• Javier Ripollés-Melchor, Ángel Espinosa, Eugenio Martínez-Hurtado, Alfredo Abad-Gurumeta, Rubén Casans-Francés, Cristina Fernández-Pérez, Francisco López-Timoneda, and José María Calvo-Vecino.
• Complutense University of Madrid and Department of Anesthesia, Hospital Universitario Infanta Leonor, Gran Vía del Este 80, 28031 Madrid, Spain; EAR (Evidence Anesthesia Review) Group. Electronic address: ripo542@gmail.com.
• J Clin Anesth. 2016 Feb 1; 28: 105-15.

Study ObjectiveGoal-directed fluid therapy (GDHT) has been proposed as a method to reduce complications and mortality.DesignMeta-analysis of the effects of perioperative GDHT in adult noncardiac surgery on mortality and postoperative complications was performed using the PRISMA methodology. A systematic search was performed in MEDLINE, PubMed, EMBASE, and the Cochrane Library (last update, October 2014). Inclusion criteria were as follows: randomized clinical trials (RCTs) in which perioperative GDHT was compared with conventional fluid management in noncardiac surgery. Exclusion criteria were as follows: trauma and pediatric surgery studies. End points were mortality and number of patients with complications.SettingDistrict general hospital.PatientsThirty-nine RCTs were initially identified, with 8 fulfilling the inclusion criteria. Two RCTs were added by manual search, resulting in 10 RCTs in the final analysis, including 1527 patients.MeasurementsThose studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by supraphysiological or physiological hemodynamic goal and by time the intervention was carried out, perioperative or postoperative), and predefined sensitivity analysis.Main ResultsA significant reduction was observed in mortality associated with GDHT compared with conventional fluid therapy (risk ratio, 0.63; 95% confidence interval, 0.42-0.94; P = .02). However, no differences were found in the number of patients with complications (risk ratio, 0.75; 95% confidence interval, 0.50-1.17; P = .21), and the sensitivity analysis did not confirm the results.ConclusionsThis meta-analysis, with its limitations, shows that the use of perioperative GDHT may reduce postoperative mortality, but it is unable to show a reduction in the number of patients with complications.Copyright © 2016 Elsevier Inc. All rights reserved.

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