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Systematic reviews

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Is goal-directed fluid therapy beneficial for gastrointestinal surgery within an enhanced recovery program? A systematic review and meta-analysis

  • Ya-Bei Huang1
  • Kai-Yu Yin2,3
  • Xin-Pei Zhang4
  • Ming-Qing Peng5

1Yabei Huang, Department of Anesthesiology, Yongchuan Affiliated Hospital of Chongqing Medical University, 402160 Chongqing, P. R. China

2Kaiyu Yin, Department of Anesthesiology, West China Women’s and Children’s Hospital, Sichuan, P. R. China

3Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education 610066 P. R. China

4Xinpei Zhang, Department of Anesthesiology, Yongchuan Affiliated Hospital of Chongqing Medical University, 402160 Chongqing, P. R. China

5Mingqing Peng, MD, Professor, Department of Anesthesiology, Yongchuan Affiliated Hospital of Chongqing Medical University, 402160 Chongqing, P. R. China

DOI: 10.22514/sv.2020.16.0099 Vol.17,Issue 3,May 2021 pp.225-233

Submitted: 03 October 2020 Accepted: 30 October 2020

Published: 08 May 2021

*Corresponding Author(s): Ming-Qing Peng E-mail: liminmedsci@126.com

Abstract

Objectives: To systematically evaluate the clinical effect of intraoperative goal-directed fluid therapy (GDFT) in gastrointestinal surgery within an enhanced recovery after surgery (ERAS) program.

Methods: EMBASE, MEDLINE, Cochrane Library, PubMed, OVID, CNKI and other databases were searched for randomized controlled trials (RCTs) from the inception dates to December 2018. These studies included patients undergoing elective gastrointestinal surgery comparing regular fluid therapy versus GDFT within ERAS. The meta-analysis was carried on with RevMan 5.3.

Results: A total of 10 RCT studies were included with 1216 patients. Compared with the regular fluid therapy group, the GDFT group reduced the rate of readmission [odds ratio, OR = 1.67, 95% CI (1.05, 2.65), P = 0.03] in gastrointestinal surgery patients within ERAS. However, there was no significant decrease in length of hospital stay (LOHS) [mean difference, MD = -0.11, 95% CI (-1.22, 1.00), P = 0.85], postoperative morbidity [OR = 0.78, 95% CI (0.55, 1.11), P = 0.17], postoperative mortality [OR = 0.86, 95% CI (0.30, 2.49), P = 0.78], postoperative ileus [OR = 1.24, 95% CI (0.70, 2.19), P = 0.45], anastomotic leaks [OR= 0.66, 95% CI (0.29, 1.49), P = 0.31] and the first gastrointestinal motility time [MD = -0.37, 95% CI (-1.07, 0.33), P = 0.30].

Conclusions: The current evidence demonstrates that, in gastrointestinal surgery within ERAS, GDFT decreased the rate of readmission. However, there was no advantage over regular fluid therapy in the reduction of LOHS, postoperative morbidity, postoperative mortality, postoperative ileus and anastomotic leaks.

Keywords

Enhanced recovery after surgery; Goal-directed fluid therapy; Gastrointestinal surgery; Meta-analysis; Randomized controlled trial

Cite and Share

Ya-Bei Huang,Kai-Yu Yin,Xin-Pei Zhang,Ming-Qing Peng. Is goal-directed fluid therapy beneficial for gastrointestinal surgery within an enhanced recovery program? A systematic review and meta-analysis. Signa Vitae. 2021. 17(3);225-233.

References

[1] Bellamy MC. Wet, dry or something else? British Journal of Anaesthesia. 2006; 97: 755-757.

[2] Li Y, Zeng K, Lin Z. New progress of perioperative goal-directed fluid therapy. Journal of Fujian Medical University. 2013; 000(003), 189-194.(In Chinese)

[3] Xu G, Xu L. Application of intraoperative goal-directed fluid therapy in enhanced recovery after surgery. Medical Journal of Peking Union Medical College Hospital. 2018; 9: 550-555.

[4] He X, Zou X, Xing H. New progress of goal-directed fluid therapy in enhanced recovery after surgery. Basic & Clinical Medicine. 2020; 40:

995- 998.

[5] Giglio MT, Marucci M, Testini M, Brienza N. Goal-directed haemody-namic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. British Journal of Anaesthesia. 2009; 103 :637-646.

[6] Benes J, Giglio M, Brienza N, Michard F. The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Critical Care (London, England). 2014; 18: 584.

[7] Yin K, Ding J, Wu Y, Peng M. Goal-directed fluid therapy based on noninvasive cardiac output monitor reduces postoperative complications in elderly patients after gastrointestinal surgery: A randomized controlled trial. Pakistan Journal of Medical Sciences. 2018; 34: 1320-1325.

[8] Chen L, Chen Y, Dong H, Feng Y, Gu X, Huang Y, et al. Chinese consensus and clinical guidelines for Enhanced Recovery After Surgery (2018 editon). Chinese Journal of Practical Surgery. 2018; 38: 1-20.

[9] Xu X, Tian Y, Liu J, Cao B, Zhang W. Evaluation of curative effect of enhanced recovery after surgery in colorectal cancer. Journal of Xinjiang Medical University. 2017; 40: 302-304. (In Chinese)

[10] Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) Society recommendations. World Journal of Surgery. 2013; 37: 259-284.

[11] Cannesson M, Gan TJ. PRO: perioperative goal-directed fluid therapy is an essential element of an enhanced recovery protocol. Anesthesia and Analgesia. 2016; 122: 1258-1260.

