title: Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis.
abstract: BACKGROUND
  Perioperative mortality after cardiac surgery has decreased in recent years although postoperative morbidity is still significant. Although there is evidence that perioperative goal-directed haemodynamic therapy (GDT) may reduce surgical mortality and morbidity in non-cardiac surgical patients, the data are less clear after cardiac surgery. The objective of this review is to perform a meta-analysis on the effects of perioperative GDT on mortality, morbidity, and length of hospital stay in cardiac surgical patients.
  
  
  METHODS
  We conducted a systematic review using Medline, EMBASE, and the Cochrane Controlled Clinical Trials Register. Additional sources were sought from experts. The inclusion criteria were randomized controlled trials, mortality reported as an outcome, pre-emptive haemodynamic intervention, and cardiac surgical population. Included studies were examined in full and subjected to quantifiable analysis, subgroup analysis, and sensitivity analysis where possible. Data synthesis was obtained by using odds ratio (OR) and mean difference (MD) for continuous data with 95% confidence interval (CI) utilizing a random-effects model.
  
  
  RESULTS
  From 4986 potential studies, 5 met all the inclusion criteria (699 patients). The quantitative analysis showed that the use of GDT reduced the postoperative complication rate (OR 0.33, 95% CI 0.15-0.73; P=0,006) and hospital length of stay (MD -2.44, 95% CI -4.03 to -0.84; P=0,003). There was no significant reduction in mortality.
  
  
  CONCLUSIONS
  The use of pre-emptive GDT in cardiac surgery reduces morbidity and hospital length of stay.
authors: St George's Hospital NHS Trust and St George's University of London, London SW170QT, UK.
authors: H D
authors: HD
authors: Aya
authors: M
authors: M
authors: Cecconi
authors: M
authors: M
authors: Hamilton
authors: A
authors: A
authors: Rhodes
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D006040:Goals; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007902:Length of Stay; D016017:Odds Ratio; D019990:Perioperative Care; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013903:Thoracic Surgery / Q000379:methods*