Tabel 1 Belangrijkste studiekarakteristieken

Study reference

Trial Design*

Experimental and control interventions*

Outcome measures selected*

 

Study Period

Comparison#

N (I/C)

Follow-up#

Timing (I)#

Device (I)

Types of fluids

 

Vasoactieve medication1

GDT endpoint (I)

Morbidity

Mortality

Length of Stay

High risk surgery

Sandham (2003)

03/1990 - 07/1999

I: GDT guided by a PAC
C: standard care without the use of a PAC

997 / 997

12 months

Intra

PAC

I: Not specified
C: Not specified

Inotrope: Not specified
Vasopressor: Not specified

CI 3.5-4.5
DO2 550-600
MAP 70
PCWP 18
HR <120

9 pre-defined morbidities

All cause (

6 months and

12 months)

Hospital

Ackland (2015)

05/2010 - 02/2014

I: GDT
C: standardized care

95 / 92

Not specified

Post

LiDCO

I: Gelatine
C: Gelatine

Inotrope: Dobutamine
Vasopressor: Alpha-agonist

SV rise <10%

Pre-defined complications

Not specified

Hospital

Pearse (2005)

11/2002 - 08/2004

I: post GDT
C: conventional management

62 / 60

60 days

Post

LiDCO

I: Gelatine
C: Gelatine

 

Inotrope: Epinephrine
Vasopressor: Dopexamine

SVV <10%
DO2 >600

20 complications in multiple organ systems

All cause (30 days and 60 days)

ICU
Hospital

Wilson, 1999

16 month period (not further specified)

I : Invasive hemodynamic monitoring, fluid, and either adrenaline or dopexamine to increase oxygen delivery
C : Routine perioperative care

46 / 46 / 46

Not specified

Pre / intra / post

PAC

I: Hartmann’s solution

Albumin
C: Not specified

Inotrope: Dopexamine
Vasopressor: Epinephrine

PAOP = 12

28 complications separated per organ system

In hospital or within 30 days#

Hospital

Orthopedic surgery

Bartha (2013)

03/2009 - 09/2011

I: GDHT
C: protocol-guided RFT

74 / 75

12 months

Intra / post

LiDCO

I: Colloids
C: Acetated Ringer’s

Inotrope: Dobutamine
Vasopressor: Phenylephrine
Ephedrine

SV increase of <10%
DO2 >600

Pre-defined complications

30-day mortality

Hospital#

Venn (2002)

Not specified

I1: additional repeated colloid fluid challenges guided by CVP

I2: additional repeated colloid fluid challenges guided by oesophageal Doppler ultrasonography

C: conventional intraoperative fluid management

31 / 30 / 29

Not specified

Intra

CVL/ODM

I: Hartmann’s solution Gelatine
C: Not specified

Inotrope: Not specified

Vasopressor: Not specified

CFT < 0.35s
CVP > 14
Maximum SV (not defined)

Not specified

In hospital or within 30 days#

Hospital#

Moppett (2015)

09/2009 - 01/2013

I: LiDCO-guided fluid therapy
C: standard care

51 / 63

Not specified (postoperative mortality was recorded using survival data to 12 months after admission)

Intra

LiDCO

I: Gelatine
C: Not specified

Inotrope: Not specified
Vasopressor: Not specified

SV rise <10%

Pre-defined complications

12-month mortality

Hospital

Abdominal surgery

Zheng (2013)

03/1999 - 03/2011

I: GDT

C: routine fluid therapy

30 / 30

Not specified

Intra

FloTrac

I: HES
C: HES

Inotrope: Not specified
Vasopressor: Dopamine
Norepinephrine

CI >2.5
MAP 65
SVI 35
SVV 12%

Adverse cardiac events and GI dysfunction

All cause
cardiac death

ICU
Hospital

Benes (2010)

07/2007 - 05/2009

I: fluid management guided by SVV (Vigileo / FloTrac system)
C: routine Intraoperative care