[12] Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to enhanced recovery after surgery (ERAS). Canadian Journal of Anesthesia/Journal Canadien d’Anesthésie. 2015; 62: 158-168.

[13] Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surgery. 2017; 152: 292-298.

[14] Varadhan KK, Neal KR, Dejong CHC, Fearon KCH; Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clinical nutrition (Edinburgh, Scotland). 2010; 29: 434-440.

[15] Makaryus R, Miller TE, Gan TJ. Current concepts of fluid management in enhanced recovery pathways. British Journal of Anaesthesia. 2018; 120:

376- 383.

[16] Chong MA, Wang Y, Berbenetz NM, McConachie I. Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes: A systematic review and meta-analysis. European Journal of Anaesthesiol-ogy. 2018; 35: 469-483.

[17] Senagore AJ, Emery T, Luchtefeld M, Kim D, Dujovny N, Hoedema R. Fluid management for laparoscopic colectomy: a prospective, randomized assessment of goal-directed administration of balanced salt solution or hetastarch coupled with an enhanced recovery program. Diseases of the Colon & Rectum. 2009; 52: 1935-1940.

[18] Gómez-Izquierdo JC, Feldman LS, Carli F, Baldini G. Meta-analysis of the effect of goal-directed therapy on bowel function after abdominal surgery. the British Journal of Surgery. 2015; 102: 577-589.

[19] Zhang X, Zheng W, Chen C, Kang X, Zheng Y, Bao F, et al. Goal-directed fluid therapy does not reduce postoperative ileus in gastrointestinal surgery: A meta-analysis of randomized controlled trials. Medicine. 2018; 97: e13097.

[20] Rollins KE, Lobo DN. Intraoperative goal-directed fluid therapy in elective major abdominal surgery: a meta-analysis of randomized controlled trials. Annals of Surgery. 2016; 263: 465-476.

[21] Jammer I, Ulvik A, Erichsen C, Lødemel O, Ostgaard G. Does central venous oxygen saturation-directed fluid therapy affect postoperative morbidity after colorectal surgery? A randomized assessor-blinded controlled trial. Anesthesiology. 2010; 113: 1072-1080.

[22] Wakeling HG, McFall MR, Jenkins CS, Woods WGA, Miles WFA, Barclay GR, et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. British Journal of Anaesthesia. 2005; 95: 634-642.

[23] Noblett SE, Snowden CP, Shenton BK, Horgan AF. Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. British Journal of Surgery. 2006; 93: 1069-1076.

[24] Challand C, Struthers R, Sneyd JR, Erasmus PD, Mellor N, Hosie KB, et al. Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery. British Journal of Anaesthesia. 2012; 108: 53-62.

[25] Zakhaleva J, Tam J, Denoya PI, Bishawi M, Bergamaschi R. The impact of intravenous fluid administration on complication rates in bowel surgery within an enhanced recovery protocol: a randomized controlled trial. Colorectal Disease. 2013; 15: 892-899.

[26] Brandstrup B, Svendsen PE, Rasmussen M, Belhage B, Rodt SÅ, Hansen B, et al. Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance?British Journal of Anaesthesia. 2012; 109: 191-199.

[27] Srinivasa S, Taylor MHG, Singh PP, Yu T-C, Soop M, Hill AG. Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomy. British Journal of Surgery. 2013; 100: 66-74.

[28] Zheng H, Guo H, Ye J, Chen L, Ma H. Goal-directed fluid therapy in gastrointestinal surgery in older coronary heart disease patients: randomized trial. World Journal of Surgery. 2013; 37: 2820-2829.

[29] Phan TD, An V, D’souza B, Rattray MJ, Johnston MJ, Cowie BS. A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery program. Anaesthesia and Intensive Care. 2014; 42: 752-760.

[30] Gómez-Izquierdo JC, Trainito A, Mirzakandov D, Stein BL, Liberman S, Charlebois P, et al. Goal-directed fluid therapy does not reduce primary postoperative ileus after elective laparoscopic colorectal surgery: A randomized controlled trial. Anesthesiology. 2017; 127: 36-49.

[31] Lai CW, Starkie T, Creanor S, Struthers RA, Portch D, Erasmus PD, et al. Randomized controlled trial of stroke volume optimization during elective major abdominal surgery in patients stratified by aerobic fitness. British Journal of Anaesthesia. 2015; 115: 578-589.

[32] Joosten A, Delaporte A, Ickx B, Touihri K, Stany I, Barvais L, et al. Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A randomized, double-blinded, controlled trial in major abdominal surgery. Anesthesiology. 2018; 128: 55-66.

[33] Scarci M, Solli P, Bedetti B. Enhanced recovery pathway for thoracic surgery in the UK. Journal of Thoracic Disease. 2016; 8: S78-S83.

[34] Rollins KE, Mathias NC, Lobo DN. Meta-analysis of goal-directed fluid therapy using transoesophageal Doppler monitoring in patients undergoing elective colorectal surgery. BJS Open. 2019; 3: 606-616.

[35] Moore-Olufemi SD, Xue H, Attuwaybi BO, Fischer U, Harari Y, Oliver DH, et al. Resuscitation-induced gut edema and intestinal dysfunction. Journal of Trauma and Acute Care Surgery. 2005; 58: 264-270.

[36] Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. New England Journal of Medicine. 2018; 378: 2263-2274.

[37] Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesthesia & Analgesia. 2011; 112: 1392-1402.

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