Clinical review: Goal-directed therapy-what is the evidence in surgical patients? The effect on different risk groups

Cecconi, Maurizio; Corredor, Carlos; Arulkumaran, Nishkantha; Abuella, Gihan; Ball, Jonathan; Grounds, R Michael; Hamilton, Mark; Rhodes, Andrew

doi:10.1186/cc11823

Critical Care

Table 1 Summary of included studies

From: Clinical review: Goal-directed therapy-what is the evidence in surgical patients? The effect on different risk groups

Study	Year	Jadad score	Type of surgery	Number of patients GDT group	Number of patients control group	Type of monitor in GDT group	Intervention type	Goals in GDT group	Goals in control group	Mortality GDT (%)	Mortality control (%)	Complications GDT (%)	Complications control (%)
Bender et al. [64]	1997	1	Elective vascular/aortic	51	53	PAC	Fluid and inotropes	CI ≥ 2.8 PAWP 8-14 SVR <1100	Standard care	1.96	1.9	13.73	13.21
Benes et al. [65]	2010	3	Elective abdominal	60	60	Flotrac	Fluid and inotropes	SVV <10% CI ≥2.5	MAP > 65 HR < 100 CVP 8-12	1.67	3.3	30	58.33
Berlauk et al. [66]	1991	2	Peripheral vascular surgery	68	21	PAC	Fluid and inotropes	CI ≥2.8 PAWP 8-14 SVR <1100	Standard care	1.47	9.5	16.7	42.8
Bonazzi et al. [67]	2002	2	Elective vascular	50	50	PAC	Fluid and inotropes	CI >3.0 PAWP 10-18 SVR <1,450 DO₂I >600	Standard care	0	0	4	8
Boyd et al. [68]	1993	1	Abdominal/vascular	53	54	PAC	Fluid and notropes	MAP 80-110 PAWP 12-14 SpO₂ >94% Hb >12 DO₂I >600	MAP 80-110 PAWP 12-14 SpO₂ >94% Hb >12 UO >0.5 ml/ kg/h	5.66	22.2	NS	NS
Buettner et al. [69]	2008	2	Major abdominal or gynaecological	40	40	PiCCO	Fluids	SPV <10% HCt >23% Normal clotting	Standard care	0	2.5	NS	NS
Cecconi et al. [70]	2011	4	Total hip replacement	20	20	Flotrac	Fluid and inotropes	SV change DO₂I >600	Standard care	0	0	80	100
Challand et al. [71]	2012	5	Major open/laparoscopic colorectal	89	90	OD	Fluids	SV change	Standard care	5.62	4.4	33.71	28.89
Conway et al. [72]	2002	2	Major bowel resection	29	28	OD	Fluids	FTc >0.35 SV change	Standard care	0	3.6	17.24	32.14
Donati et al. [73]	2007	3	Elective major abdominal/aortic	68	67	CVC	Fluids	O₂ER <27% MAP >80 UO >0.5 CVP 8-12 Hb >10	MAP >80 UO >0.5 CVP 8-12 Hb >10	2.94	3	13.24	40.3
Forget et al. [74]	2010	2	Major intrabdominal	41	41	Masimo pulsoximeter	Fluids	PVI <13%	Standard care	4.88	0	78.05	100
Gan et al. [75]	2002	5	Elective general, urological, gynaecologic	50	50	OD	Fluids	FTc >0.35 SV change	Increase HR >20% baseline sBP <90 or CVP <20% baseline	0	0	42	76
Harten et al. [76]	2008	3	Emergency abdominal	14	15	Lidco	Fluids	PPV	Standard care	7.14	13.3	50	26.67
Jhanji et al. [77]	2010	3	Major surgery	45	45	LiDCO	Fluids	SV	CVP standard care	11.11	13.3	57.58	66.67
Lobo et al. [78]	2000	3	Major surgery	19	18	PAC	Fluid and inotropes	DO₂I >600	Standard care	15.79	50	31.58	66.67
Lobo et al. [79]	2006	3	Major surgery	25	25	PAC	Fluid and inotropes	PWP 12-16 MAP 70-110 HCt >30%, SAO2 >94% UO >0.5 DO2I >600	PAWP 12-16 MAP 70-110 HCt >30% SaO2 >94% UO >0.5	8	28	16	52