60 / 60

Not specified

Intra

FloTrac

I: HES
C: Not specified

Inotrope: Dobutamine
Vasopressor: Norepinephrine
Ephedrine

CI 2.5-4
SVV <10%

Organ dysfunction
Hospital infections

All cause

ICU

Hospital#

Donati (2007)

48-months period (not further specified)

I: protocolized strategy to maintain O2ER <27
C: conventional strategy to maintain O2ER <27

68 / 67

Not specified

Intra / post

CVL

I: Colloids
C: Not specified

Inotrope: Dobutamine

Vassopressor: Not specified

O2ER <27

6 organ failures as defined

In hospital or within 30 days#

Hospital

Jhanji (2010)

12/2007 - 02/2009

I1: GDFT guided by SV

I2: GDFT guided by SV and DPX
C: standard care (CVP)
 

45 / 45 / 45

28 days

Post

LiDCO

I: Gelatine
C: Gelatine

Inotrope: Dopexamine

Vasopressor: Not specified

CVP 6-12
Optimal SV (not specified)

Pre-defined complications

In hospital or within 30 days#

Hospital

Schmid (2016)

03/2010 - 12/2012

I: algorithm-guided GDHT
C: good standard clinical care

92 / 88

12 months after surgery

Intra / post

PiCCO

I: HES
Acetated Ringer’s
C: Not specified

Inotrope: Dobutamine

Vasopressor: Norepinephrine

CI >2.5
GEDVI > 640
EVLWI < 10
MAP > 70

Specifically kidney injury
Other pre-defined complications

12-month mortality

Not reported#

Cardiothoracic surgery

Kapoor (2017)

Not specified

I: GDT with OPCAB
C: conventional hemodynamic management

66 / 76

1 month

Intra / post

FloTrac

I: Crystalloids Colloids
C: Crystalloids Colloids

Inotrope: Dobutamine
Epinephrine

Vasopressor: Not specified

ScVO2 >70%
CI >2.0-4.5
SVV <10%
SVRI 1500-2500
DO2 450-600
SVI >30-65
GEDV 680-800
EVLW <7

Renal failure

All cause

ICU
Hospital

Osawa (2016)

12/2011 - 02/2014

I: GDT
C: usual care

62 / 64

30 days after surgery

Intra

LiDCO

I: Lactated Ringer’s
C: Lactated Ringer’s

Inotrope: Dobutamine

Vasopressor: Not specified

CI >3.01

Pre-defined major morbidity

30-day mortality

ICU
Hospital

Fellahi (2015)

01/2012 - 02/2013

I: early goal-directed hemodynamic therapy based on cardiac output monitoring
C: standard of care on postoperative outcome

48 / 44

Not specified

Intra

ECOM

I: HES
C: Not specified

Inotrope: Dobutamine
Vasopressor: Ephedrine Phenylephrine

CI >2.4

SVV <11

Major adverse cardiac events

Cardiac death and hospital death

ICU#

Groepfert, 2013

Not specified

I: therapy guided by stroke volume variation, individually optimized global end-diastolic volume index, cardiac index, and mean arterial pressure
C: algorithm based on mean arterial pressure and central venous pressure

46 / 46

Not specified

Intra / post

PiCCO

I: HES
C: HES

Inotrope: Not specified
Vasopressor: Not specified

CI >2.0

SVV <10%

EVLWI <12

MAP >65

HR 50-100

Pre-defined complications

Not reported

ICU

Hospital

McKendry, 2004

04/2000 - 01/2003

I: Algorithm guided by oesophageal Doppler flowmetry
C: Conventional hemodynamic management

85 / 89

Not specified

Post

ODM

I: Colloids
C: Not specified

Inotrope: Not specified
Vasopressor: Epinephrine

SV increase <10%

9 pre-defined morbidities

In hospital or within 30 days#

ICU

Hospital

Mythen, 1995

01/1992 - 02/1993

I: after the intuction of general anesthesia, the protocol group received, in addition, 200-mL boluses of a 6% hydroxyethyl starch solution to obtain a maximum stroke volume
C: treated according to standard practices

