Perioperative goal-directed therapy

Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery: a Cochrane Systematic Review

What was this review about? 

Death and serious complications commonly occur following major surgery and are a significant public health problem. 

These outcomes might be prevented by using fluids and drugs to maintain the supply of oxygen and other nutrients to vital organs. Global blood flow, adjusted to maintain specific targets, might serve as a proxy in determining whether administered fluid and drugs maintain critical nutrient supply.

This Cochrane systematic review looked at randomised trials comparing the use of fluids, with or without additional drugs, to achieve defined targets associated with increased total blood flow with a control, in adult patients undergoing major surgery.

What did the review find? 

The review identified 31 eligible trials involving 5292 patients.

There was no difference in mortality between those receiving the intervention and controls. There was a reduction in the number of patients with complications and the length of time patients stayed in hospital (by 1.2 days). However, the quality of the studies in this area was mediocre. 

The authors recommended that future studies in this area should test an explicitly framed hypothesis, be adequately powered (and preferably multicentre), methodologically rigorous, and include blinded interventions where possible.

Publications

  • Authors: Grocott MP, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K; Optimisation Systematic Review Steering Group Title: Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane Systematic Review Publication: British Journal of Anaesthesia Journal website PubMed citation
  • Authors: Grocott MP, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K; Optimisation Systematic Review Steering Group Title: Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery Publication: Cochrane Database of Systematic Reviews Journal website PubMed citation