Hemodynamic optimization reduced overall mortality (RR 0.75) compared to standard care, an effect primarily driven by peri-operative interventions in high-risk surgical patients.
Meta-Analysis (n=5,733)
Does hemodynamic optimization reduce mortality in adult intensive care and surgical patients?
Hemodynamic optimization using fluids and vasoactive agents significantly reduces mortality in high-risk peri-operative and trauma patients, but offers no survival benefit for patients with sepsis and organ failure.
Relative Risk: 0.75 (95% CI 0.62–0.9)
Absolute Risk Reduction: 0.4%
INTRODUCTION: To review systematically the effect of interventions aimed at hemodynamic optimization and to relate this to the quality of individual published trials. METHODS: A systematic, computerized bibliographic search of published studies and citation reviews of relevant studies was performed. All randomized clinical trials in which adult patients were included in a trial deliberately aiming at an optimized or maximized hemodynamic condition of the patients (with oxygen delivery, cardiac index, oxygen consumption, mixed venous oxygen saturation and/or stroke volume as end-points) were selected. A total of 30 studies were selected for independent review. Two reviewers extracted data on population, intervention, outcome and methodological quality. Agreement between reviewers was high: differences were eventually resolved by third-party decision. The methodological quality of the studies was moderate (mean 9.0, SD 1.7), and the outcomes of the randomized clinical trials were not related to their quality. RESULTS: Efforts to achieve an optimized hemodynamic condition resulted in a decreased mortality rate (relative risk ratio (RR) 0.75 (95% confidence interval (CI) 0.62 to 0.90) in all studies combined. This was due to a significantly decreased mortality in peri-operative intervention studies (RR 0.66 (95% CI 0.54 to 0.81). Overall, patients with sepsis and overt organ failure do not benefit from this method (RR 0.92 (95% CI 0.75 to 1.11)). CONCLUSION: This systematic review showed that interventions aimed at hemodynamic optimization reduced mortality. In particular, trials including peri-operative interventions aimed at the hemodynamic optimization of high-risk surgical patients reduce mortality. Overall, this effect was not related to the trial quality.
Poeze et al. (Tue,) conducted a meta-analysis in Critical illness (peri-operative, trauma, sepsis, organ failure) (n=5,733). Hemodynamic optimization vs. Standard care was evaluated on Overall mortality at 28 to 30 days (RR 0.75, 95% CI 0.62 to 0.90). Hemodynamic optimization reduced overall mortality (RR 0.75) compared to standard care, an effect primarily driven by peri-operative interventions in high-risk surgical patients.
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