al, 2015;Kim et al, 2018;Kumar et al, 2016;Luo et al, 2017;Mayer et al, 2010;Moppett et al, 2015;Osawa et al, 2016;Pearse et al, 2005;Pearse et al, 2014;Peng et al, 2014;Salzwedel et al, 2013;Scheeren et al, 2013;Schmid et al, 2016;Van der Linden et al, 2010;Weinberg et al, 2017;Weinberg et al, 2019;Wu et al, 2017;Xu et al, 2017;Zeng et al, 2014;Zhang et al, 2013), followed by oesophageal Doppler (17 studies) (Brandstrup et al, 2012;Calvo-Vecino et al, 2018;El Sharkawy et al, 2013;Gan et al, 2002;Gomez-Izquierdo et al, 2017;Kaufmann et al, 2017;…”

Section: Resultsmentioning

confidence: 99%

“…Goal-directed haemodynamic therapy was initiated intra-operatively in the majority of studies (82%) (Bahlmann et al, 2019;Benes et al, 2010;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Brandstrup et al, 2012;Calvo-Vecino et al, 2018;Cecconi et al, 2011;Colantonio et al, 2015;Correa-Gallego et al, 2015;Davies et al, 2019;Donati et al, 2007;El Sharkawy et al, 2013;Funk et al, 2015;Gan et al, 2002;Goepfert et al, 2013;Gomez-Izquierdo et al, 2017;Han et al, 2016;Jammer et al, 2010;Jammer et al, 2015;Joosten et al, 2019;Kaufmann et al, 2017;Kaufmann et al, 2018;Kim et al, 2018;Kumar et al, 2016;Lobo et al, 2000;Luo et al, 2017;Mayer et al, 2010;McKenny et al, 2013;Mikor et al, 2015;Moppett et al, 2015;Mythen & Webb, 1995;Osawa et al, 2016;Pearse et al, 2014;Peng et al, 2014;Pestana et al, 2014;Phan et al, 2014;Reisinger et al, 2017;Salzwedel et al, 2013;Scheeren et al, 2013;…”

Section: Resultsmentioning

confidence: 99%

“…In 22 studies (33%), the GDHT intervention used fluids alone (Brandstrup et al, 2012;Correa-Gallego et al, 2015;El Sharkawy et al, 2013;Gan et al, 2002;Gomez-Izquierdo et al, 2017;Han et al, 2016;Jammer et al, 2010;Joosten et al, 2019;Kim et al, 2018;McKenny et al, 2013;Moppett et al, 2015;Mythen & Webb, 1995;Peng et al, 2014;Phan et al, 2014;Reisinger et al, 2017;Scheeren et al, 2013;Senagore et al, 2009;Sinclair et al, 1997;Venn et al, 2002;Wakeling et al, 2005;Zakhaleva et al, 2013;Zeng et al, 2014) and the rest used fluids with vasoactive or inotropic agents as part of their GDHT protocol (Ackland et al, 2015;Bahlmann et al, 2019;Bartha et al, 2013;Bender et al, 1997;Benes et al, 2010;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Boyd et al, 1993;Calvo-Vecino et al, 2018;Cecconi et al, 2011;Colantonio et al, 2015;Davies et al, 2019;Donati et al, 2007;Funk et al, 2015;Gerent et al, 2018;Goepfert et al, 2013;Jammer et al, 2015;Kaufmann et al, 2017;…”

Section: Resultsmentioning

confidence: 99%

“…In nine studies (14%), there was incomplete outcome data (El Sharkawy et al, 2013;Jammer et al, 2015;Pestana et al, 2014;Salzwedel et al, 2013;Scheeren et al, 2013;Stens et al, 2017;Zakhaleva et al, 2013;Zeng et al, 2014;Zhang et al, 2013). Sixty-one studies (92%) were identified as at low risk of selective reporting bias (Ackland et al, 2015;Bahlmann et al, 2019;Bartha et al, 2013;Bender et al, 1997;Benes et al, 2010;Bisgaard et al, 2013a;Bisgaard et al, 2013b;Boyd et al, 1993;Brandstrup et al, 2012;Calvo-Vecino et al, 2018;Cecconi et al, 2011;Colantonio et al, 2015;Correa-Gallego et al, 2015;Davies et al, 2019;Donati et al, 2007;Funk et al, 2015;Gan et al, 2002;Gerent et al, 2018;Goepfert et al, 2013;Gomez-Izquierdo et al, 2017;Jammer et al, 2010;Joosten et al, 2019;Kaufmann et al, 2017;Kaufmann et al, 2018;Kim et al, 2018;Kumar et al, 2016;Luo et al, 2017;Mayer et al, 2010;McKendry et al, 2004;McKenny et al, 2013;Mikor ...…”

