Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial
Abstract:The Vigileo-FloTrac system High-risk patients Major abdominal surgeries Postoperative Morbidity Mortality a b s t r a c tBackground: This study evaluated impact of intraoperative goal-directed therapy (GDT) judged by changes of stroke volume variation (SVV) and cardiac index (CI) using the Vigileo/FloTrac system on postoperative (PO) morbidities and mortality rates in high risk patients scheduled for major abdominal surgeries in comparison to conventional fluid therapy (CT). Methods: 86 patients were randomly … Show more
“…2 ) and table (Additional file 2 ). A total of 18 studies (58%) [ 25 , 26 , 28 – 30 , 32 , 34 , 36 , 38 , 40 , 42 , 44 , 45 , 48 – 52 ] were judged to carry a low risk of bias (Table 1 ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Seventeen trials [ 28 , 29 , 31 – 33 , 35 , 36 , 39 , 41 , 43 , 45 – 51 ] included patients who were less than 65 years old, and 14 trials [ 3 , 9 , 24 – 27 , 30 , 34 , 37 , 38 , 40 , 42 , 44 , 52 ] included patients who were more than 65 years old. As for the type of alpha-1 adrenergic agonists used in studies, 17 studies [ 3 , 25 , 27 – 30 , 34 – 38 , 40 , 44 , 45 , 49 – 52 ] selected norepinephrine, 11 studies [ 24 , 26 , 31 – 33 , 39 , 41 , 42 , 50 , 52 ] considered phenylephrine, 2 studies [ 43 , 46 ] used norepinephrine and phenylephrine, and 1 study [ 9 ] used metaraminol.…”
Section: Resultsmentioning
confidence: 99%
“…The subgroup analyses revealed that GDFT combined with alpha-1 adrenergic agonists significantly reduced LOS associated with abdominal surgery (WMD − 1.20 days; 95% CI –2.12 to − 0.28; P = 0.01; I 2 = 71%; n = 16 [ 3 , 27 – 29 , 31 , 32 , 35 , 38 , 40 – 45 , 48 , 52 ]), norepinephrine as interventions (WMD − 1.46 days; 95% CI –2.29 to − 0.64; P = 0.0005; I 2 = 62%; n = 16 [ 3 , 25 , 27 – 30 , 34 – 36 , 38 , 40 , 44 , 45 , 48 , 50 , 52 ]) (Fig. 5 ) and low risk of bias (WMD − 0.98 days; 95% CI –1.58 to − 0.38; P = 0.001; I 2 = 56%; n = 16 [ 25 , 26 , 28 – 30 , 32 , 34 , 36 , 38 , 40 , 42 , 45 , 48 – 50 , 52 ]) (Additional file 7 ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The subgroup analyses showed a significant reduction in the intervention group in studies including patients ≥65 years old (RR 0.86; 95% CI 0.75–0.98; P = 0.02; I 2 = 0%; n = 9 [ 3 , 9 , 24 – 27 , 35 , 38 , 40 ]) and using norepinephrine as an intervention (RR 0.81; 95% CI 0.66–0.99; P = 0.04; I 2 = 45%; n = 10 [ 3 , 25 , 27 , 28 , 35 , 36 , 38 , 40 , 45 , 48 ]) (Additional file 10 ).…”
Section: Resultsmentioning
confidence: 99%
“…Neither the Egger’s regression asymmetry test ( P = 0.236) nor the Begg’s adjusted rank correlation test ( P = 0.762) showed any evidence of publication bias. Eleven trials [ 26 , 28 , 30 , 31 , 33 , 36 , 38 – 40 , 45 , 49 ] reported suitable data on the numbers of patients with postoperative respiratory support. The pooled RR of 0.55 showed a reduction in this complication rate following surgery in the intervention group compared with the control group (95% CI 0.38–0.81; P = 0.003; I 2 = 0%) (Fig.…”
BackgroundPast studies have demonstrated that goal-directed fluid therapy (GDFT) may be more marginal than previously believed. However, beneficial effects of alpha-1 adrenergic agonists combined with appropriate fluid administration is getting more and more attention. This study aimed to systematically review the effects of goal-directed fluid therapy (GDFT) combined with the application of alpha-1 adrenergic agonists on postoperative outcomes following noncardiac surgery.MethodsThis meta-analysis included randomized controlled trials (RCTs) on GDFT combined with the application of alpha-1 adrenergic agonists in patients undergoing noncardiac surgery. The primary outcomes included the postoperative mortality rate and length of hospital stay (LOS). The secondary outcome indexes were the incidence of postoperative complications and recovery of postoperative gastrointestinal (GI) function. The traditional pairwise meta-analysis was conducted to compare the effect of fluid therapy. The quality of included RCTs was evaluated according to the Cochrane Collaboration’s risk-of-bias tool. Also, the publication bias was detected using funnel plots, Egger’s regression test, and Begg’s adjusted rank correlation test. The meta-analysis was conducted using the RevMan 5.3 and Stata 14.0 software.ResultsThirty-two eligible RCTs were included in this meta-analysis. Perioperative GDFT combined with the application of alpha-1 adrenergic agonists was associated with a significant reduction in LOS (P = 0.002; I2 = 69%), and overall complication rates (P = 0.04; I2 = 41%). It facilitated gastrointestinal function recovery, as demonstrated by shortening the time to first flatus by 6.30 h (P < 0.00001; I2 = 91%) and the time to toleration of solid food by 1.69 days (P < 0.00001; I2 = 0%). Additionally, there was no significant reduction in short-term mortality in the GDFT combined with alpha-1 adrenergic agonists group (P = 0.05; I2 = 0%).ConclusionThis systematic review of available evidence suggested that the use of perioperative GDFT combined with alpha-1 adrenergic agonists might facilitate recovery in patients undergoing noncardiac surgery.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0564-y) contains supplementary material, which is available to authorized users.
