Effects Of Goal-directed Fluid Therapy On Intraoperative Balance Between Oxygen Delivery And Consumption In Patients Undergoing Thoracic Surgeries:A Systematic Review

Objective:To systematically evaluate the effects of goal-directed fluid therapy（GDFT）on intraoperative balance between oxygen delivery and consumption in patients undergoing thoracic surgeries.Methods:We searched PubMed,The Cochrane Library,VIP,WanFang Date and CNKI,Literatures were selected according to inclusion and exclusion criteria,electived intrabronchial anesthesia for thoracic surgeries including pulmonary lobectomy,Pulmonary segmentectomy,Pulmonary wedge resection,radical surgery of lung cancer and esophageal cancer radical operation,and all the studies were RCT,the patients were under 75 years old and had no previous cardiopulmonary and renal complications.The primary outcome was the intraoperative oxygen delivery and consumption including oxygen delivery index,oxygen index,lactic acid and the cardiac index.The secondary outcome was the postoperative resuscitation as well as the incidence of postoperative complications including the incidence of postoperative pulmonary infection,acute lung injury,pulmonary edema,postoperative nausea and vomiting,acute renal injury,time for extubation and length of hospital stay.Systematic review was completed by meta-analysis using RevMan 5.3.Results:There were eligible 11RCTs,and a total of 810 patients.The results of this article showed that:use of GDFT in thoracic surgical patients significantly increase Oxygen index（at the end of OLV:MD=57.04,95%CI 24.04 to 90.05,P<0.05;at the end of surgery:MD=97.33,95%CI27.21 to 167.45,P<0.05）,cardiac index（at the end of OLV:MD=0.42,95%CI 0.23 to 0.61,P<0.05;at the end of surgery:MD=0.40,95%CI 0.26to 0.54,P<0.05）of the intraoperative,increase Oxygen delivery index（MD=46.80,95%CI 29.92 to 63.68,P<0.05）at the end of surgery,and significantly decrease level of lactic acid（MD=-0.51,95%CI-0.84 to-0.18,P<0.05）at the end of surgery;Meanwhile,incidence of postoperative complications were significantly lower with use of GDFT including the incidence of postoperative pulmonary infection（RR=-0.35,95%CI 0.16 to0.76,P<0.05）,acute lung injury（RR=-0.15,95%CI 0.04 to 0.67,P<0.05）,postoperative nausea and vomiting（RR=0.39,95%CI 0.22 to 0.68,P<0.05）,as well as the time for extubation（MD=-8.69,95%CI-13.85 to-3.54,P<0.05）and length of hospital stay（MD=-0.66,95%CI-1.20 to-0.12,P<0.05）was shorten in GDFT group.However,there was not statistical difference of lactic acid at the end of OLV and postoperative pulmonary edema and acute renal injury（P>0.05）between the GDFT group and the control group.Conclusion:Use of GDFT can effectively improve the OI,DO₂I and level of CI in patients undergoing thoracic surgeries,reduce level of lactic acid,reduce incidences of postoperative pulmonary infection,acute lung injury and postoperative nausea and vomiting,shorten time for extubation and length of hospital stay,and improve the prognosis of patients.