Section: Resultsmentioning

confidence: 99%

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Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

et al. 2020

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Background Perioperative goal-directed haemodynamic therapy (GDHT), defined as the administration of fluids with or without inotropes or vasoactive agents against explicit measured goals to augment blood flow, has been evaluated in many randomised controlled trials (RCTs) over the past four decades. Reported post-operative pulmonary complications commonly include chest infection or pneumonia, atelectasis, acute respiratory distress syndrome or acute lung injury, aspiration pneumonitis, pulmonary embolism, and pulmonary oedema. Despite the substantial clinical literature in this area, it remains unclear whether their incidence is reduced by GDHT. This systematic review aims to determine the effect of GDHT on the respiratory outcomes listed above, in surgical patients. Methods We searched the Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, EMBASE, and clinical trial registries up until January 2020. We included all RCTs reporting pulmonary outcomes. The primary outcome was post-operative pulmonary complications and secondary outcomes were specific pulmonary complications and intra-operative fluid input. Data synthesis was performed on Review Manager and heterogeneity was assessed using I2 statistics. Results We identified 66 studies with 9548 participants reporting pulmonary complications. GDHT resulted in a significant reduction in total pulmonary complications (OR 0.74, 95% CI 0.59 to 0.92). The incidence of pulmonary infections, reported in 45 studies with 6969 participants, was significantly lower in the GDHT group (OR 0.72, CI 0.60 to 0.86). Pulmonary oedema was recorded in 23 studies with 3205 participants and was less common in the GDHT group (OR 0.47, CI 0.30 to 0.73). There were no differences in the incidences of pulmonary embolism or acute respiratory distress syndrome. Sub-group analyses demonstrated: (i) benefit from GDHT in general/abdominal/mixed and cardiothoracic surgery but not in orthopaedic or vascular surgery; and (ii) benefit from fluids with inotropes and/or vasopressors in combination but not from fluids alone. Overall, the GDHT group received more colloid (+280 ml) and less crystalloid (−375 ml) solutions than the control group. Due to clinical and statistical heterogeneity, we downgraded this evidence to moderate. Conclusions This systematic review and meta-analysis suggests that the use of GDHT using fluids with inotropes and/or vasopressors, but not fluids alone, reduces the development of post-operative pulmonary infections and pulmonary oedema in general, abdominal and cardiothoracic surgical patients. This evidence was graded as moderate. PROSPERO registry reference: CRD42020170361

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

et al. 2020

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Perfusion speed of indocyanine green in the stomach before tubulization is an objective and useful parameter to evaluate gastric microcirculation during Ivor-Lewis esophagectomy

et al. 2020

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The effect of enhanced recovery after minimally invasive esophagectomy: a randomized controlled trial

et al. 2022

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Background The purpose of this randomized controlled trial was to determine if enhanced recovery after surgery (ERAS) would improve outcomes for three-stage minimally invasive esophagectomy (MIE). Methods Patients with esophageal cancer undergoing MIE between March 2016 and August 2018 were consecutively enrolled, and were randomly divided into 2 groups: ERAS+group that received a guideline-based ERAS protocol, and ERAS- group that received standard care. The primary endpoint was morbidity after MIE. The secondary endpoints were the length of stay (LOS) and time to ambulation after the surgery. The perioperative results including the Surgical Apgar Score (SAS) and Visualized Analgesia Score (VAS) were also collected and compared. Results A total of 60 patients in the ERAS+ group and 58 patients in the ERAS- group were included. Postoperatively, lower morbidity and pulmonary complication rate were recorded in the ERAS+ group (33.3% vs. 51.7%; p = 0.04, 16.7% vs. 32.8%; p = 0.04), while the incidence of anastomotic leakage remained comparable (11.7% vs. 15.5%; p = 0.54). There was an earlier ambulation (3 [2–3] days vs. 3 [3–4] days, p = 0.001), but comparable LOS (10 [9–11.25] days vs. 10 [9–13] days; p = 0.165) recorded in ERAS+ group. The ERAS protocol led to close scores in both SAS (7.80 ± 1.03 vs. 8.07 ± 0.89, p = 0.21) and VAS (1.74 ± 0.85 vs. 1.78 ± 1.06, p = 0.84). Conclusions Implementation of an ERAS protocol for patients undergoing MIE resulted in earlier ambulation and lower pulmonary complications, without a change in anastomotic leakage or length of hospital stay. Further studies on minimizing leakage should be addressed in ERAS for MIE.

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Goal-directed therapy during transthoracic oesophageal resection does not improve outcome

Cited by 27 publications

References 33 publications

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications

Perfusion speed of indocyanine green in the stomach before tubulization is an objective and useful parameter to evaluate gastric microcirculation during Ivor-Lewis esophagectomy

The effect of enhanced recovery after minimally invasive esophagectomy: a randomized controlled trial

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