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Perioperative goal-directed therapy: A systematic review without meta-analysis
Thomas Kaufmann1, Ramon P Clement1, Thomas W L Scheeren1
1Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Acta Anaesthesiologica Scandinavica
|July 7, 2018
Summary
Perioperative goal-directed therapy (PGDT) trials show conflicting results. Due to significant clinical heterogeneity, a meta-analysis was not feasible, highlighting the need for standardized definitions in future research.
Area of Science:
- Critical Care Medicine
- Anesthesiology
- Surgical Research
Background:
- Perioperative goal-directed therapy (PGDT) involves optimizing hemodynamics using fluids and vasoactive drugs.
- Conflicting results exist from trials investigating PGDT.
- This study systematically reviewed PGDT to assess its benefits and harms.
Purpose of the Study:
- To conduct a systematic review and meta-analysis of randomized trials on perioperative goal-directed therapy.
- To investigate the benefits and harms associated with perioperative goal-directed therapy protocols.
- To identify the impact of perioperative goal-directed therapy on patient outcomes.
Main Methods:
- Searched major databases (PubMed, EMBASE, Web of Science, Cochrane Library).
- Included randomized trials with a perioperative goal-directed therapy protocol.
- Assessed risk of bias and used GRADE for evidence quality evaluation.
Main Results:
- 112 randomized trials were included, with only 1% having a low risk of bias.
- Substantial clinical heterogeneity was observed in patient populations, interventions, and outcomes.
- Meta-analysis was deemed inappropriate due to this heterogeneity.
Conclusions:
- Clinical heterogeneity across perioperative goal-directed therapy trials prevents a comprehensive meta-analysis.
- Future research and meta-analyses require universally agreed-upon definitions for PGDT components and evaluation.
- Standardization is crucial for advancing the understanding of perioperative goal-directed therapy effectiveness.
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