title: Perioperative goal-directed hemodynamic therapy in noncardiac surgery: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Goal-directed fluid therapy (GDHT) has been proposed as a method to reduce complications and mortality.
  
  
  METHODS
  Meta-analysis of the effects of perioperative GDHT in adult noncardiac surgery on mortality and postoperative complications was performed using the PRISMA methodology. A systematic search was performed in MEDLINE, PubMed, EMBASE, and the Cochrane Library (last update, October 2014). Inclusion criteria were as follows: randomized clinical trials (RCTs) in which perioperative GDHT was compared with conventional fluid management in noncardiac surgery. Exclusion criteria were as follows: trauma and pediatric surgery studies. End points were mortality and number of patients with complications.
  
  
  METHODS
  District general hospital.
  
  
  METHODS
  Thirty-nine RCTs were initially identified, with 8 fulfilling the inclusion criteria. Two RCTs were added by manual search, resulting in 10 RCTs in the final analysis, including 1527 patients.
  
  
  METHODS
  Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by supraphysiological or physiological hemodynamic goal and by time the intervention was carried out, perioperative or postoperative), and predefined sensitivity analysis.
  
  
  RESULTS
  A significant reduction was observed in mortality associated with GDHT compared with conventional fluid therapy (risk ratio, 0.63; 95% confidence interval, 0.42-0.94; P = .02). However, no differences were found in the number of patients with complications (risk ratio, 0.75; 95% confidence interval, 0.50-1.17; P = .21), and the sensitivity analysis did not confirm the results.
  
  
  CONCLUSIONS
  This meta-analysis, with its limitations, shows that the use of perioperative GDHT may reduce postoperative mortality, but it is unable to show a reduction in the number of patients with complications.
authors.affiliation: Complutense University of Madrid and Department of Anesthesia, Hospital Universitario Infanta Leonor, Gran Vía del Este 80, 28031 Madrid, Spain; EAR (Evidence Anesthesia Review) Group. Electronic address: ripo542@gmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Ripollés-Melchor
authors.affiliation: Department of Anesthesia, Center of Vascular and Thoracic Surgery and Intensive Care, Örebro University Hospital, Sweden; EAR (Evidence Anesthesia Review) Group.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Espinosa
authors.affiliation: Complutense University of Madrid and Department of Anesthesia, Hospital Universitario Infanta Leonor, Gran Vía del Este 80, 28031 Madrid, Spain; EAR (Evidence Anesthesia Review) Group.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Martínez-Hurtado
authors.affiliation: Department of Anesthesia, Hospital Universitario la Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain; EAR (Evidence Anesthesia Review) Group.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Abad-Gurumeta
authors.affiliation: Zaragoza University and Department of Anesthesia, Hospital Clínico Universitario Lozano Blesa, Avenida San Juan Bosco, 15, 50009 Zaragoza, Spain; EAR (Evidence Anesthesia Review) Group.
authors.forename: Rubén
authors.initials: R
authors.lastname: Casans-Francés
authors.affiliation: Complutense University of Madrid and Department of Preventive Medicine and Public Health, Hospital Clinico San Carlos, Prof Martin Lagos s/n, 28040 Madrid, Spain; EAR (Evidence Anesthesia Review) Group.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández-Pérez
authors.affiliation: Complutense University of Madrid and Department of Anesthesia, Hospital Clinico San Carlos, Prof Martin Lagos s/n, 28040 Madrid, Spain; EAR (Evidence Anesthesia Review) Group.
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Timoneda
authors.affiliation: Complutense University of Madrid and Department of Anesthesia, Hospital Universitario Infanta Leonor, Gran Vía del Este 80, 28031 Madrid, Spain; EAR (Evidence Anesthesia Review) Group.
authors.forename: José María
authors.initials: JM
authors.lastname: Calvo-Vecino
mesh_terms: D005440:Fluid Therapy; D006040:Goals; D006439:Hemodynamics; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000401:mortality
keywords: Goal-directed fluid therapy; Hemodynamic goal; Meta-analysis; Noncardiac surgery; Perioperative care