30 / 30

Patients were followed up postoperatively untill discharge from the hospital or death

Pre / intra / post

PAC

I: HES Crystalloids
C: Not specified

Inotrope: Not specified
Vasopressor: Dopamine, Epinephrine, Phenylephrine

Maximum SV

Organ failure and complications not further specified

Not specified

ICU

Hospital

Parke, 2015

01/2013 - 10/2013

I: Protocolized algorithm, utilising stroke volume variation, to guide fluid administration to patients who were deemed to have inadequate cardiac output and were likely to be volume responsive
C: Usual care

70 / 74

9 months

Post

FloTrac

I: Not specified
C: Crystalloids

Inotrope: Not specified
Vasopressor: Not specified

SVV <13%

Not specified

90-day mortality

ICU

Hospital

Vascular surgery

Van der Linden (2010)

03/2006 - 01/2008

I1: GDT with sevoflurane-based anesthesia
I2: GDT with propofol-based anesthesia
C: routine clinical practice

20 / 20 / 17

Not specified

Intra

FloTrac

I: HES
C: Not specified

Inotrope: Dobutamine

Vasopressor: Not specified

CI >2.5
CVP 15

Not specified

In hospital or within 30 days#

Hospital#

Bisgaard AAA (2013)

06/2008 - 10/2010

I: individualized goal-directed therapy
C: conventional therapy

32 / 32

1 month

Intra/post

LiDCO

I: HES
C: HES

Inotrope: Dobutamine
Vasopressor: Phenylephrine, Ephedrine, Dopamine

Sustained rise of SVI >10%

Pre-defined complications

In hospital or within 30 days#

ICU
Hospital#

Funk AAA (2015)

Not specified

I: GDT targeting stroke volume variation with an arterial pulse contour cardiac output monitor
C: fluid therapy was administered at the discretion of the attending anesthesiologist

20 / 20

Not specified

Intra

FloTrac

I: HES
C: HES

Inotrope: Not specified
Vasopressor: Ephedrine

SVV <13%

Pre-defined complications

Not specified

Hospital

1 Used in study
* Deduced from systematic review Kaufmann, 2018, unless stated otherwise
# Deduced from individual study

 

Abbreviations: C: Control, CFT: corrected flow time, CI: cardiac index (L/min/m2), CVL: central venous line, CVP: central venous pressure (mm Hg), DO2: oxygen delivery (mL/min), DPX: dopexamine, ECOM: Endotracheal Cardiac Output Monitor, EVLWI: extra-vascular lung water index (mL/kg), GDT: goal-directed therapy, GDHT: Goal-directed hemodynamic treatment, GEDVI: global end-diastolic volume index (mL/m2), GEDV: Global End Diastolic Volume; GI: Gastrointestinal , HES: Hydroxyethyl starch, HR: heart rate (beats per minute), I: Intervention, ICU Hospital: Intensive Care Unit Hospital, Intra: intra-operative, LiDCO: Lithium Dilution Cardiac Output, MAP: mean arterial pressure (mm Hg), MODS: multi organ dysfunction syndrome, ODM: oesophageal doppler monitor, OPCAB: off-pump coronary artery bypass (OPCAB), OR: Operating room, O2ER: oxygen extraction ratio (percentage), P: Protocol, PAC: pulmonary artery catheter, PAOP: pulmonary artery occlusion pressure (mm Hg), PCWP: pulmonary capillary wedge pressure (mm Hg), PiCCO: Pulse Contour Cardiac Output PF-ratio: PaO2/FiO2-ratio, post: Postoperative, RFT: routine fluid treatment, ScvO2: central venous oxygen saturation (percentage), SV: stroke volume (mL/min), SVI: stroke volume index (mL/m2), SVR: systemic vascular resistance (dynes/sec/cm5), SVRI: systemic vascular resistance index (dynes/s/cm5/m2), SVV: stroke volume variation (percentage), TTD: transpulmonary thermodilution, UP: urine production (mL/kg/2hr), VO2: oxygen uptake (mL/min)