“…2 ) and table (Additional file 2 ). A total of 18 studies (58%) [ 25 , 26 , 28 – 30 , 32 , 34 , 36 , 38 , 40 , 42 , 44 , 45 , 48 – 52 ] were judged to carry a low risk of bias (Table 1 ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Seventeen trials [ 28 , 29 , 31 – 33 , 35 , 36 , 39 , 41 , 43 , 45 – 51 ] included patients who were less than 65 years old, and 14 trials [ 3 , 9 , 24 – 27 , 30 , 34 , 37 , 38 , 40 , 42 , 44 , 52 ] included patients who were more than 65 years old. As for the type of alpha-1 adrenergic agonists used in studies, 17 studies [ 3 , 25 , 27 – 30 , 34 – 38 , 40 , 44 , 45 , 49 – 52 ] selected norepinephrine, 11 studies [ 24 , 26 , 31 – 33 , 39 , 41 , 42 , 50 , 52 ] considered phenylephrine, 2 studies [ 43 , 46 ] used norepinephrine and phenylephrine, and 1 study [ 9 ] used metaraminol.…”
Section: Resultsmentioning
confidence: 99%
“…The subgroup analyses revealed that GDFT combined with alpha-1 adrenergic agonists significantly reduced LOS associated with abdominal surgery (WMD − 1.20 days; 95% CI –2.12 to − 0.28; P = 0.01; I 2 = 71%; n = 16 [ 3 , 27 – 29 , 31 , 32 , 35 , 38 , 40 – 45 , 48 , 52 ]), norepinephrine as interventions (WMD − 1.46 days; 95% CI –2.29 to − 0.64; P = 0.0005; I 2 = 62%; n = 16 [ 3 , 25 , 27 – 30 , 34 – 36 , 38 , 40 , 44 , 45 , 48 , 50 , 52 ]) (Fig. 5 ) and low risk of bias (WMD − 0.98 days; 95% CI –1.58 to − 0.38; P = 0.001; I 2 = 56%; n = 16 [ 25 , 26 , 28 – 30 , 32 , 34 , 36 , 38 , 40 , 42 , 45 , 48 – 50 , 52 ]) (Additional file 7 ). Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The subgroup analyses showed a significant reduction in the intervention group in studies including patients ≥65 years old (RR 0.86; 95% CI 0.75–0.98; P = 0.02; I 2 = 0%; n = 9 [ 3 , 9 , 24 – 27 , 35 , 38 , 40 ]) and using norepinephrine as an intervention (RR 0.81; 95% CI 0.66–0.99; P = 0.04; I 2 = 45%; n = 10 [ 3 , 25 , 27 , 28 , 35 , 36 , 38 , 40 , 45 , 48 ]) (Additional file 10 ).…”
Section: Resultsmentioning
confidence: 99%
“…Neither the Egger’s regression asymmetry test ( P = 0.236) nor the Begg’s adjusted rank correlation test ( P = 0.762) showed any evidence of publication bias. Eleven trials [ 26 , 28 , 30 , 31 , 33 , 36 , 38 – 40 , 45 , 49 ] reported suitable data on the numbers of patients with postoperative respiratory support. The pooled RR of 0.55 showed a reduction in this complication rate following surgery in the intervention group compared with the control group (95% CI 0.38–0.81; P = 0.003; I 2 = 0%) (Fig.…”
BackgroundPast studies have demonstrated that goal-directed fluid therapy (GDFT) may be more marginal than previously believed. However, beneficial effects of alpha-1 adrenergic agonists combined with appropriate fluid administration is getting more and more attention. This study aimed to systematically review the effects of goal-directed fluid therapy (GDFT) combined with the application of alpha-1 adrenergic agonists on postoperative outcomes following noncardiac surgery.MethodsThis meta-analysis included randomized controlled trials (RCTs) on GDFT combined with the application of alpha-1 adrenergic agonists in patients undergoing noncardiac surgery. The primary outcomes included the postoperative mortality rate and length of hospital stay (LOS). The secondary outcome indexes were the incidence of postoperative complications and recovery of postoperative gastrointestinal (GI) function. The traditional pairwise meta-analysis was conducted to compare the effect of fluid therapy. The quality of included RCTs was evaluated according to the Cochrane Collaboration’s risk-of-bias tool. Also, the publication bias was detected using funnel plots, Egger’s regression test, and Begg’s adjusted rank correlation test. The meta-analysis was conducted using the RevMan 5.3 and Stata 14.0 software.ResultsThirty-two eligible RCTs were included in this meta-analysis. Perioperative GDFT combined with the application of alpha-1 adrenergic agonists was associated with a significant reduction in LOS (P = 0.002; I2 = 69%), and overall complication rates (P = 0.04; I2 = 41%). It facilitated gastrointestinal function recovery, as demonstrated by shortening the time to first flatus by 6.30 h (P < 0.00001; I2 = 91%) and the time to toleration of solid food by 1.69 days (P < 0.00001; I2 = 0%). Additionally, there was no significant reduction in short-term mortality in the GDFT combined with alpha-1 adrenergic agonists group (P = 0.05; I2 = 0%).ConclusionThis systematic review of available evidence suggested that the use of perioperative GDFT combined with alpha-1 adrenergic agonists might facilitate recovery in patients undergoing noncardiac surgery.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0564-y) contains supplementary material, which is available to authorized users.
The available evidence does not suggest a close relationship between COI and study results in GDHT research. However, a potential association may exist between COI and an article's conclusion in GDHT research.
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