Association of conflicts of interest with the results and conclusions of goal-directed hemodynamic therapy research: a systematic review with meta-analysis

  • Lina Zhang
  • Feng Dai
  • Alexandria Brackett
  • Yuhang Ai
  • Lingzhong Meng
Systematic Review



The association between conflicts of interest (COI) and study results or article conclusions in goal-directed hemodynamic therapy (GDHT) research is unknown.


Randomized controlled trials comparing GDHT with usual care were identified. COI were classified as industry sponsorship, author conflict, device loaner, none, or not reported. The association between COI and study results (complications and mortality) was assessed using both stratified meta-analysis and mixed effects meta-regression. The association between COI and an article’s conclusion (graded as GDHT-favorable, neutral, or unfavorable) was investigated using logistic regression.


Of the 82 eligible articles, 43 (53%) had self-reported COI, and 50 (61%) favored GDHT. GDHT significantly reduced complications on the basis of the meta-analysis of studies with any type of COI, studies declaring no COI, industry-sponsored studies, and studies with author conflict but not on studies with a device loaner. However, no significant relationship between COI and the relative risk (GDHT vs. usual care) of developing complications was found on the basis of meta-regression (p = 0.25). No significant effect of GDHT was found on mortality. COI had a significant overall effect (p = 0.016) on the odds of having a GDHT-favorable vs. neutral conclusion based on 81 studies. Eighty-four percent of the industry-sponsored studies had a GDHT-favorable conclusion, while only 27% of the studies with a device loaner had the same conclusion grade.


The available evidence does not suggest a close relationship between COI and study results in GDHT research. However, a potential association may exist between COI and an article’s conclusion in GDHT research.


Conflicts of interest Goal-directed hemodynamic therapy Study results Article conclusions Association 



We thank Dr. Cary P. Gross from the Center for Outcomes Research & Evaluation, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut for his help with manuscript preparation.


Support was provided from institutional and/or departmental sources at Yale University and Central South University, China.

Compliance of ethical standards

Conflicts of interest

L. Meng is a consultant for CAS Medical Systems, Inc. The other authors declare no competing interests.

Supplementary material

134_2018_5345_MOESM1_ESM.docx (100 kb)
Supplementary material 1 (DOCX 100 kb)
134_2018_5345_MOESM2_ESM.tif (747 kb)
Supplementary material 2 (TIFF 746 kb)
134_2018_5345_MOESM3_ESM.tif (424 kb)
Supplementary material 3 (TIFF 423 kb)
134_2018_5345_MOESM4_ESM.tif (502 kb)
Supplementary material 4 (TIFF 502 kb)
134_2018_5345_MOESM5_ESM.docx (48 kb)
Supplementary material 5 (DOCX 47 kb)
134_2018_5345_MOESM6_ESM.docx (50 kb)
Supplementary material 6 (DOCX 49 kb)
134_2018_5345_MOESM7_ESM.docx (19 kb)
Supplementary material 7 (DOCX 19 kb)
134_2018_5345_MOESM8_ESM.docx (21 kb)
Supplementary material 8 (DOCX 21 kb)


