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. Research is to be developed in children to clarify the impact of goal directed fluid and hemodynamic therapy on postoperative outcome. Introduction Background In adult surgery, there is evidence that intraoperative Goal Directed Fluid and Haemodynamic Therapy (GDFHT) improves postoperative outcome (mortality, morbidity and length of hospital stay). Several studies have shown that when goal directed fluid and Kumba C1, Willems A2, Querciagrossa S1, Harte C1, Blanc T3, De Cock A1, Orliaguet G4 and Melot C5 1Department of Paediatric Anaesthesia and Critical Care, Necker Enfants Malades University Hospital, France 2Paediatric Intensive Care Unit, Leids Universitair Medisch Centrum, Netherlands 3Department of Paediatric Digestive and Urologic Surgery, Necker Enfants Malades University Hospital, France 4Department of Paeditaric and Obstetrical Anesthesia and Critical Care, Department of Pharamacology and Therapeutic Evaluation in Children and Pregnant Women, Necker University Hospital, Paris Descartes (Paris V) University, France 5Emergency Department, Erasme University Hospital, Belgium Address for Correspondence Kumba C, Department of Paediatric Anaesthesia and Critical Care, Necker Enfants Malades University Hospital, 149 Rue De Sèvres, 75015 Paris, France, Tel: 0033144494000; E-mail: claudine.kumba@gmail.com Submission: 09 April 2019 Accepted: 02 May 2019 Published: 06 May 2019 Copyright: © 2019 Kumba C, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research Article Open Access Journal of Emergency Medicine & Critical Care Avens Publishing Group Inviting Innovations J Emerg Med Critical Care May 2019 Vol.:5, Issue:1 © All rights are reserved by Kumba C et al. Avens Publishing Group Inviting Innovations haemodynamic therapy was applied in the perioperative period in high risk patients, mortality, renal and gastro-intestinal complications and infections were reduced [1-7]. In children conclusions concerning this subject are not clear. Why was it important to do this review? This review was important to bring some evidence for pediatric intraoperative management using goal directed fluid and haemodynamic therapy to improve postoperative outcome and to develop research in fields where evidence is still unclear and not developed. How the intervention might work The aims of the goal directed fluid and haemodynamic therapy are to increase end organ blood flow (oxygen delivery) which results in improved patient outcome. Goal directed fluid therapy and haemodynamic aim to avoid hypovolemia or hypervolemia which can compromise end organ perfusion and oxygen delivery. Objectives of this study The main objective was to determine whether intraoperative goal directed fluid and haemodynamic therapy reduced postoperative mortality and or morbidity in children. Secondary objective was to determine whether intraoperative goal directed fluid therapy diminished postoperative length of hospital stay in children.