Background
Methods
Literature search
Study selection
Type of participants
Type of intervention
Type of comparison
Type of outcome measures
Data extraction
Quality assessment
Statistical analysis
Results
Study selection and characteristics
Study | Type of surgery | Patients (GDFT), n | Patients (control), n | Risk | Age, years | GDFTdyn goals | Other goals | Monitoring devices | Interventions |
---|---|---|---|---|---|---|---|---|---|
Benes J 2010 [13] | Major abdominal | 60 | 60 | High | > 18 | SVV < 10% | CI 2.5–4 L/min/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Broch O 2016 [14] | Major abdominal | 39 | 40 | High | > 18 | PPV < 10%a | CI > 2.5 L/min/m2 | Nexfinb | Fluid inotropes vasopressors |
Buettner M 2008 [15] | Major abdominal | 40 | 40 | High | > 18 | SPV < 10% | – | PiCCOplus | Fluid vasopressor |
Cesur S 2018 [16] | Abdominal | 35 | 35 | Moderate | > 18 | PVI < 13% | – | Masimo Radical 7b | Fluid vasopressors |
Colantonio L 2015 [17] | Major abdominal | 38 | 42 | High | > 18 | SVV < 15% | SVI > 35 mL/min/m2 CI > 2.5 L/min/m2 | FloTrac/Vigileo | Fluid inotropes |
Correa-Gallego C 2015 [18] | Major abdominal | 69 | 66 | High | NR | SVV < 15% | CO > 4 L/min CI > 2 L/min/m2 | FloTrac | Fluid |
Demirel İ 2018 [19] | Abdominal | 30 | 30 | Moderate | > 18 | PVI < 14% | – | Masimo Co.b | Fluid vasopressors |
Elgendy MA 2017 [20] | High risk | 43 | 43 | High | NR | SVV < 12% | CI > 2.5 L/min/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Fellahi JL 2015 [21] | Cardiac | 48 | 44 | High | > 18 | SVV ≤11% | CI > 2.4 L/min/m2 | Endotracheal cardiac output monitor | Fluid inotropes |
Forget P 2010 [22] | Abdominal | 41 | 41 | Moderate | > 18 | PVI < 13% | – | Masimo Co.b | Fluid vasopressors |
Funk DJ 2015 [23] | Major vascular | 20 | 20 | High | > 18 | SVV < 13% | CI > 2.2 L/min/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Goepfert MS 2013 [24] | Cardiac | 50 | 50 | High | > 18 | SVV < 10% | CI > 2 L/min/m2 | PiCCOplus | Fluid inotropes vasopressors |
Hand WR 2016 [25] | Head and neck | 47 | 47 | Moderate | NR | SVV < 13% | CI > 3 L/min/m2 SVR > 800 dynes/s/cm5/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Harten J 2008 [26] | Emergency abdominal | 14 | 15 | High | > 50 | PPV < 10% | – | Lidco plus | Fluid |
Kapoor PM 2008 [27] | Cardiac | 13 | 14 | High | NR | SVV < 10%a | CI 2.5–4.2 L/min/m2 SVI 30-65 mL/beat/m2 SVRI: 1500–2500 dynes/s/cm5/m2 DO2 450–600 mL/min/m2 ScVO2 > 70% | FloTrac/Vigileo | Fluid inotropes vasoactives |
Kapoor PM 2016 [28] | Cardiac | 60 | 60 | High | NR | SVV < 10%a | CI 2.5–4.2 L/min/m2 SVI 30–65 mL/beat/m2 SVRI 1500–2500 dynes/s/cm5/m2 DO2 450–600 mL/min/m2 ScVO2 > 70% Hct > 30% ScVO2 > 70% | FloTrac/Vigileo | Fluid inotropes vasodilators |
Kim HJ 2018 [29] | Head and neck | 31 | 31 | Moderate | 20–80 | SVV < 12% | CI > 2.5 L/min/m2 | FloTrac/Vigileo | Fluid inotropes vasodilators |
