Meta analysis Compares Goal-Directed Fluid Therapy with Conventional Fluid Therapy in Neurosurgical Patients

The research published recently compared the impact of goal-directed fluid therapy (GDFT) and conventional fluid therapy on various perioperative outcomes in neurosurgical patients. The meta-analysis includes ten randomized controlled trials and evaluates neurological outcomes, postoperative complications, ICU and hospital stay, and pulmonary complications. The results indicate that GDFT did not influence neurological outcomes but significantly reduced postoperative complications, ICU and hospital stay, and pulmonary complications. Additionally, the study found that the amount of intraoperative fluids administered and blood loss were comparable between the GDFT and conventional therapy groups.

Comparison between GDFT and Conventional Fluid Therapy

The meta-analysis report observed no statistically significant difference in neurological outcomes between GDFT and conventional fluid therapy. However, GDFT significantly reduced postoperative complications, intensive care unit (ICU) and hospital stay, and pulmonary complications. The study found that the total amount of intraoperative fluids administered and blood loss were similar between the GDFT and conventional therapy groups. Additionally, sensitivity analysis was conducted for outcomes, and it was found that the neurological outcome was not affected by considering only studies with low risk of bias. Similarly, the sensitivity analysis for overall and pulmonary complications also showed that the results were stable when omitting studies with high risk of bias.

Conclusion

Furthermore, the study outlined the methodology used for risk of bias assessment, sensitivity analysis, trial sequential analysis, and GRADE profile. The authors highlighted the need for larger multicenter trials with uniform techniques and tools to measure the targets of GDFT and outcomes to better understand the effects of GDFT among neurosurgical patients. In conclusion, the meta-analysis reveals that GDFT did not influence neurological outcomes but was associated with reduced postoperative complications and ICU and hospital stays, reducing the overall cost.

Key Points -

- The research paper compares the effects of goal-directed fluid therapy (GDFT) and conventional fluid therapy on perioperative outcomes in neurosurgical patients, specifically those undergoing craniotomies under general anesthesia.

- The meta-analysis, including ten randomized controlled trials, shows that GDFT did not impact neurological outcomes but significantly reduced postoperative complications, ICU and hospital stay, and pulmonary complications. It also found that the total amount of intraoperative fluids administered and blood loss were similar between the two therapy groups.

- The study emphasizes the need for larger multicenter trials with consistent techniques and tools to measure the targets of GDFT and outcomes for a better understanding of its effects in neurosurgical patients.

Reference –

Jangra, Kiran†, Gandhi, Aravind P.1,†, Mishra, Nitasha2, Shamim, Muhammad Aaqib3, Padhi, Bijaya K4. Intraoperative goal-directed fluid therapy in adult patients undergoing craniotomies under general anaesthesia: A systematic review and meta-analysis with trial sequential analysis. Indian Journal of Anaesthesia 68(7):p 592-605, July 2024. | DOI: 10.4103/ija.ija_240_24