Clinical Focus ›› 2021, Vol. 36 ›› Issue (8): 677-684.doi: 10.3969/j.issn.1004-583X.2021.08.001

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Effects of goal-directed fluid therapy on intraoperative balance between oxygen delivery and consumption and postoperative outcomes in thoracic surgery patients: a meta-analysis

Li Guanzhu1, Lai Yuan2, Zheng Xiaozhuo3, Jiang Ran3, Wei Ke3()   

  1. 1. Department of Anesthesiology,Second Affiliated Hospital, Guangzhou University of Chinese Medicine & Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
    2. Department of Anesthesiology,Affiliated Hospital of Chongqing Three Gorges Medical College, Chongqing 404000, China
    3. Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
  • Received:2020-07-04 Online:2021-08-20 Published:2021-08-30
  • Contact: Wei Ke E-mail:wk202448@hospital-cumq.com

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Abstract:

Objective To systematically evaluate the effects of goal-directed fluid therapy (GDFT) on intraoperative balance between oxygen delivery and consumption and postoperative outcomes in patients undergoing thoracic surgery. Methods We searched PubMed, Cochrane Library, VIP, CNKI and WanFang Database from inception to October 2019, literature selection, quality evaluation and data extraction were performed according to inclusion and exclusion criteria, and meta-analysis was completed by RevMan 5.3. Results A total of 11 eligible randomized controlled trials (RCTs) were enrolled, including 810 patients. The results of meta-analysis showed that intraoperative oxygenation index (OI) was significantly increased by the use of GDFT for thoracic surgery patients (at the end of one-lung ventilation [OLV]: MD=57.04, 95%CI [24.04, 90.05], P=0.001; at the end of surgery: MD=97.33, 95%CI[27.21, 167.45], P=0.007), significantly decreased for postoperative blood lactic acid (Lac) (MD=-0.51, 95%CI[-0.84, -0.18], P=0.002), significantly increased for intraoperative cardiac index (CI) (at the end of OLV: MD=0.42, 95%CI [0.23, 0.61], P<0.01; at the end of surgery: MD=0.40, 95%CI[0.26, 0.54], P<0.01); meanwhile, incidence of postoperative complications were significantly decreased with use of GDFT, including the incidence of postoperative pulmonary infection (RR=0.35, 95%CI[0.16, 0.76], P=0.008), incidence of acute lung injury (ALI) (RR=0.15, 95%CI[0.04, 0.67], P=0.010), incidence of postoperative nausea and vomiting (PONV) (RR=0.39, 95%CI [0.22, 0.68], P=0.001), as well as reduced hospitalization time in GDFT group (MD=-0.66, 95%CI [-1.20, -0.12], P=0.020).Conclusion For thoracic surgery patients, using GDFT can effectively improve tissue perfusion and balance of oxygen delivery and consumption, reduce incidence of PONV and complications of pulmonary, decrease medical expenses, and improve the prognosis of patients.

Key words: goal-directed fluid therapy, thoracic surgical procedures, oxygen delivery and consumption, postoperative outcomes, meta-analysis

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