title: Goal directed hemodynamic therapy based in esophageal Doppler flow parameters: A systematic review, meta-analysis and trial sequential analysis.
abstract: BACKGROUND
  Numerous studies have compared perioperative esophageal doppler monitoring (EDM) guided intravascular volume replacement strategies with conventional clinical volume replacement in surgical patients. The use of the EDM within hemodynamic algorithms is called 'goal directed hemodynamic therapy' (GDHT).
  
  
  METHODS
  Meta-analysis of the effects of EDM guided GDHT in adult non-cardiac surgery on postoperative complications and mortality using PRISMA methodology. A systematic search was performed in Medline, PubMed, EMBASE, and the Cochrane Library (last update, March 2015).
  
  
  METHODS
  Randomized clinical trials (RCTs) in which perioperative GDHT was compared to other fluid management.
  
  
  METHODS
  Overall complications.
  
  
  RESULTS
  Mortality; number of patients with complications; cardiac, renal and infectious complications; incidence of ileus. Studies were subjected to quantifiable analysis, pre-defined subgroup analysis (stratified by surgery, type of comparator and risk); pre-defined sensitivity analysis and trial sequential analysis (TSA).
  
  
  RESULTS
  Fifty six RCTs were initially identified, 15 fulfilling the inclusion criteria, including 1,368 patients. A significant reduction was observed in overall complications associated with GDHT compared to other fluid therapy (RR=0.75; 95%CI: 0.63-0.89; P=0.0009) in colorectal, urological and high-risk surgery compared to conventional fluid therapy. No differences were found in secondary outcomes, neither in other subgroups. The impact on preventing the development of complications in patients using EDM is high, causing a relative risk reduction (RRR) of 50% for a number needed to treat (NNT)=6.
  
  
  CONCLUSIONS
  GDHT guided by EDM decreases postoperative complications, especially in patients undergoing colorectal surgery and high-risk surgery. However, no differences versus restrictive fluid therapy and in intermediate-risk patients were found.
authors.affiliation: Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid. Servicio de Anestesia, Hospital Universitario Infanta Leonor, Madrid, España. Electronic address: ripo542@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Ripollés-Melchor
authors.affiliation: Facultad de Medicina, Universidad de Zaragoza. Servicio de Anestesia, Hospital Universitario Lozano Blesa, Zaragoza, España.
authors.forename: R
authors.initials: R
authors.lastname: Casans-Francés
authors.affiliation: Department of Anesthesia, Center of Vascular and Thoracic Surgery and Intensive Care, Örebro University Hospital, Örebro, Suecia.
authors.forename: A
authors.initials: A
authors.lastname: Espinosa
authors.affiliation: Servicio de Anestesia, Hospital Universitario La Paz, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Abad-Gurumeta
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte and Campus Charité Virchow-Klinikum, Berlín, Alemania.
authors.forename: A
authors.initials: A
authors.lastname: Feldheiser
authors.affiliation: Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid. Servicio de Anestesia, Hospital Clínico Universitario San Carlos, Madrid, España.
authors.forename: F
authors.initials: F
authors.lastname: López-Timoneda
authors.affiliation: Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid. Servicio de Anestesia, Hospital Universitario Infanta Leonor, Madrid, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Calvo-Vecino
mesh_terms: D015150:Echocardiography, Doppler; D005440:Fluid Therapy; D006040:Goals; D006439:Hemodynamics; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control
keywords: Atención perioperatoria; Esophageal Doppler monitoring; Fluidoterapia por objetivos; Goal-directed fluid therapy; Hemodynamic goal; Meta-analysis; Metaanálisis; Monitorización Doppler esofágico; Objetivo hemodinámico; Perioperative care