title: Meta-analysis of hemodynamic optimization: relationship to methodological quality.
abstract: BACKGROUND
  To review systematically the effect of interventions aimed at hemodynamic optimization and to relate this to the quality of individual published trials.
  
  
  METHODS
  A systematic, computerized bibliographic search of published studies and citation reviews of relevant studies was performed. All randomized clinical trials in which adult patients were included in a trial deliberately aiming at an optimized or maximized hemodynamic condition of the patients (with oxygen delivery, cardiac index, oxygen consumption, mixed venous oxygen saturation and/or stroke volume as end-points) were selected. A total of 30 studies were selected for independent review. Two reviewers extracted data on population, intervention, outcome and methodological quality. Agreement between reviewers was high: differences were eventually resolved by third-party decision. The methodological quality of the studies was moderate (mean 9.0, SD 1.7), and the outcomes of the randomized clinical trials were not related to their quality.
  
  
  RESULTS
  Efforts to achieve an optimized hemodynamic condition resulted in a decreased mortality rate (relative risk ratio (RR) 0.75 (95% confidence interval (CI) 0.62 to 0.90) in all studies combined. This was due to a significantly decreased mortality in peri-operative intervention studies (RR 0.66 (95% CI 0.54 to 0.81). Overall, patients with sepsis and overt organ failure do not benefit from this method (RR 0.92 (95% CI 0.75 to 1.11)).
  
  
  CONCLUSIONS
  This systematic review showed that interventions aimed at hemodynamic optimization reduced mortality. In particular, trials including peri-operative interventions aimed at the hemodynamic optimization of high-risk surgical patients reduce mortality. Overall, this effect was not related to the trial quality.
authors.affiliation: Department of Surgery, University Hospital Maastricht, P Debyelaan 25, 6202 AZ Maastricht, The Netherlands. m.poeze@ah.unimaas.nl
authors.forename: Martijn
authors.initials: M
authors.lastname: Poeze
authors.forename: Jan Willem M
authors.initials: JW
authors.lastname: Greve
authors.forename: Graham
authors.initials: G
authors.lastname: Ramsay
mesh_terms: D003422:Critical Care / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D009102:Multiple Organ Failure / Q000503:physiopathology / Q000628:therapy; D016017:Odds Ratio; D010101:Oxygen Consumption; D019990:Perioperative Care / Q000379:methods; D012306:Risk; D018805:Sepsis / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000503:physiopathology / Q000628:therapy