Kumar L 2016 [30] | Major abdominal | 30 | 30 | High | > 18 | SVV < 10% | CI ≥2.5 L/min/m2 O2ER ≤ 27% | FloTrac/Vigileo | Fluid inotropes vasopressors |
Lai CW 2015 [31] | Major abdominal | 109 | 111 | High | NR | SVV < 10% | – | LiDCOrapid | Fluid |
Liang M 2017 [32] | Urologic | 30 | 30 | High | 60–80 | SVV 8%–13% | DO2I ≥ 500 mL/min/m2 | FloTrac/Vigileo | Fluid inotropes |
Lopes MR 2007 [33] | High risk | 17 | 16 | High | > 18 | PPV < 10% | – | IBPplus | Fluid |
Luo J 2017 [34] | Craniotomy | 73 | 72 | High | > 18 | SVV < 15% | CI > 2.5 L/min/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Mayer J 2010 [35] | Major abdominal | 30 | 30 | High | > 18 | SVV < 12% | CI > 2.5 L/min/m2 SVI > 35 mL/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Peng K 2014 [36] | Major orthopedic | 40 | 40 | High | > 18 | SVV < 10%/14% | – | FloTrac/Vigileo | Fluid vasopressors |
Pösö T 2014 [37] | Abdominal | 30 | 20 | Moderate | NR | SVV < 12% | CI ≥2.0 L/min/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Ramsingh DS 2013 [38] | Major abdominal | 18 | 20 | High | > 18 | SVV < 12% | – | FloTrac/Vigileo | Fluid |
Salzwedel C 2013 [39] | Major abdominal | 79 | 81 | High | NR | PPV < 10% | CI > 2.5 L/min/m2 | ProAQT | Fluid inotropes vasopressors |
Scheeren TW 2013 [40] | High risk | 26 | 26 | High | > 18 | SVV < 10% | SV rise > 10% | FloTrac/Vigileo | Fluid |
Stens J 2015 [41] | Abdominal | 13 | 18 | Moderate | > 18 | PPV < 12% | CI > 2.5 L/min/m2 | Nexfinb | Fluid inotropes vasopressors |
Sundaram SC 2016 [42] | Intracranial tumor | 30 | 30 | High | 20–80 | PPV < 13% | – | Phillips Intellivue MP50 | Fluid vasopressors |
Weinberg L 2017 [43] | Major abdominal | 26 | 26 | High | > 18 | SVV < 20% | CI > 2.0 L/min/m2 PaO2 > 100 mmHg Hb > 8 g/dL T > 36 °C | FloTrac/Vigileo | Fluid inotropes vasopressors |
Wu J 2017 [44] | Intracranial tumor | 33 | 30 | High | NR | SVV < 12% | CI > 2.5 L/min/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Xu H 2017 [45] | Thoracic | 84 | 84 | Moderate | 18–60 | SVV 10– 13% | CI > 2.5 L/min/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Yu Y 2014 [46] | Abdominal | 15 | 15 | Moderate | 20–65 | PVI < 13% | – | Masimo Radical 7b | Fluid vasopressors |
Zhang J 2013 [47] | Thoracic | 30 | 30 | Moderate | 18–60 | SVV 9– 11% | CI > 2.5 L/min/m2 | FloTrac/Vigileo | Fluid inotropes |
Zheng H 2013 [48] | Major abdominal | 30 | 30 | High | 60–80 | SVV < 12% | CI > 2.5 L/min/m2 SVI > 35 mL/m2 | FloTrac/Vigileo | Fluid inotropes vasopressors |
Zheng LS 2016 [49] | Major abdominal | 39 | 37 | High | 65–90 | SVV < 12% | CI > 2.5 L/min/m2 | FloTrac/Vigileo | Fluid vasopressors |
Quality assessment
Meta-analyses
Analysis 1: GDFTdyn alone versus standard fluid therapy
Secondary outcomes
Events | Studies, n | Patients (GDFT), n | Events (GDFT), n | Patients (control), n | Events (control), n | OR | 95%CI | P value | References |
