2018, Number 2
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ABSTRACTObjectives: To compare the effects of goal-directed fluid therapy versus standard fluid therapy during elective major non-cardiac surgery, measuring postoperative morbidity and mortality. Material and methods: A meta-analysis of controlled clinical trials of adult patients undergoing elective major non-cardiac surgery was conducted comparing GDFT versus SFT. The results measured in the postoperative period were relative risks for morbidity and mortality. Results: A total of 14 studies were included with 1,924 patients: 961 who underwent GDFT and 963 in the SFT. The GDFT was administered in the studies using several invasive hemodynamic monitors (transesophageal echocardiogram, arterial line, central venous catheter, etc.). The GDFT significantly reduced patient´s morbidity (RR 0.798, 95% CI 0.694-0.918, p = 0.002). The complications included in the analysis were anastomosis leakage, postoperative ileus, dehiscence and surgical wound infection. However, there was no significant difference in mortality between both types of therapies (RR 0.784, 95% CI 0.461-1.335, p = 0.370). The most common causes of mortality were due to major cardiovascular complications (AMI, Arrhythmias, etc.). Conclusions: Goal-directed fluid therapy (GDFT) seems to benefit patients undergoing major elective non-cardiac surgery in reducing postoperative morbidity.
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology. 1999;90:896-905.
Pestaña D, Espinosa E, Eden A, Nájera D, Collar L, Aldecoa C, et al. Perioperative Goal-Directed Hemodynamic Optimization Using Noninvasive Cardiac Output Monitoring in Major Abdominal Surgery: A Prospective, Randomized, Multicenter, Pragmatic. Trial: POEMAS Study (PeriOperative goal-directed therapy in Major Abdominal Surgery). Anesth Analg. 2014;119:579-587.
Phan TD, D’Souza B, Rattray MJ, Johnston MJ, Cowie BS. A randomised controlled trial of fluid restriction compared to oesophageal dopplerguided goal-directed fluid therapy in elective major colorectal surgery within an enhanced recovery after surgery program. Anaesth Intensive Care. 2014;42:752-760.