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Journal of Clinical Monitoring and Computing
Published in: Journal of Clinical Monitoring and Computing 3/2018

Open Access 01-06-2018 | Original Research

Impact of hemodynamic goal-directed resuscitation on mortality in adult critically ill patients: a systematic review and meta-analysis

Authors: Maria Cronhjort, Olof Wall, Erik Nyberg, Ruifeng Zeng, Christer Svensen, Johan Mårtensson, Eva Joelsson-Alm

Published in: Journal of Clinical Monitoring and Computing | Issue 3/2018

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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.
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Metadata
Title
Impact of hemodynamic goal-directed resuscitation on mortality in adult critically ill patients: a systematic review and meta-analysis
Authors
Maria Cronhjort
Olof Wall
Erik Nyberg
Ruifeng Zeng
Christer Svensen
Johan Mårtensson
Eva Joelsson-Alm
Publication date
01-06-2018
Publisher
Springer Netherlands
Published in
Journal of Clinical Monitoring and Computing / Issue 3/2018
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-017-0032-0

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