Haemodynamic optimisation in lower limb arterial surgery: room for improvement?

Abstract

Perioperative individualised goal-directed therapy may reduce post-operative complications in open elective lower limb arterial surgery.

Perioperative goal-directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis

“…Analyzing the 10 RCTs, 9 reported the number of patients with complications [17][18][19][20][21][22][23][24][25]. There were no differences in the number of patients with complications between the GDHT and control groups (RR, 0.76; 95% CI, 0.50-1.17; P = .21) (Fig.…”

“…In 7 RCTs, perioperative GDHT was performed [16,17,[20][21][22]24,25], which significantly reduced mortality vs conventional fluid therapy (RR, 0.61; 95% CI, 0.39-0.96; P = .03), whereas no differences were found the postoperative GDHT subgroup [18,19,23] (RR, 0.76; 95% CI, 0.40-1.46; P = .42) (Fig. 7).…”

“…Changes were found in the analysis of the primary outcome when studies with allocation bias were excluded [16,22,24] (RR, 0.61; 95% CI, 0.37-1.02; P = .06), or when those not having allocation and/or randomization bias were analyzed [16,[18][19][20][21]23,25] (RR, 0.73; 95% CI, 0.41-1.31; P = .29). We found that if studies of lower methodological quality were excluded, there were no differences between GDHT and conventional fluid therapy.…”

“…Mortality was analyzed in all RCTs included [16][17][18][19][20][21][22][23][24][25]. Use of perioperative GDHT compared with conventional fluid therapy significantly reduced mortality (RR, 0.63; 95% CI, 0.42-0.94; P = .02) (Fig.…”

“…Subgroup analysis 3.6.1. Hemodynamic target In 5 RCTs, GDHT was used with a supraphysiological hemodynamic target [16][17][18]20,22], where it was found that this target significantly reduced mortality (RR, 0.42; 95% CI, 0.23-0.43; P = .004), whereas no differences were found in the subgroup in which physiological values were used as the hemodynamic target [19,21,[23][24][25] (RR, 0.91; 95% CI, 0.52-1.59; P = .74) (Fig. 6).…”