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Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis

Critical care (London, England), 2019-06, Vol.23 (1), p.232-232, Article 232 [Peer Reviewed Journal]

COPYRIGHT 2019 BioMed Central Ltd. ;The Author(s). 2019 ;ISSN: 1364-8535 ;EISSN: 1466-609X ;DOI: 10.1186/s13054-019-2516-4 ;PMID: 31242941

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Title:
Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis
Author: Giglio, Mariateresa ; Dalfino, Lidia ; Puntillo, Filomena ; Brienza, Nicola
Subjects: Acute Kidney Injury - drug therapy ; Acute Kidney Injury - physiopathology ; Cardiac output ; Care and treatment ; Critical Illness - therapy ; Fluid therapy ; Fluid Therapy - methods ; Hemodynamic monitoring ; Hemodynamics - drug effects ; Hemodynamics - physiology ; High-risk patients ; Hospital patients ; Humans ; Injuries ; Kidney ; Medical examination ; Methods ; Orthopedic surgery ; Oxygen delivery ; Patient Care Planning ; Patient monitoring equipment ; Patient outcomes ; Perioperative hemodynamic optimization ; Postoperative acute renal injury ; Postoperative care ; Postoperative Complications - etiology ; Postoperative Complications - physiopathology ; Postoperative Period
Is Part Of: Critical care (London, England), 2019-06, Vol.23 (1), p.232-232, Article 232
Description: Perioperative goal-directed therapy (GDT) reduces the risk of renal injury. However, several questions remain unanswered, such as target, kind of patients and surgery, and role of fluids and inotropes. We therefore update a previous analysis, including all studies published in the meanwhile, to clarify the clinical impact of this strategy on acute kidney injury. Randomized controlled trials enrolling adult patients undergoing major surgery were considered. GDT was defined as perioperative monitoring and manipulation of hemodynamic parameters to reach normal or supranormal values by fluids alone or with inotropes. Trials comparing the effects of GDT and standard hemodynamic therapy were considered. Primary outcome was acute kidney injury, whichever definition was used. Meta-analytic techniques (analysis software RevMan, version 5.3) were used to combine studies, using random-effect odds ratios (OR) and 95% confidence intervals (CI). Trial sequential analyses were performed including all trials and considering only low risk of bias trials. Sixty-five trials with an overall sample of 9308 patients were included. OR for the development of renal injury was 0.64 (95% CI, 0.62-0.87; p = 0.0003), with no statistical heterogeneity. Trial sequential analyses and sensitivity analysis including studies with low risk of bias confirmed the main results. A significant decrease in renal injury rate was observed in studies that adopted cardiac output and oxygen delivery as hemodynamic target and that used both fluids and inotropes. The postoperative kidney injury rate was significantly lower in trials enrolling "high-risk" patients and major abdominal and orthopedic surgery. The present meta-analysis suggests that targeting GDT to perioperative systemic oxygen delivery, by means of fluids and inotropes, can be the best way to improve renal perfusion and oxygenation in high-risk patients undergoing major abdominal and orthopedic surgery.
Publisher: England: BioMed Central Ltd
Language: English
Identifier: ISSN: 1364-8535
EISSN: 1466-609X
DOI: 10.1186/s13054-019-2516-4
PMID: 31242941
Source: AUTh Library subscriptions: ProQuest Central
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Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis

COPYRIGHT 2019 BioMed Central Ltd. ;The Author(s). 2019 ;ISSN: 1364-8535 ;EISSN: 1466-609X ;DOI: 10.1186/s13054-019-2516-4 ;PMID: 31242941

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