  1. 1.
    Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186PubMedCrossRefGoogle Scholar
  2. 2.
    Mythen MG, Webb AR (1995) Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 130:423–429PubMedCrossRefGoogle Scholar
  3. 3.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRefGoogle Scholar
  4. 4.
    ARISE Investigators, ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, Webb SA, Williams P (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371:1496–1506CrossRefGoogle Scholar
  5. 5.
    Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM, Pro MTI (2015) Trial of early, goal-directed resuscitation for septic shock. N Engl J Med 372:1301–1311PubMedCrossRefGoogle Scholar
  6. 6.
    Pro CI, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693CrossRefGoogle Scholar
  7. 7.
    Meng L, Heerdt PM (2016) Perioperative goal-directed haemodynamic therapy based on flow parameters: a concept in evolution. Br J Anaesth 117:iii3–iii17PubMedCrossRefGoogle Scholar
  8. 8.
    Hamilton MA, Cecconi M, Rhodes A (2011) A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 112:1392–1402PubMedCrossRefGoogle Scholar
  9. 9.
    Cecconi M, Corredor C, Arulkumaran N, Abuella G, Ball J, Grounds RM, Hamilton M, Rhodes A (2013) Clinical review: goal-directed therapy-what is the evidence in surgical patients? The effect on different risk groups. Crit Care 17:209PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Jones C, Kelliher L, Dickinson M, Riga A, Worthington T, Scott MJ, Vandrevala T, Fry CH, Karanjia N, Quiney N (2013) Randomized clinical trial on enhanced recovery versus standard care following open liver resection. Br J Surg 100:1015–1024PubMedCrossRefGoogle Scholar
  11. 11.
    Una Orejon R, Huercio Martinez I, Mateo Torres E, Jofre Escudero C, Gomez Rivas J, Diez Sebastian J, Ureta Tolsada MP (2017) Impact of a goal directed therapy in the implementation of an ERAS (enhanced recovery after surgery) protocol in laparoscopic radical cystectomy. Arch Esp Urol 70:707–714PubMedGoogle Scholar
  12. 12.
    van der Zee E, Egal M, Gommers D, Groeneveld A (2017) Targeting urine output and 30-day mortality in goal-directed therapy: a systematic review with meta-analysis and meta-regression. BMC Anesthesiol 17:22PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Parker MM (2007) Goals for fluid resuscitation: a real challenge. Crit Care Med 35:295–296PubMedCrossRefGoogle Scholar
  14. 14.
    Vincent JL, Weil MH (2006) Fluid challenge revisited. Crit Care Med 34:1333–1337PubMedCrossRefGoogle Scholar
  15. 15.
    Kalil AC, Johnson DW, Lisco SJ, Sun J (2017) Early goal-directed therapy for sepsis: a novel solution for discordant survival outcomes in clinical trials. Crit Care Med 45:607–614PubMedCrossRefGoogle Scholar
  16. 16.
    Piller C (2018) Hidden conflicts? Science 361:16–20PubMedCrossRefGoogle Scholar
  17. 17.
    Tobin MJ (2018) Conflicts of interest and the patient-doctor covenant. Intensive Care Med. PubMedCrossRefGoogle Scholar
  18. 18.
    Lundh A, Lexchin J, Mintzes B, Schroll JB, Bero L (2017) Industry sponsorship and research outcome. Cochrane Database Syst Rev 2:MR000033PubMedGoogle Scholar
  19. 19.
    Bekelman JE, Li Y, Gross CP (2003) Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA 289:454–465PubMedCrossRefGoogle Scholar
  20. 20.
    Chartres N, Fabbri A, Bero LA (2016) Association of industry sponsorship with outcomes of nutrition studies: a systematic review and meta-analysis. JAMA Intern Med 176:1769–1777PubMedCrossRefGoogle Scholar
  21. 21.
    Als-Nielsen B, Chen W, Gluud C, Kjaergard LL (2003) Association of funding and conclusions in randomized drug trials: a reflection of treatment effect or adverse events? JAMA 290:921–928PubMedCrossRefGoogle Scholar
  22. 22.
    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRefGoogle Scholar
  23. 23.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Boyd O, Grounds RM, Bennett ED (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270:2699–2707PubMedCrossRefGoogle Scholar
  25. 25.
    Chong MA, Wang Y, Berbenetz NM, McConachie I (2018) Does goal-directed haemodynamic and fluid therapy improve peri-operative outcomes? A systematic review and meta-analysis. Eur J Anaesthesiol 35:469–483PubMedGoogle Scholar
  26. 26.
    Jorgensen L, Paludan-Muller AS, Laursen DR, Savovic J, Boutron I, Sterne JA, Higgins JP, Hrobjartsson A (2016) Evaluation of the Cochrane tool for assessing risk of bias in randomized clinical trials: overview of published comments and analysis of user practice in Cochrane and non-Cochrane reviews. Syst Rev 5:80PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Viechtbauer W (2010) Conducting meta-analyses in R with the metafor package. J Stat Softw 36:48CrossRefGoogle Scholar
