title: Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review.
abstract: Goal-directed hemodynamic therapy (GDT) is used to prevent hypoperfusion resulting from surgery. The objective of this study was to analyze the efficacy and importance of perioperative GDT.
  
  
  
  PUBMED, MEDLINE, CENTRAL, and Google Scholar databases were searched until 17 June 2016 using the search terms: cardiac output, cardiac surgical procedures, hemodynamics, goal-directed therapy, and intraoperative. Randomized-controlled trials with pre-emptive hemodynamic intervention for cardiac surgical population versus standard hemodynamic therapy were included.
  
  
  
  Nine studies were included with a total of 1148 patients. The overall analysis revealed no significant difference in the all-cause mortality (pooled peto OR =0.58, 95%CI =0.27-1.525, p = 0.164), duration of mechanical ventilation (pooled difference in mean= -1.48, 95%CI= -3.24 to 0.28, p = 0.099), or length of intensive care unit (ICU) stay (pooled difference in mean= -9.10, 95%CI= -20.14 to 1.93, p = 0.106) between patients in the GDT and control groups. Patients in the GDP group were associated with shorter hospital stay than those in the control group (pooled difference in mean= -1.52, 95%CI= -2.31 to -0.73, p < 0.001).
  
  
  
  GDT reduces the length of hospital stay compared with the standard of care. Further studies are necessary to continually assess the benefit of GDT following major surgery. Key Messages The results of this analysis revealed no significant difference between cardiac surgery patients receiving goal-directed hemodynamic therapy (GDT) or conventional fluid therapy in terms of the all-cause mortality, duration of mechanical intervention, and length of ICU-stay. The length of hospital stay was significantly reduced in patients treated with GDT compare to conventional fluid therapy. GDT may have limited benefit in reducing mortality; however, the association to shorter length of hospital stay may suggest that better hemodynamic balance can facilitate postoperative recovery.
authors.affiliation: a Department of Nephrology , Yantai Yuhuangding Hospital , Yantai , Shandong , China.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.affiliation: b Department of Obstetrics , Yantai Yuhuangding Hospital , Yantai , Shandong , China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Qu
authors.affiliation: a Department of Nephrology , Yantai Yuhuangding Hospital , Yantai , Shandong , China.
authors.forename: Dong
authors.initials: D
authors.lastname: Qi
authors.affiliation: c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.|d Kidney and Dialysis Institute of Shanghai , Shanghai , China.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.affiliation: c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.|d Kidney and Dialysis Institute of Shanghai , Shanghai , China.
authors.forename: Yi-Mei
authors.initials: YM
authors.lastname: Wang
authors.affiliation: c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.|d Kidney and Dialysis Institute of Shanghai , Shanghai , China.
authors.forename: Jia-Rui
authors.initials: JR
authors.lastname: Xu
authors.affiliation: c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.|d Kidney and Dialysis Institute of Shanghai , Shanghai , China.
authors.forename: Wu-Hua
authors.initials: WH
authors.lastname: Jiang
authors.affiliation: c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.|d Kidney and Dialysis Institute of Shanghai , Shanghai , China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.|d Kidney and Dialysis Institute of Shanghai , Shanghai , China.|e Shanghai Key Laboratory of Kidney and Blood Purification , Shanghai , China.
authors.forename: Xiao-Qiang
authors.initials: XQ
authors.lastname: Ding
authors.affiliation: c Department of Nephrology , Zhongshan Hospital, Shanghai Medical College, Fudan University , Shanghai , China.|d Kidney and Dialysis Institute of Shanghai , Shanghai , China.|e Shanghai Key Laboratory of Kidney and Blood Purification , Shanghai , China.
authors.forename: Jie
authors.initials: J
authors.lastname: Teng
mesh_terms: D000368:Aged; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003422:Critical Care; D006439:Hemodynamics; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
keywords: Cardiac output; cardiac surgical procedures; goal-directed therapy; hemodynamics; intraoperative