Hemodynamic optimization in severe XXXX : a systematic review and meta-analysis.

@entity1 @entity601 @entity130 @entity548
OBJECTIVE: Severe @entity130 can be associated with significant @entity548 and impaired organ perfusion. We hypothesized that goal-directed therapy would confer morbidity and mortality benefits in major @entity130 . METHODS: The MedLine, Embase and Cochrane Controlled Clinical Trials Register databases were systematically searched for randomized, controlled trials of goal-directed therapy in severe @entity130 @entity1 . Mortality was the primary outcome of this review. Secondary outcomes included complication rates, length of hospital and intensive care unit stay, and the volume of fluid and blood administered. Meta-analysis was performed using RevMan software, and the data presented are as odds ratios for dichotomous outcomes and as mean differences (MDs) and standard MDs for continuous outcomes. RESULTS: Four randomized, controlled trials including 419 @entity1 were analyzed. Mortality risk was significantly reduced in goal-directed therapy-treated @entity1 , compared to the control group(OR=0.56, 95%CI: 0.34-0.92). Intensive care ( @entity601 : 3.7 days 95%CI: 1.06-6.5)and hospital length of stay ( @entity601 : 3.5 days,95%CI: 2.75-4.25) were significantly shorter in the protocol group @entity1 .There were no differences in reported total fluid volume or blood transfusions administered. Heterogeneity in reporting among the studies prevented quantitative analysis of complications. CONCLUSION: Following severe @entity130 , early goal-directed therapy was associated with lower mortality and shorter durations of intensive care unit and hospital stays. The findings of this analysis should be interpreted with caution due to the presence of significant heterogeneity and the small number of the
