Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study
Top Cited Papers
- 1 June 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 37 (6), 2079-2090
- https://doi.org/10.1097/ccm.0b013e3181a00a43
Abstract
Objective: Postoperative acute deterioration in renal function, producing oliguria and/or increase in serum creatinine, is one of the most serious complication in surgical patients. Most cases are due to renal hypoperfusion as a consequence of systemic hypotension, hypovolemia, and cardiac dysfunction. Although some evidence suggests that perioperative monitoring and manipulation of oxygen delivery by volume expansion and inotropic drugs may decrease mortality in surgical patients, no study analyzed this approach on postoperative renal dysfunction. The objective of this investigation is to perform a meta-analysis on the effects of perioperative hemodynamic optimization on postoperative renal dysfunction. Data Sources, Study Selection, Data Extraction: A systematic literature review, using MEDLINE, EMBASE, and The Cochrane Library databases through January 2008 was conducted and 20 studies met the, inclusion criteria (4220 participants). Data synthesis was obtained by using odds ratio (OR) with 95% confidence interval (CI) by random-effects model. Data Synthesis: Postoperative acute renal injury was significantly reduced by perioperative hemodynamic optimization when compared with control group (OR 0.64; Cl 0.50-0.83; p = 0.0007). Perioperative optimization was effective in reducing renal injury defined consistently with risk, injury, failure, and loss and end-stage kidney disease and Acute Kidney Injury Network classifications, and in studies defining renal dysfunction by serum creatinine and/or need of renal replacement therapy only (OR 0.66; Cl 0.50-0.88; p = 0.004). The occurrence of renal dysfunction was reduced when treatment started both preoperatively and intraoperatively or postoperatively, was performed in high-risk patients, and was obtained by fluids and inotropes. Mortality was significantly reduced in treatment group (OR 0.50; Cl 0.31-0.80; p 0.004), but statistical heterogeneity was observed. Conclusions: Surgical patients receiving perioperative hemodynamic optimization are at decreased risk of renal impairment. Because of the impact of postoperative renal complications on adverse outcome, efforts should be aimed to identify patients and surgery that would most benefit from perioperative optimization. (Crit Care Med 2009; 37:2079-2090)Keywords
This publication has 61 references indexed in Scilit:
- The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass graftingCritical Care, 2007
- Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injuryCritical Care, 2007
- The case of the misleading funnel plotBMJ, 2006
- Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resectionBritish Journal of Surgery, 2006
- A comparison between fenoldopam and low-dose dopamine in early renal dysfunction of critically ill patients*Critical Care Medicine, 2006
- Measuring inconsistency in meta-analysesBMJ, 2003
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- A prospective randomized trial of preoperative “optimization” of cardiac function in patients undergoing elective peripheral vascular surgerySurgery, 1997
- The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failureIntensive Care Medicine, 1996
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996