Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2024

Open Access 01-12-2024 | Esophagus Resection | Review

The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis

Authors: Shuang Han, Xiaoqian Wu, Pan Li, Kun He, Jianli Li

Published in: Journal of Cardiothoracic Surgery | Issue 1/2024

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
2.
Serpa Neto A, Hemmes SN, Barbas CS, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: a systematic review and meta-analysis. Lancet Respir Med. 2014;2(12):1007–15.CrossRefPubMed
3.
Assaad S, Popescu W, Perrino A. Fluid management in thoracic surgery. Curr Opin Anaesthesiol. 2013;26(1):31–9.CrossRefPubMed
4.
Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008;109(4):723–40.CrossRefPubMed
5.
Şentürk M, Orhan Sungur M, Sungur Z. Fluid management in thoracic anesthesia. Minerva Anestesiol. 2017;83(6):652–9.CrossRefPubMed
6.
Kaida T, Wakamatsu M, Machino A, et al. Perioperative effect of intraoperative fluid restriction with the same fixed volume of 5 ml · kg(-1) · h(-1) in patients undergoing major abdominal versus thoracic surgery. Masui. 2015;64(10):1030–5.PubMed
7.
Ahn HJ, Kim JA, Lee AR, et al. The risk of acute kidney injury from fluid restriction and hydroxyethyl starch in thoracic surgery. Anesth Analg. 2016;122(1):186–93.CrossRefPubMed
8.
9.
Coeckelenbergh S, Delaporte A, Ghoundiwal D, et al. Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial. BMC Anesthesiol. 2019;19(1):34.CrossRefPubMedPubMedCentral
10.
Rathore A, Singh S, Lamsal R, et al. Validity of pulse pressure variation (PPV) compared with stroke volume variation (SVV) in predicting fluid responsiveness. Turk J Anaesthesiol Reanim. 2017;45(4):210–7.CrossRefPubMedPubMedCentral
11.
Som A, Maitra S, Bhattacharjee S, Baidya DK. Goal directed fluid therapy decreases postoperative morbidity but not mortality in major non-cardiac surgery: a meta-analysis and trial sequential analysis of randomized controlled trials. J Anesth. 2017;31(1):66–81.CrossRefPubMed
12.
Dushianthan A, Knight M, Russell P, Grocott MP. Goal-directed haemodynamic therapy (GDHT) in surgical patients: systematic review and meta-analysis of the impact of GDHT on post-operative pulmonary complications. Perioper Med (Lond). 2020;9:30.CrossRefPubMed
13.
Xu H, Shu SH, Wang D, et al. Goal-directed fluid restriction using stroke volume variation and cardiac index during one-lung ventilation: a randomized controlled trial. J Thorac Dis. 2017;9(9):2992–3004.CrossRefPubMedPubMedCentral
14.
Kaufmann KB, Stein L, Bogatyreva L, et al. Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery-a single centre randomized parallel-arm trial. Br J Anaesth. 2017;118(6):852–61.CrossRefPubMed
15.
Bahlmann H, Halldestam I, Nilsson L. Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: randomised controlled trial. Eur J Anaesthesiol. 2019;36(2):153–61.CrossRefPubMed
16.
Higgins JPT. Cochrane collaboration: Cochrane handbook for systematic reviews of interventions. 2nd ed. Hoboken: Wiley-Blackwell; 2020.
17.
18.
Zhang J, Chen CQ, Lei XZ, et al. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study. Clinics (Sao Paulo). 2013;68(7):1065–70.CrossRefPubMed
19.
Mukai A, Suehiro K, Watanabe R, et al. Impact of intraoperative goal-directed fluid therapy on major morbidity and mortality after transthoracic oesophagectomy: a multicentre, randomised controlled trial. Br J Anaesth. 2020;125(6):953–61.CrossRefPubMed
20.
Tang W, Qiu Y, Lu H, et al. Stroke volume variation-guided goal-directed fluid therapy did not significantly reduce the incidence of early postoperative complications in elderly patients undergoing minimally invasive esophagectomy: a randomized controlled trial. Front Surg. 2021;8: 794272.CrossRefPubMedPubMedCentral
21.
Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6.CrossRefPubMed
22.
Veelo DP, van Berge Henegouwen MI, Ouwehand KS, et al. Effect of goal-directed therapy on outcome after esophageal surgery: a quality improvement study. PLoS ONE. 2017;12(3): e0172806.CrossRefPubMedPubMedCentral
23.
Alam N, Park BJ, Wilton A, et al. Incidence and risk factors for lung injury after lung cancer resection. Ann Thorac Surg. 2007;84(4):1085–91.CrossRefPubMed
24.
Arslantas MK, Kara HV, Tuncer BB, et al. Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections. J Thorac Cardiovasc Surg. 2015;149(1):314–21.CrossRefPubMed
25.
De Robertis E, Afshari A, Longrois D. The quest for the holy volume therapy. Eur J Anaesthesiol. 2016;33(7):483–7.CrossRefPubMed
26.
Wu Y, Yang R, Xu J, et al. Effects of intraoperative fluid management on postoperative outcomes after lobectomy. Ann Thorac Surg. 2019;107(6):1663–9.CrossRefPubMed
27.
28.
Wrzosek A, Jakowicka-Wordliczek J, Zajaczkowska R, et al. Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery. Cochrane Database Syst Rev. 2019;12(12):Cd012767.PubMed
29.
Grocott MP, Dushianthan A, Hamilton MA, et al. Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery. Cochrane Database Syst Rev. 2012;11(11):Cd004082.PubMed
30.
Sahutoglu C, Turksal E, Kocabas S, Askar FZ. Influence of stroke volume variation on fluid treatment and postoperative complications in thoracic surgery. Ther Clin Risk Manag. 2018;14:575–81.CrossRefPubMedPubMedCentral
31.
Kobayashi M, Ko M, Kimura T, et al. Perioperative monitoring of fluid responsiveness after esophageal surgery using stroke volume variation. Expert Rev Med Devices. 2008;5(3):311–6.CrossRefPubMed
32.
Haas S, Eichhorn V, Hasbach T, et al. Goal-directed fluid therapy using stroke volume variation does not result in pulmonary fluid overload in thoracic surgery requiring one-lung ventilation. Crit Care Res Pract. 2012;2012: 687018.PubMedPubMedCentral
33.
Bangash MN, Patel NS, Benetti E, et al. Dopexamine can attenuate the inflammatory response and protect against organ injury in the absence of significant effects on hemodynamics or regional microvascular flow. Crit Care. 2013;17(2):R57.CrossRefPubMedPubMedCentral
34.
Allen JM, Feild C, Shoulders BR, Voils SA. Recent updates in the pharmacological management of sepsis and septic shock: a systematic review focused on fluid resuscitation, vasopressors, and corticosteroids. Ann Pharmacother. 2019;53(4):385–95.CrossRefPubMed
35.
Harrois A, Hamada SR, Duranteau J. Fluid resuscitation and vasopressors in severe trauma patients. Curr Opin Crit Care. 2014;20(6):632–7.CrossRefPubMed
36.
Jessen MK, Vallentin MF, Holmberg MJ, et al. Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2022;128(3):416–33.CrossRefPubMed
Metadata
Title
The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis
Authors
Shuang Han
Xiaoqian Wu
Pan Li
Kun He
Jianli Li
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2024
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-024-02519-y

Other articles of this Issue 1/2024

Journal of Cardiothoracic Surgery 1/2024 Go to the issue

Research

The association of regional block with intraoperative opioid consumption in patients undergoing video-assisted thoracoscopic surgery: a single-center, retrospective study

Research

Off-pump bilateral internal thoracic artery grafting in patients with left main coronary artery disease

Case Report

Hemorrhagic pericardial tamponade in a hemodialysis patient with catheter-related superior vena cava syndrome: a case report

Case Report

Unexpected diagnosis: large hemangioma in the interatrial septum

Case Report

Delivering ECMO despite jugular vein thrombosis

Research

Double lung transplantation is better than single lung transplantation for end-stage chronic obstructive pulmonary disease: a meta-analysis