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Table 1 Trials of “goal-directed fluid therapy” (GDT) in abdominal surgery versus “standard therapy”

From: Fluid therapy in the perioperative setting—a clinical review

Author

Surgery

No. of patients/ASA

Blinding/monitor/timing

Primary outcome

Intervention

Preoperative fluid volume, mL (control vs. GDT)

Intraoperative fluid volume, mL (control vs. GDT)

Postoperative fluid volume, mL (control vs. GDT)

Effect of GDT

Conway et al. [56]

Elective bowel surgery

57/ASA I-III

No blinding/ODM (CardioQ®)/intraoperative

Cardiac output

Optimizing SV (<10 %) and cFT (<350 ms) with HES 6 %

Not given

Coll: 19 mL/kg vs.28 mL/kg

Total: 55 mL/kg vs. 64 mL/kg

Not given

↑ SV and CO

→ LOS

→ Complications

↓ Critical care admission

Mortality: 1 (control) vs. 0 (GDT)

Gan et al. [55]

Elective major urological or gynecological

100/ASA I-III

No blinding/ODM (CardioQ®)/intraoperative

LOS

Optimizing cFT (<350 ms) and SV (<10 %) with HES 6 %

Not given

Coll: 282 vs. 847

Cryst: 4375 vs. 4405

Totala: 4775 vs. 5420

Not given

↓ LOS

→ Complications

↓ PONV

Mortality not reported.

Wakeling et al. [42].

2005

Elective colorectal resection

128/ASA II (media)

Observer blinded/ODM (CardioQ®)/intraoperative

LOS

Optimizing SV (<10 %) with Haemaccel® or Gelofusine®

1000–2000 Hartmann’s solution from midnight

Coll: 1500 vs. 2000

Cryst: 3000 vs. 3000

Total: not given

Not given

Early oral intake

↓ LOS

↓ Complications

↓ GI complications

Mortality: d30: non; d60: 1 (control) vs. 0 (GDT)

Noblett et al. [16]

Elective colorectal resection

108/ASA II (median)

Observer blinded/ODM (CardioQ®)/intraoperative

LOS

Optimizing SV (<10 %) and cFT (<350 ms) with Volplex®

Not given

Coll: 1209 vs. 1340 Cryst: 2625 vs. 2298

Total: not given

Not given

Early oral intake

↓ LOS

↓ Complications

↓ Critical care admission

↓ Interleukin 6 response

Mortality: 1 (control) vs. 0 (GDT)

Lopes et al. [52]

Elective mixed GI and urological

33/ASA II-IV

No blinding/IBPplus®/intraoperative

LOS

Optimizing PPV (≤10 %) with HES 6 %

Not given

Coll: 0 vs. 2247

Cryst: 1563 vs. 2176

Totala: 1694 vs. 4618

Not given

Patients transferred to ICU

↓ LOS

↓ Complications

↓ Mechanical ventilation

↓ ICU stay

Mortality: 5 (control) vs. 2 (GDT)

Buettner et al. [57]

Elective general, urological, or gynecological

80/ASA I-III

Not blinded. PiCCOplus®/intraoperative

ScvO2 and serum lactate

Optimizing SPV (<10 %) with HES 6 %, 130/0.4

(Voluven®) and vasopressors

Not given

Coll: 1000 vs. 1500

Cryst: 4250 vs. 4500

Total: not given

Not given

→ ScvO2 or lactate

→ Complications

→ Mechanical ventilation

→ ICU stay

Mortality: 1 (control) vs. 0 (GDT)

Forget et al. [58]

Elective mixed GI surgery

82/ASA II-III

Observer blinded/Masimo Set®/intraoperative

Whole blood lactate levels

Optimizing PVI (>13 %) with HES 6 %, 130/0.4 (Voluven®) and vasopressors

Not given

Coll: 1003 vs. 890

Cryst: 1815 vs. 1363

Totala: 2918 vs. 2394

48 h postop. Coll: 358 vs. 268

Cryst: 3516 vs. 3107

↓ Lactate levels

→ Complications

→ Renal function

Mortality: 0 (control) vs. 2 (GDT)

