A Systematic Review and Meta-Analysis of Intraoperative Goal Directed Fluid and Haemodynamic Therapy in Children and Postoperative Outcome

Introduction:In adults, studies have shown that when goal directed fluid and haemodynamic therapy was applied in the perioperative period, morbi-mortality was reduced.In children the impact on postoperative outcome of this therapy is not clear.Objective: To determine the impact of intraoperative goal directed fluid and haemodynamic therapy on postoperative morbimortality in children less than 18 years old.Methods: Systematic review and meta-analysis of randomised and non randomised studies.RevMan 5.3 sofware was used for statistic analysis.Results: 23 studies were included with 3389 children among which 21 trials concerned cardiac surgical children and two concerned non cardiac patients: 1° In 3290 children in 21 studies included, mortality was significantly lower in the experimental group (the group with higher above baseline values of regional oxygen saturation, of mixed central venous oxygen saturation, and lower lactate levels) (odds ratio=0.03[0.01, 0.14], p<0.00001).The quality of evidence (GRADE) was low.2° In 14 studies with 2347 children included, organ dysfunction was significantly lower in the experimental group (odds ratio = 0.02 [0.00, 0.08], p <0.00001).The quality of evidence (GRADE) was low.3° in 8 studies length of hospital stay was significantly lower in the experimental group (p=0.018).The quality of evidence (GRADE) was very low. Conclusions:Intraoperative goal directed fluid and haemodynamic therapy is not developed in children, there are biomarkers of postoperative adverse outcome in pediatric cardiac surgery.