Why the study?
To determine whether intraoperative goal-directed perfusion has better outcomes compared to conventional methods during cardiac surgery with cardiopulmonary bypass.
Does goal-directed perfusion (GDP) improve clinical outcomes in adult patients undergoing cardiac surgery with cardiopulmonary bypass compared to conventional methods?
Does goal-directed perfusion (GDP) improve clinical outcomes in adult patients undergoing cardiac surgery with cardiopulmonary bypass compared to conventional methods?
Goal-directed perfusion during cardiopulmonary bypass significantly reduces postoperative complications, acute kidney injury, and length of stay compared to conventional perfusion methods.
GDP protocols were associated with shorter ICU/hospital stays and fewer complications; leaves open whether RCTs will confirm survival benefit or support routine use.
PURPOSE: Goal-directed perfusion (GDP) refers to individualized goal-directed therapy using comprehensive monitoring and optimizing the delivery of oxygen during cardiopulmonary bypass (CPB). This study aims to determine whether the intraoperative GDP protocol method has better outcomes compared to conventional methods. METHODS: We searched the PubMed, Central, and Scopus databases up to October 12, 2023. We primarily examined the GDP protocol in adult cardiac surgery, using CPB with oxygen delivery index (DO2I) and cardiac index (CI) as the main parameters. RESULTS: In all, 1128 participants from seven studies were included in our analysis. The results showed significant differences in the duration of intensive care unit (ICU) stays (p = 0.01), with a mean difference of -0.33 (-0.59 to 0.07), and hospital length of stay (LOS) (p = 0.0002), with a mean difference of -0.84 (-1.29 to -0.39). There was also a notable reduction in postoperative complications (p <0.00001), odds ratio (OR) of 0.43 (0.32-0.60). However, there was no significant decrease in mortality rate (p = 0.54), OR of 0.77 (0.34-1.77). CONCLUSION: Postoperative acute kidney injury and ICU and hospital LOS are significantly reduced when GDP protocols with indicators of flow management, oxygen delivery index, and CI are used in intraoperative cardiac surgery using CPB.
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Pratomo et al. (2024) studied this question.
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