---|---|---|---|---|---|---|---|---|---|
Neurological events | |||||||||
Stroke | |||||||||
Analysis 2 | 7 | 292 | 3 | 286 | 10 | 0.38 | (0.13, 1.13) | 0.08 | |
Cardiovascular events | |||||||||
Arrhythmia | |||||||||
Analysis 1 | 2 | 57 | 4 | 56 | 6 | 0.59 | (0.16, 2.25) | 0.44 | |
Analysis 2 | 14 | 513 | 37 | 504 | 57 | 0.58 | (0.37, 0.92) | 0.02* | |
Myocardial infarction | |||||||||
Analysis 2 | 10 | 423 | 8 | 416 | 23 | 0.35 | (0.16, 0.76) | 0.008* | |
Heart failure/cardiovascular dysfunction | |||||||||
Analysis 1 | 2 | 57 | 0 | 56 | 2 | 0.17 | (0.01, 3.73) | 0.26 | |
Analysis 2 | 9 | 403 | 7 | 400 | 25 | 0.31 | (0.14, 0.67) | 0.003* | |
Pulmonary events | |||||||||
ALI/ARDS | |||||||||
Analysis 1 | 2 | 57 | 2 | 56 | 5 | 0.4 | (0.09, 1.86) | 0.24 | |
Analysis 2 | 3 | 170 | 1 | 170 | 10 | 0.13 | (0.02, 0.74) | 0.02* | |
Pneumonia | |||||||||
Analysis 1 | 2 | 57 | 6 | 56 | 8 | 0.69 | (0.22, 2.15) | 0.53 | |
Analysis 2 | 10 | 423 | 26 | 420 | 58 | 0.4 | (0.24, 0.65) | 0.0002* | |
Pulmonary embolism | |||||||||
Analysis 1 | 1 | 17 | 0 | 16 | 1 | 0.3 | (0.01, 7.79) | 0.47 | [33] |
Analysis 2 | 6 | 257 | 0 | 253 | 2 | 0.31 | (0.03, 3.04) | 0.31 | |
Abdominal events | |||||||||
GIT bleeding | |||||||||
Analysis 1 | 3 | 98 | 5 | 97 | 5 | 0.98 | (0.27, 3.57) | 0.98 | |
Analysis 2 | 3 | 116 | 1 | 116 | 2 | 0.66 | (0.11, 4.03) | 0.65 | |
GIT obstruction | |||||||||
Analysis 1 | 1 | 17 | 0 | 16 | 1 | 0.3 | (0.01, 7.79) | 0.47 | [33] |
Analysis 2 | 5 | 170 | 4 | 170 | 5 | 0.83 | (0.24, 2.79) | 0.76 | |
Renal events | |||||||||
AKI | |||||||||
Analysis 1 | 3 | 190 | 7 | 192 | 14 | 0.49 | (0.19, 1.23) | 0.13 | |
Analysis 2 | 10 | 444 | 16 | 444 | 25 | 0.6 | (0.31, 1.17) | 0.14 | |
Renal failure with dialysis | |||||||||
Analysis 1 | 2 | 81 | 2 | 81 | 0 | 3.08 | (0.31, 30.19) | 0.34 | |
Analysis 2 | 7 | 380 | 7 | 381 | 8 | 0.87 | (0.32, 2.39) | 0.79 |
Subgroups | Analysis 1 | Analysis 2 | ||||||
---|---|---|---|---|---|---|---|---|
Studies, n | OR/MD | 95%CI | P value | Studies, n | OR/MD | 95% CI | P value | |
Short-term mortality | ||||||||
Surgery | ||||||||
Non-cardiac | 6 | 0.85 | (0.32, 2.24) | 0.74 | 11 | 0.49 | (0.24, 1.00) | 0.05 |
Cardiac | – | – | – | – | 2 | 0.35 | (0.09, 1.36) | 0.13 |
risk | ||||||||
High | 5 | 0.69 | (0.25, 1.93) | 0.48 | 12 | 0.45 | (0.24, 0.85) | 0.01* |
Moderate | 1 | 5.25 | (0.24, 112.8) | 0.29 | – | – | – | – |
Fluid/inotropes | ||||||||
Fluid | 6 | 0.85 | (0.32, 2.24) | 0.74 | 2 | 0.96 | (0.04, 23.99) | 0.98 |
Fluid+inotropes | – | – | – | – | 11 | 0.42 | (0.22, 0.82) | 0.01* |
Monitoring devices | ||||||||
Minimally invasive | 5 | 0.69 | (0.25, 1.93) | 0.48 | 13 | 0.45 | (0.24, 0.85) | 0.01* |
Non-invasive | 1 | 5.25 | (0.24, 112.8) | 0.29 | – | – | – | – |
Overall morbidity | ||||||||
Surgery | ||||||||
Non-cardiac | 3 | 1.03 | (0.31, 3.37) | 0.97 | 14 | 0.4 | (0.28, 0.59) | <0.00001* |
