title: Hemodynamic optimization in severe trauma: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Severe trauma can be associated with significant hemorrhagic shock and impaired organ perfusion. We hypothesized that goal-directed therapy would confer morbidity and mortality benefits in major trauma.
  
  
  METHODS
  The MedLine, Embase and Cochrane Controlled Clinical Trials Register databases were systematically searched for randomized, controlled trials of goal-directed therapy in severe trauma patients. Mortality was the primary outcome of this review. Secondary outcomes included complication rates, length of hospital and intensive care unit stay, and the volume of fluid and blood administered. Meta-analysis was performed using RevMan software, and the data presented are as odds ratios for dichotomous outcomes and as mean differences (MDs) and standard MDs for continuous outcomes.
  
  
  RESULTS
  Four randomized, controlled trials including 419 patients were analyzed. Mortality risk was significantly reduced in goal-directed therapy-treated patients, compared to the control group(OR=0.56, 95%CI: 0.34-0.92). Intensive care (MD: 3.7 days 95%CI: 1.06-6.5)and hospital length of stay (MD: 3.5 days,95%CI: 2.75-4.25) were significantly shorter in the protocol group patients.There were no differences in reported total fluid volume or blood transfusions administered. Heterogeneity in reporting among the studies prevented quantitative analysis of complications.
  
  
  CONCLUSIONS
  Following severe trauma, early goal-directed therapy was associated with lower mortality and shorter durations of intensive care unit and hospital stays. The findings of this analysis should be interpreted with caution due to the presence of significant heterogeneity and the small number of the
authors.affiliation: Department of Intensive Care Medicine, St George's Hospital, London, UK.
authors.forename: Carlos
authors.initials: C
authors.lastname: Corredor
authors.affiliation: Department of Intensive Care Medicine, St George's Hospital, London, UK.
authors.forename: Nishkantha
authors.initials: N
authors.lastname: Arulkumaran
authors.affiliation: Department of Intensive Care Medicine, St George's Hospital, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ball
authors.affiliation: Department of Intensive Care Medicine, St George's Hospital, London, UK.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Grounds
authors.affiliation: Department of Intensive Care Medicine, St George's Hospital, London, UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hamilton
authors.affiliation: Department of Intensive Care Medicine, St George's Hospital, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rhodes
authors.affiliation: Department of Intensive Care Medicine, St George's Hospital, London, UK.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cecconi
mesh_terms: D006439:Hemodynamics / Q000502:physiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic; D012771:Shock, Hemorrhagic / Q000209:etiology*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*