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Review
. 2011 Jun 24;15(3):R154.
doi: 10.1186/cc10284.

Haemodynamic goal-directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis

Lidia Dalfino  1 , Maria T Giglio, Filomena Puntillo, Massimo Marucci, Nicola Brienza
Affiliations
Review

Haemodynamic goal-directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis

Lidia Dalfino et al. Crit Care. .

Abstract

Introduction: Infectious complications are the main causes of postoperative morbidity. The early timing of their promoting factors is the rationale for perioperative strategies attempting to reduce them. Our aim was to determine the effects of perioperative haemodynamic goal-directed therapy on postoperative infection rates.

Methods: We performed a systematic review and meta-analysis. MEDLINE, EMBASE, The Cochrane Library and the DARE databases were searched up to March 2011. Randomised, controlled trials of major surgery in adult patients managed with perioperative goal-directed therapy or according to routine haemodynamic practice were included. Primary outcome measure was specific type of infection.

Results: Twenty-six randomised, controlled trials with a combined total of 4,188 participants met our inclusion criteria. Perioperative goal-directed therapy significantly reduced surgical site infections (pooled OR 0.58, 95% CI 0.46 to 0.74; P < 0.0001), pneumonia (pooled OR 0.71, 95% CI 0.55 to 0.92; P = 0.009), and urinary tract infections (pooled OR 0.44, 95% CI 0.22 to 0.84; P = 0.02). A significant benefit was found regarding total infectious episodes (OR 0.40, 95% CI 0.28 to 0.58; P < 0.00001).

Conclusions: Flow-directed haemodynamic therapy designed to optimise oxygen delivery protects surgical patients against postoperative hospital-acquired infections and must be strongly encouraged, particularly in the high-risk surgical population.

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Figures

Figure 1
Figure 1
Outline of studies selection process. Flowchart summarising the procedure of studies selection for the meta-analysis. CRBSI: catheter-related bloodstream infection; SSI: surgical site infection; UTI: urinary tract infection.
Figure 2
Figure 2
Surgical site infections. Rates of postoperative surgical site infections for each of the studies with OR and 95% CI data are shown. The studies were divided into two subgroups, high risk of bias or low risk of bias, according to the SIGN checklist (see materials and methods section for details). The pooled OR and 95% CI data are shown as the totals. The size of the box at the point estimate of the OR is a visual representation of the 'weighting' of the study. The diamond represents the point estimate of the pooled OR, and the length of the diamond is proportional to the 95% CI. 95% CI: 95% confidence interval; M-H: Mantel-Hentzel; OR: odds ratio; SIGN: Scottish Intercollegiate Guidelines Network.
Figure 3
Figure 3
Pneumonia. Rates of postoperative pneumonia for each of the studies included are shown along with ORs and 95% CIs. The studies were divided into two subgroups, high risk of bias and low risk of bias, according to the SIGN checklist (see text for details). The pooled OR and 95% CI are shown as the total. The size of the box at the point estimate of the OR gives a visual representation of the 'weighting' of the study. The diamond represents the point estimate of the pooled OR and the length of the diamond is proportional to the CI. 95% CI: 95% confidence interval; OR: odds ratio; SIGN: Scottish Intercollegiate Guidelines Network.
Figure 4
Figure 4
Urinary tract infections. Rates of postoperative urinary tract infections for each of the studies with ORs and 95% CIs. The studies were divided into two subgroups defined as high risk of bias and low risk of bias, according to the SIGN checklist (see materials and methods section for details). The pooled OR and 95% CI data are shown as the totals. The size of the box at the point estimate of the OR is a visual representation of the 'weighting' of the study. The diamond represents the point estimate of the pooled OR, and the length of the diamond is proportional to the 95% CI. 95% CI: 95% confidence interval; OR: odds ratio; SIGN: Scottish Intercollegiate Guidelines Network.
Figure 5
Figure 5
Total postoperative infectious episodes. Rates of total postoperative infectious episodes for each of the studies included are shown along with ORs and 95% CIs. The pooled OR and 95% CI data are shown as the totals. The size of the box at the point estimate of the OR is a visual representation of the 'weighting' of the study. The diamond represents the point estimate of the pooled OR, and the length of the diamond is proportional to the 95% CI. 95% CI: 95% confidence interval; OR: odds ratio.
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