Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery: a systematic review and meta-analysis

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Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery : a systematic review and meta-analysis. / Jessen, Marie K.; Fink Vallentin, Mikael; Holmberg, Mathias J. et al.

I: British Journal of Anaesthesia, Bind 128, Nr. 3, 03.2022, s. 416-433.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

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Jessen, MK, Fink Vallentin, M, Holmberg, MJ, Bolther, M, Hansen, FB, Holst, JM, Magnussen, A, Hansen, NS, Johannsen, CM, Enevoldsen, J, Jensen, TH, Roessler, LL, Lind, PC, Klitholm, MP, Eggertsen, MA, Caap, P, Boye, C, Dabrowski, KM, Vormfenne, L, Høybye, M, Henriksen, J, Karlsson, CM, Balleby, IR, Rasmussen, MS, Pælestik, K, Granfeldt, A & Andersen, LW 2022, 'Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery: a systematic review and meta-analysis', British Journal of Anaesthesia, bind 128, nr. 3, s. 416-433. https://doi.org/10.1016/j.bja.2021.10.046

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@article{bf0ae551c22246f1bf39be5ba9179973,
title = "Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery: a systematic review and meta-analysis",
abstract = "Background: During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes. Methods: Included clinical trials investigated goal-directed haemodynamic therapy during general anaesthesia in adults undergoing noncardiac surgery and reported at least one patient-centred postoperative outcome. PubMed and Embase were searched for relevant articles on March 8, 2021. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. The primary outcomes were mortality and hospital length of stay, whereas 15 postoperative complications were included based on availability. From a main pool of comparable trials, meta-analyses were performed on trials with homogenous outcome definitions. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results: The main pool consisted of 76 trials with intermediate risk of bias for most outcomes. Overall, goal-directed haemodynamic therapy might reduce mortality (odds ratio=0.84; 95% confidence interval [CI], 0.64 to 1.09) and shorten length of stay (mean difference=–0.72 days; 95% CI, –1.10 to –0.35) but with low certainty in the evidence. For both outcomes, larger effects favouring goal-directed haemodynamic therapy were seen in abdominal surgery, very high-risk surgery, and using targets based on preload variation by the respiratory cycle. However, formal tests for subgroup differences were not statistically significant. Goal-directed haemodynamic therapy decreased risk of several postoperative outcomes, but only infectious outcomes and anastomotic leakage reached moderate certainty of evidence. Conclusions: Goal-directed haemodynamic therapy during general anaesthesia might decrease mortality, hospital length of stay, and several postoperative complications. Only infectious postoperative complications and anastomotic leakage reached moderate certainty in the evidence.",
keywords = "fluid, general anaesthesia, goal-directed haemodynamic therapy, haemodynamics, perioperative care, postoperative complications, stroke volume",
author = "Jessen, {Marie K.} and {Fink Vallentin}, Mikael and Holmberg, {Mathias J.} and Maria Bolther and Hansen, {Frederik B.} and Holst, {Johanne M.} and Andreas Magnussen and Hansen, {Niklas S.} and Johannsen, {Cecilie M.} and Johannes Enevoldsen and Jensen, {Thomas H.} and Roessler, {Lara L.} and Lind, {Peter C.} and Klitholm, {Maibritt P.} and Eggertsen, {Mark A.} and Philip Caap and Caroline Boye and Dabrowski, {Karol M.} and Lasse Vormfenne and Maria H{\o}ybye and Jeppe Henriksen and Karlsson, {Carl M.} and Balleby, {Ida R.} and Rasmussen, {Marie S.} and Kim P{\ae}lestik and Asger Granfeldt and Andersen, {Lars W.}",
note = "Publisher Copyright: {\textcopyright} 2021 The Author(s)",
year = "2022",
month = mar,
doi = "10.1016/j.bja.2021.10.046",
language = "English",
volume = "128",
pages = "416--433",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "3",

}

RIS

TY - JOUR

T1 - Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery

T2 - a systematic review and meta-analysis

AU - Jessen, Marie K.

AU - Fink Vallentin, Mikael

AU - Holmberg, Mathias J.

AU - Bolther, Maria

AU - Hansen, Frederik B.

AU - Holst, Johanne M.

AU - Magnussen, Andreas

AU - Hansen, Niklas S.