Lopes et al. [80]	2007	2	Major surgery	17	16	IBPplus; Dixtal	Fluids	ΔPP <10%	Standard care	11.76	31.3	41.18	75
Mayer et al. [81]	2010	2	Major gastrointestinal surgery	30	30	Flotrac	Fluid and inotropes	CI >2.5 SVV <12%	CVP 8-12 MAP >65 UO >0.5	6.67	6.7	20	50
Noblett et al. [82]	2006	5	Colorectal	51	52	OD	Fluids	FTc >0.35 SV change	Standard care	0	1.9	1.96	15.38
Pearse et al. [83]	2005	3	Major surgery	62	60	LiDCO	Fluid and inotropes	DO₂I >600	SaO2 ≥94% Hb >8 Temp >37°C HR <100 or <20 above baseline MAP 60-100 CI ≥2.5	11.29	15	43.35	68.33
Senagore et al. [84]	2009	3	Elective lap colorectal	42	22	OD	Fluids	SV response	Standard care	2.38	4.7	NS	NS
Shoemaker et al. [85]	1988	2	Major surgery	28	60	PAC	Fluid and inotropes	CI >4.5 VO2 >170 DO2I >600	Standard care	3.57	30	28.5	50
Sinclair et al. [86]	1997	2	Neck of femur repair	20	20	OD	Fluids	FTc >0.35 SV change	Standard care	5	10	NS	NS
Szakmany et al. [87]	2005	3	Major abdominal	20	20	PiCCO	Fluids	ITBV 850-950 ml/m²	CVP Standard care	9.09	5	NS	NS
Ueno et al. [88]	1998	2	Hepatic resection	16	18	PAC	Fluid and inotropes	CI >4.5 VO2 >170 DO2I >600	SpO2 >95% Mean PAOP 11-15 mmHg Hb >10	0	11.1	0	27.78
Valentine et al. [89]	1998	3	Aortic	60	60	PAC	Fluid and inotropes	CI >2.8 PAWP 8-15 SVR <1100	Standard care	5	1.7	25	16.67
Van Der linden et al. [90]	2010	4	Vascular	40	17	LiDCO + CVC	Fluid and inotropes	CI >2.5	Standard care	7.5	0	10	0
Venn et al. [91]	2002	3	Neck of femur repair	30	60	OD	Fluids	FTc >0.35 SV change	Standard care	10	6.9	34.4	72.4
Wakeling et al. [92]	2005	3	Colorectal	67	67	OD	Fluids	SV change	Standard care	0	1.5	35.82	56.72
Wenkui et al. [93]	2010	3	Elective GI Cancer	109	105	Lactate	Fluids	Lactate <1.6	Standard care	0.92	3.8	22.94	33.3
Wilson et al. [94]	1999	4	Major surgery	92	46	PAC	Fluid and inotropes	DO2I >600	Standard care	3.26	17.4	41.3	60.87
Ziegler et al. [95]	1997	2	Vascular	32	40	PAC	Fluid and inotropes	PAOP >12	Standard care	9.38	5	25	27.5

CI, cardiac index (ml/minute/m²); CVP, central venous pressure (cmH₂O); CVC, central venous catheter; DO₂I, oxygen delivery index (ml/minute/m²); FTc, corrected flow time; GDT, goal-directed therapy; Hb, haemoglobin (g/dl); Hct, haematocrit (%); HR, heart rate (beats/minute); ITBV, intrathoracic blood volume; VO₂, oxygen consumption (ml/minute); MAP, mean arterial pressure (mmHg); NS, not stated; O₂ER, oxygen extraction ratio (%); OD, oesophageal Doppler; PAC, pulmonary artery catheter; PAOP, pulmonary artery occlusion pressure (mmHg); PAWP, pulmonary artery wedge pressure (mmHg); PP, pulse pressure; PPV, pulse pressure variation; PVI, plethysmographic variability index; SAO₂, aterial oxygen saturation; sBP, systolic blood pressure (mmHg); SpO₂, oxygen saturation (%); SV, stroke volume (ml); SVR, systemic vascular resistance (dynes-s/cm⁵); SVV, stroke volume variation (%); UO, urine output (ml/kg/h); VO₂, oxygen consumption (ml/minute).

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