Journal of Emergency Medicine & Critical Care

Research Article

A Systematic Review and Meta-Analysis of Intraoperative Goal Directed Fluid and Haemodynamic Therapy in Children and Postoperative Outcome

Kumba C1*, Willems A2, Querciagrossa S1, Harte C1, Blanc T3, De Cock A1, Orliaguet G4 and Melot C5

1Department of Paediatric Anaesthesia and Critical Care, Necker Enfants Malades University Hospital, France
2Paediatric Intensive Care Unit, Leids Universitair Medisch Centrum, Netherlands
3Department of Paediatric Digestive and Urologic Surgery, Necker Enfants Malades University Hospital, France
4Department of Paeditaric and Obstetrical Anesthesia and Critical Care, Department of Pharamacology and Therapeutic Evaluation in Children and Pregnant Women, Necker University Hospital, Paris Descartes (Paris V) University, France
5Emergency Department, Erasme University Hospital, Belgium
*Address for Correspondence: Kumba C, Department of Paediatric Anaesthesia and Critical Care, Necker Enfants Malades University Hospital, 149 Rue De Sèvres, 75015 Paris, France, Tel: 0033144494000; E-mail: claudine.kumba@gmail.com
Submission: 09 April 2019; Accepted: 02 May 2019; Published: 06 May 2019
Copyright: © 2019 Kumba C, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction: In adults, studies have shown that when goal directed fluid and haemodynamic therapy was applied in the perioperative period, morbi-mortality was reduced. In children the impact on postoperative outcome of this therapy is not clear.
Objective: To determine the impact of intraoperative goal directed fluid and haemodynamic therapy on postoperative morbimortality in children less than 18 years old.
Methods: Systematic review and meta-analysis of randomised and non randomised studies.
RevMan 5.3 sofware was used for statistic analysis.
Results: 23 studies were included with 3389 children among which 21 trials concerned cardiac surgical children and two concerned non cardiac patients.
1° In 3290 children in 21 studies included, mortality was significantly lower in the experimental group (the group with higher above baseline values of regional oxygen saturation, of mixed central venous oxygen saturation, and lower lactate levels) (odds ratio=0.03 [0.01, 0.14], p<0.00001). The quality of evidence (GRADE) was low.
2° In 14 studies with 2347 children included, organ dysfunction was significantly lower in the experimental group.
(odds ratio = 0.02 [0.00, 0.08], p <0.00001). The quality of evidence (GRADE) was low.
3° in 8 studies length of hospital stay was significantly lower in the experimental group (p=0.018). The quality of evidence (GRADE) was very low.
Conclusions: Intraoperative goal directed fluid and haemodynamic therapy is not developed in children, there are biomarkers of postoperative adverse outcome in pediatric cardiac surgery.