Meta-analysis Reinforces the Message: Perioperative Fluid Management Improves Renal Perfusion

Published in the journal Critical Care last summer, authors Giglio et al have updated their previous meta-analysis to clarify the clinical impact of Goal-Directed Therapy (GDT) on Acute Kidney Injury (AKI) in patients undergoing major surgery. As the paper reminds us; “AKI is a well-known complication following surgical procedures, independently associated with increased hospital mortality and doubling of hospital costs. Therefore, the prevention of this postoperative complication is of paramount importance.”

The researchers applied statistical meta-analytic techniques to 65 Randomized Controlled Trials (RCTs) in which AKI was the primary outcome. Overall sample size was 9308 patients.

Their GDT strategy was defined as “perioperative monitoring and manipulation of hemodynamic parameters to reach normal or supranormal values by fluids alone or in combination with inotropic therapy, within 8 h after surgery.”

The data yielded a significant decrease in renal injury rate in studies that used cardiac output and oxygen delivery as their hemodynamic target, when using both fluid and inotropes.

Postoperative kidney injury was significantly lower when these practices were adopted in “high risk” patients and major abdominal and orthopedic surgery.

The results were unsurprising to the experienced hemodynamic management advocates at Deltex Medical. CEO Andy Mears comments; “It’s naturally gratifying to see another independent group come to the same conclusion as that reached in every credible study. Once again the most powerful data tells the same story, that avoiding AKI is best achieved by keeping on top of the patient’s peri-operative fluid status.

“At Deltex we see the power of accurate, real time, centrally measured hemodynamic information every day. We continue to relish the task of helping clinicians enjoy the benefits of improved outcomes and avoidance of avoidable AKI.”  

Ref: Hemodynamic goal-directed therapy and postoperative kidney injury: an updated meta-analysis with trial sequential analysis; Giglio et al

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