The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis
Abstract Background Pulmonary complications after thoracic surgery are common and associated with significant morbidity and high cost of care. Goal-directed fluid therapy (GDFT) could reduce the incidence of postoperative pulmonary complications (PPCs) and facilitate recovery in patients undergoing...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-02-01
|
| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-024-02519-y |
| _version_ | 1797273305688834048 |
|---|---|
| author | Shuang Han Xiaoqian Wu Pan Li Kun He Jianli Li |
| author_facet | Shuang Han Xiaoqian Wu Pan Li Kun He Jianli Li |
| author_sort | Shuang Han |
| collection | DOAJ |
| description | Abstract Background Pulmonary complications after thoracic surgery are common and associated with significant morbidity and high cost of care. Goal-directed fluid therapy (GDFT) could reduce the incidence of postoperative pulmonary complications (PPCs) and facilitate recovery in patients undergoing major abdominal surgery. However, whether GDFT could reduce the incidence of PPCs in patients undergoing thoracic surgery was unclear. The present meta-analysis was designed to assess the impact of Goal-directed Fluid Therapy on PPCs in patients undergoing thoracic surgery. Methods Randomized controlled trials (RCTs) comparing GDFT with other conventional fluid management strategies in adult patients undergoing thoracic surgery were identified. Databases searched included PubMed, Web of Science, Embase, and Cochrane Library databases. Review Manager 5.4 (The Cochrane Collaboration, Oxford, UK) software was used for statistical analysis. Heterogeneity was analyzed using I2 statistics, and a standardized mean difference with 95% CI and P value was used to calculate the treatment effect for outcome variables. The primary study outcomes were the incidence of PPCs. Secondary outcomes were the total volume infused, the length of hospitalization, the incidence of cardiac complications, and the incidence of renal dysfunction. Subgroup analysis was planned to verify the definite role of GDFT. Results A total of 6 RCTs consisting of 680 patients were included in this meta-analysis, which revealed that GDFT did not reduce the incidence of PPCs in patients undergoing thoracic surgery (RR, 0.57; 95% CI 0.29–1.14). However, GDFT decreased the total intra-operative fluid input (MD, − 244.40 ml; 95% CI − 397.06 to − 91.74). There was no statistical difference in the duration of hospitalization (MD; − 1.31, 95% CI − 3.00 to 0.38), incidence of renal dysfunction (RR, 0.62; 95% CI 0.29–1.35), and incidence of cardiac complications (RR, 0.62; 95% CI 0.27–1.40). Conclusions The results of this meta-analysis indicate that GDFT did not reduce the postoperative incidence of pulmonary complications in individuals undergoing thoracic surgery. However, considering the small number of contributing studies, these results should be interpreted with caution. |
| first_indexed | 2024-03-07T14:41:31Z |
| format | Article |
| id | doaj.art-336d30417f52494784c1ba7aaa2939bb |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-03-07T14:41:31Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-336d30417f52494784c1ba7aaa2939bb2024-03-05T20:19:02ZengBMCJournal of Cardiothoracic Surgery1749-80902024-02-0119111210.1186/s13019-024-02519-yThe impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysisShuang Han0Xiaoqian Wu1Pan Li2Kun He3Jianli Li4Department of Anesthesiology, Hebei General HospitalDepartment of Anesthesiology, Hebei General HospitalDepartment of Anesthesiology, Hebei General HospitalDepartment of Anesthesiology, The Fourth Hospital of ShijiazhuangDepartment of Anesthesiology, Hebei General HospitalAbstract Background Pulmonary complications after thoracic surgery are common and associated with significant morbidity and high cost of care. Goal-directed fluid therapy (GDFT) could reduce the incidence of postoperative pulmonary complications (PPCs) and facilitate recovery in patients undergoing major abdominal surgery. However, whether GDFT could reduce the incidence of PPCs in patients undergoing thoracic surgery was unclear. The present meta-analysis was designed to assess the impact of Goal-directed Fluid Therapy on PPCs in patients undergoing thoracic surgery. Methods Randomized controlled trials (RCTs) comparing GDFT with other conventional fluid management strategies in adult patients undergoing thoracic surgery were identified. Databases searched included PubMed, Web of Science, Embase, and Cochrane Library databases. Review Manager 5.4 (The Cochrane Collaboration, Oxford, UK) software was used for statistical analysis. Heterogeneity was analyzed using I2 statistics, and a standardized mean difference with 95% CI and P value was used to calculate the treatment effect for outcome variables. The primary study outcomes were the incidence of PPCs. Secondary outcomes were the total volume infused, the length of hospitalization, the incidence of cardiac complications, and the incidence of renal dysfunction. Subgroup analysis was planned to verify the definite role of GDFT. Results A total of 6 RCTs consisting of 680 patients were included in this meta-analysis, which revealed that GDFT did not reduce the incidence of PPCs in patients undergoing thoracic surgery (RR, 0.57; 95% CI 0.29–1.14). However, GDFT decreased the total intra-operative fluid input (MD, − 244.40 ml; 95% CI − 397.06 to − 91.74). There was no statistical difference in the duration of hospitalization (MD; − 1.31, 95% CI − 3.00 to 0.38), incidence of renal dysfunction (RR, 0.62; 95% CI 0.29–1.35), and incidence of cardiac complications (RR, 0.62; 95% CI 0.27–1.40). Conclusions The results of this meta-analysis indicate that GDFT did not reduce the postoperative incidence of pulmonary complications in individuals undergoing thoracic surgery. However, considering the small number of contributing studies, these results should be interpreted with caution.https://doi.org/10.1186/s13019-024-02519-yGoal-directed fluid therapyThoracic surgeryPulmonary complicationsPneumoniaMeta-analysis |
| spellingShingle | Shuang Han Xiaoqian Wu Pan Li Kun He Jianli Li The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis Journal of Cardiothoracic Surgery Goal-directed fluid therapy Thoracic surgery Pulmonary complications Pneumonia Meta-analysis |
| title | The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis |
| title_full | The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis |
| title_fullStr | The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis |
| title_full_unstemmed | The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis |
| title_short | The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis |
| title_sort | impact of goal directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery a systematic review and meta analysis |
| topic | Goal-directed fluid therapy Thoracic surgery Pulmonary complications Pneumonia Meta-analysis |
| url | https://doi.org/10.1186/s13019-024-02519-y |
| work_keys_str_mv | AT shuanghan theimpactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis AT xiaoqianwu theimpactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis AT panli theimpactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis AT kunhe theimpactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis AT jianlili theimpactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis AT shuanghan impactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis AT xiaoqianwu impactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis AT panli impactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis AT kunhe impactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis AT jianlili impactofgoaldirectedfluidtherapyonpostoperativepulmonarycomplicationsinpatientsundergoingthoracicsurgeryasystematicreviewandmetaanalysis |