Cardiac | – | – | – | – | 1 | 0.4 | (0.15, 1.06) | 0.07 |
risk | ||||||||
High | 3 | 1.03 | (0.31, 3.37) | 0.97 | 14 | 0.4 | (0.27, 0.58) | <0.00001* |
Moderate | – | – | – | – | 1 | 0.51 | (0.18, 1.42) | 0.2 |
Fluid/inotropes | ||||||||
Fluid | 3 | 1.03 | (0.31, 3.37) | 0.97 | 3 | 0.6 | (0.30, 1.20) | 0.15 |
Fluid+inotropes | – | – | – | – | 12 | 0.37 | (0.25, 0.55) | <0.00001* |
Monitoring devices | ||||||||
Minimally invasive | 3 | 1.03 | (0.31, 3.37) | 0.97 | 14 | 0.4 | (0.27, 0.58) | <0.00001* |
Non-invasive | – | – | – | – | 1 | 0.51 | (0.17, 1.58) | 0.24 |
Serum lactate concentration | ||||||||
Surgery | ||||||||
Non-cardiac | 9 | -0.21 | (−0.39, −0.03) | 0.02* | 9 | −0.67 | (−1.14, −0.20) | 0.005* |
Cardiac | – | – | – | – | 1 | 0.03 | (−0.18, 0.24) | 0.78 |
risk | ||||||||
High | 6 | − 0.17 | (− 0.32, − 0.02) | 0.03* | 10 | − 0.6 | (− 1.04, − 0.15) | 0.009* |
Moderate | 3 | − 0.19 | (− 0.49, 0.11) | 0.21 | – | – | – | – |
Fluid/inotropes | ||||||||
Fluid | 9 | − 0.21 | (− 0.39, − 0.03) | 0.02* | 1 | − 0.4 | (− 0.87, 0.07) | 0.1 |
Fluid+inotropes | – | – | – | – | 9 | − 0.62 | (− 1.10, − 0.13) | 0.01* |
Monitoring devices | ||||||||
Minimally invasive | 6 | − 0.17 | (− 0.32, − 0.02) | 0.03* | 9 | − 0.68 | (− 1.15, − 0.22) | 0.004* |
Non-invasive | 3 | − 0.19 | (− 0.49, 0.11) | 0.21 | 1 | 0.24 | (− 0.22, 0.70) | 0.31 |
length of stay in ICU | ||||||||
Surgery | ||||||||
Non-cardiac | 2 | −0.26 | (−2.00, 1.47) | 0.77 | 10 | −0.77 | (−1.15, − 0.39) | <0.0001* |
Cardiac | – | – | – | – | 4 | −0.86 | (− 1.68, − 0.04) | 0.04* |
Risk | ||||||||
High | 2 | −0.26 | (−2.00, 1.47) | 0.77 | 12 | −0.77 | (−1.09, − 0.45) | < 0.00001* |
Moderate | – | – | – | – | 2 | −0.76 | (− 1.67, 0.15) | 0.1 |
Fluid/inotropes | ||||||||
Fluid | 2 | −0.26 | (− 2.00, 1.47) | 0.77 | 1 | −0.5 | (−1.46, 0.46) | 0.3 |
Fluid+inotropes | – | – | – | – | 13 | −0.79 | (−1.10, − 0.47) | <0.00001* |
Monitoring devices | ||||||||
Minimally invasive | 1 | −0.67 | (−2.88, 1.54) | 0.55 | 14 | −0.77 | (−1.07, − 0.46) | <0.00001* |
Non-invasive | 1 | 0.4 | (−2.41, 3.21) | 0.78 | – | – | – | – |
length of stay in hospital | ||||||||
Surgery | ||||||||
Non-cardiac | 7 | 0.19 | (−1.11, 1.49) | 0.77 | 17 | −1.13 | (−1.94, −0.32) | 0.006* |
Cardiac | – | – | – | – | 4 | −1.42 | (−2.63, − 0.21) | 0.02* |
Risk | ||||||||
High | 5 | 0.54 | (−1.88, 2.96) | 0.66 | 17 | −1.45 | (−2.37, −0.52) | 0.002* |
Moderate | 2 | −0.01 | (−0.55, 0.54) | 0.98 | 4 | −0.33 | (−1.47, 0.81) | 0.58 |
Fluid/inotropes | ||||||||
Fluid | 7 | 0.19 | (−1.11, 1.49) | 0.77 | 2 | 0.16 | (−1.74, 2.05) | 0.87 |
Fluid+inotropes | – | – | – | – | 19 | −1.28 | (− 1.82, −0.73) | <0.00001* |
Monitoring devices | ||||||||
Minimally invasive | 5 | 0.54 | (−1.88, 2.96) | 0.66 | 20 | −1.23 | (−1.96, −0.49) | 0.001* |
Non-invasive | 2 | −0.01 | (−0.55, 0.54) | 0.98 | 1 | 0 | (−2.65, 2.65) | 1 |