Mayer et al. [41]

Elective mixed GI surgery

60/ASA III

Observer blinded/FloTrac®, Vigileo/intraoperative

LOS

Optimizing CI (≥2.5 L/min/m2) with crystalloids, colloids, inotropes and vasopressors

Not given

Coll: 817 vs. 1188

Cryst: 3153 vs. 2489

Totala: 4494 vs. 4528

Not given

↓ LOS

↓ Complications

→ Mechanical ventilation

→ ICU stay

Mortality: 2 (control) vs. 2 (GDT)

Benes et al. [54]

Elective mixed GI and vascular surgery

120/ASA II-IV

Observer blinded/FloTrac®, Vigileo/intraoperative

Complications

Optimizing SVV (<10 %) with HES 6 %, 130/0.4 (Voluven®) and inotropes

Not given

Coll: 1000 vs. 1425

Cryst: 2459 vs. 2321

Totala: 3729 vs. 3746

8 h postop:

Coll: 0 vs. 0

Cryst: 1528 vs. 1587

↓ Complications

→ ICU stay

→ LOS

↓ Lactate levels

Mortality: 2 (control) vs. 1 (GDT)

Challand et al. [59]

Elective open or laparoscopic colorectal surgery

179 subdivided into: fit (123) vs. unfit (56)/ASA I-IV

Observer blinded/ODM (CardioQ®)/intraoperative

LOS

Optimizing SV (<10 %) with HES 6 %, 130/0.4 (Voluven®)

971 vs. 1273

Hartmann’s solution

Coll: 336 vs. 1718

Cryst: 3593 vs. 3479

Totala: 4010 vs. 5309

1 postop. day:

Fluid balance: 2011 vs. 2083

Unfit patients:

→ LOS

→ Complications

Fit patients:

↑ LOS

↑ ICU admission

→ Complications

Mortality: d30: 2 (control) vs. 2 (GDT); d90: 4 (control) vs. 5 (GDT)

Salzwedel et al. [53]

Elective general, urological, or gynecological

160/ASA II-III

Patient blinded/ProAQT®, PULSION®/intraoperative

Complications

Optimizing PPV (<10 %) and CI (≥2.5 L/min/m2) with fluids, vasopressors and inotropes

Not given

Coll: 725 vs. 774

Cryst: 2680 vs. 2862

Total: not given

24 h postop.

Coll: 147 vs. 57

Cryst: 3452 vs. 3204

↓ Complications

→ LOS

→ Stay in postop. semi intensive care

→ Bowel movement

Mortality: not given

Pearse et al. [14]

Planned/urgent GI surgery

734/ASA I-IV

No blinding/LiDCOrapid®/intraoperative and 6 h postop.

Complications and mortality d30

Optimizing SV (<10 %) with any colloid and dopexamine

Not given

Coll: 500 vs. 1250

Cryst: 2000 vs. 1000

Totalb: 4024 vs. 4190

Coll: 0 vs. 500

Cryst: 600 vs. 506

→ Mortality and complications d30

→ Complications d7

→ Mortality d30

Mortality: d30: 11 (control) vs. 12 (GDT); d180: 42 (control) vs. 28 (GDT)

  1. ICU intensive care unit, PONV postoperative nausea and vomiting, LOS length of hospital stay, ODM oesophageal Doppler monitoring, CI cardiac index, SV stroke volume, SVV stroke volume variation, SPV systolic pressure variation, PPV pulse pressure variation, PVI pleth variability index, cFT corrected flow time, CVP central venous pressure
  2. aTotal volume infused including colloid, crystalloid and blood products
  3. bTotal volume infused including colloid, crystalloid, blood products and intravenous medicine during intervention
  4. ↑significantly increased, ↓ significantly decreased, → no significant changes