AU - Johannsen, Cecilie M.

AU - Enevoldsen, Johannes

AU - Jensen, Thomas H.

AU - Roessler, Lara L.

AU - Lind, Peter C.

AU - Klitholm, Maibritt P.

AU - Eggertsen, Mark A.

AU - Caap, Philip

AU - Boye, Caroline

AU - Dabrowski, Karol M.

AU - Vormfenne, Lasse

AU - Høybye, Maria

AU - Henriksen, Jeppe

AU - Karlsson, Carl M.

AU - Balleby, Ida R.

AU - Rasmussen, Marie S.

AU - Pælestik, Kim

AU - Granfeldt, Asger

AU - Andersen, Lars W.

N1 - Publisher Copyright: © 2021 The Author(s)

PY - 2022/3

Y1 - 2022/3

N2 - Background: During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes. Methods: Included clinical trials investigated goal-directed haemodynamic therapy during general anaesthesia in adults undergoing noncardiac surgery and reported at least one patient-centred postoperative outcome. PubMed and Embase were searched for relevant articles on March 8, 2021. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. The primary outcomes were mortality and hospital length of stay, whereas 15 postoperative complications were included based on availability. From a main pool of comparable trials, meta-analyses were performed on trials with homogenous outcome definitions. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results: The main pool consisted of 76 trials with intermediate risk of bias for most outcomes. Overall, goal-directed haemodynamic therapy might reduce mortality (odds ratio=0.84; 95% confidence interval [CI], 0.64 to 1.09) and shorten length of stay (mean difference=–0.72 days; 95% CI, –1.10 to –0.35) but with low certainty in the evidence. For both outcomes, larger effects favouring goal-directed haemodynamic therapy were seen in abdominal surgery, very high-risk surgery, and using targets based on preload variation by the respiratory cycle. However, formal tests for subgroup differences were not statistically significant. Goal-directed haemodynamic therapy decreased risk of several postoperative outcomes, but only infectious outcomes and anastomotic leakage reached moderate certainty of evidence. Conclusions: Goal-directed haemodynamic therapy during general anaesthesia might decrease mortality, hospital length of stay, and several postoperative complications. Only infectious postoperative complications and anastomotic leakage reached moderate certainty in the evidence.

AB - Background: During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes. Methods: Included clinical trials investigated goal-directed haemodynamic therapy during general anaesthesia in adults undergoing noncardiac surgery and reported at least one patient-centred postoperative outcome. PubMed and Embase were searched for relevant articles on March 8, 2021. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. The primary outcomes were mortality and hospital length of stay, whereas 15 postoperative complications were included based on availability. From a main pool of comparable trials, meta-analyses were performed on trials with homogenous outcome definitions. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results: The main pool consisted of 76 trials with intermediate risk of bias for most outcomes. Overall, goal-directed haemodynamic therapy might reduce mortality (odds ratio=0.84; 95% confidence interval [CI], 0.64 to 1.09) and shorten length of stay (mean difference=–0.72 days; 95% CI, –1.10 to –0.35) but with low certainty in the evidence. For both outcomes, larger effects favouring goal-directed haemodynamic therapy were seen in abdominal surgery, very high-risk surgery, and using targets based on preload variation by the respiratory cycle. However, formal tests for subgroup differences were not statistically significant. Goal-directed haemodynamic therapy decreased risk of several postoperative outcomes, but only infectious outcomes and anastomotic leakage reached moderate certainty of evidence. Conclusions: Goal-directed haemodynamic therapy during general anaesthesia might decrease mortality, hospital length of stay, and several postoperative complications. Only infectious postoperative complications and anastomotic leakage reached moderate certainty in the evidence.

KW - fluid

KW - general anaesthesia

KW - goal-directed haemodynamic therapy

KW - haemodynamics

KW - perioperative care

KW - postoperative complications

KW - stroke volume

UR - http://www.scopus.com/inward/record.url?scp=85121147145&partnerID=8YFLogxK

U2 - 10.1016/j.bja.2021.10.046

DO - 10.1016/j.bja.2021.10.046

M3 - Journal article

C2 - 34916049

AN - SCOPUS:85121147145

VL - 128

SP - 416

EP - 433

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 3

ER -