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Title: Impact of hemodynamic goal-directed resuscitation on mortality in adult critically ill patients: a systematic review and meta-analysis.
Austin Authors: Cronhjort, Maria;Wall, Olof;Nyberg, Erik;Zeng, Ruifeng;Svensen, Christer;Mårtensson, Johan;Joelsson-Alm, Eva
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Anesthesiology, The University of Texas Medical Branch UTMB Health, John Sealy Hospital, Galveston, USA
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
The Second Hospital and Yuying Children's Hospital, Wenzhou Medical College, Wenzhou, China
Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden
Issue Date: Jun-2018 2017-06-08
Publication information: Journal of clinical monitoring and computing 2018; 32(3): 403-414
Abstract: The effect of hemodynamic optimization in critically ill patients has been challenged in recent years. The aim of the meta-analysis was to evaluate if a protocolized intervention based on the result of hemodynamic monitoring reduces mortality in critically ill patients. We performed a systematic review and meta-analysis according to the Cochrane Handbook for Systematic Reviews of Interventions. The study was registered in the PROSPERO database (CRD42015019539). Randomized controlled trials published in English, reporting studies on adult patients treated in an intensive care unit, emergency department or equivalent level of care were included. Interventions had to be protocolized and based on results from hemodynamic measurements, defined as cardiac output, stroke volume, stroke volume variation, oxygen delivery, and central venous-or mixed venous oxygenation. The control group had to be treated without any structured intervention based on the parameters mentioned above, however, monitoring by central venous pressure measurements was allowed. Out of 998 screened papers, thirteen met the inclusion criteria. A total of 3323 patients were enrolled in the six trials with low risk of bias (ROB). The mortality was 22.4% (374/1671 patients) in the intervention group and 22.9% (378/1652 patients) in the control group, OR 0.94 with a 95% CI of 0.73-1.22. We found no statistically significant reduction in mortality from hemodynamic optimization using hemodynamic monitoring in combination with a structured algorithm. The number of high quality trials evaluating the effect of protocolized hemodynamic management directed towards a meaningful treatment goal in critically ill patients in comparison to standard of care treatment is too low to prove or exclude a reduction in mortality.
DOI: 10.1007/s10877-017-0032-0
ORCID: 0000-0002-0444-8553
Journal: Journal of clinical monitoring and computing
PubMed URL: 28593456
Type: Journal Article
Subjects: Critical care
Fluid therapy
Hemodynamic monitoring
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