  29. 29.
    Bender JS, Smith-Meek MA, Jones CE (1997) Routine pulmonary artery catheterization does not reduce morbidity and mortality of elective vascular surgery: results of a prospective, randomized trial. Ann Surg 226:229–236 (discussion 236–227) PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ 315:909–912PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Bonazzi M, Gentile F, Biasi GM, Migliavacca S, Esposti D, Cipolla M, Marsicano M, Prampolini F, Ornaghi M, Sternjakob S, Tshomba Y (2002) Impact of perioperative haemodynamic monitoring on cardiac morbidity after major vascular surgery in low risk patients. A randomised pilot trial. Eur J Vasc Endovasc Surg 23:445–451PubMedCrossRefGoogle Scholar
  32. 32.
    Gan TJ, Soppitt A, Maroof M, el-Moalem H, Robertson KM, Moretti E, Dwane P, Glass PS (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 97:820–826PubMedCrossRefGoogle Scholar
  33. 33.
    Conway DH, Mayall R, Abdul-Latif MS, Gilligan S, Tackaberry C (2002) Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia 57:845–849PubMedCrossRefGoogle Scholar
  34. 34.
    Venn R, Steele A, Richardson P, Poloniecki J, Grounds M, Newman P (2002) Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth 88:65–71PubMedCrossRefGoogle Scholar
  35. 35.
    Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, Laporta DP, Viner S, Passerini L, Devitt H, Kirby A, Jacka M (2003) A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 348:5–14PubMedCrossRefGoogle Scholar
  36. 36.
    Wakeling HG, McFall MR, Jenkins CS, Woods WG, Miles WF, Barclay GR, Fleming SC (2005) Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth 95:634–642PubMedCrossRefGoogle Scholar
  37. 37.
    Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED (2005) Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]. Crit Care 9:R687–R693PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Noblett SE, Snowden CP, Shenton BK, Horgan AF (2006) Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Br J Surg 93:1069–1076PubMedCrossRefGoogle Scholar
  39. 39.
    Lopes MR, Oliveira MA, Pereira V, Lemos I, Auler J, Michard F (2007) Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Crit Care 11(5):R100PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Donati A, Loggi S, Preiser JC, Orsetti G, Munch C, Gabbanelli V, Pelaia P, Pietropaoli P (2007) Goal-directed intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients. Chest 132:1817–1824PubMedCrossRefGoogle Scholar
  41. 41.
    Harten J, Crozier JE, McCreath B, Hay A, McMillan DC, McArdle CS, Kinsella J (2008) Effect of intraoperative fluid optimisation on renal function in patients undergoing emergency abdominal surgery: a randomised controlled pilot study (ISRCTN 11799696). Int J Surg 6:197–204PubMedCrossRefGoogle Scholar
  42. 42.
    Buettner M, Schummer W, Huettemann E, Schenke S, van Hout N, Sakka SG (2008) Influence of systolic-pressure-variation-guided intraoperative fluid management on organ function and oxygen transport. Br J Anaesth 101:194–199PubMedCrossRefGoogle Scholar
  43. 43.
    Kapoor P, Kakani M, Chowdhury U, Choudhury M, Lakshmy R, Kiran U (2008) Early goal-directed therapy in moderate to high-risk cardiac surgery patients. Ann Card Anaesth 11:27PubMedCrossRefGoogle Scholar
  44. 44.
    Smetkin AA, Kirov MY, Kuzkov VV, Lenkin AI, Eremeev AV, Slastilin VY, Borodin VV, Bjertnaes LJ (2009) Single transpulmonary thermodilution and continuous monitoring of central venous oxygen saturation during off-pump coronary surgery. Acta Anaesthesiol Scand 53:505–514PubMedCrossRefGoogle Scholar
  45. 45.
    Van der Linden PJ, Dierick A, Wilmin S, Bellens B, De Hert SG (2010) A randomized controlled trial comparing an intraoperative goal-directed strategy with routine clinical practice in patients undergoing peripheral arterial surgery. Eur J Anaesthesiol 27:788–793PubMedCrossRefGoogle Scholar
  46. 46.
    Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R (2010) Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care 14(3):R118PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Jammer I, Ulvik A, Erichsen C, Lodemel O, Ostgaard G (2010) Does central venous oxygen saturation-directed fluid therapy affect postoperative morbidity after colorectal surgery? A randomized assessor-blinded controlled trial. Anesthesiology 113:1072–1080PubMedCrossRefGoogle Scholar
  48. 48.
    Mayer J, Boldt J, Mengistu AM, Rohm KD, Suttner S (2010) Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial. Crit Care 14:R18PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Pillai P, McEleavy I, Gaughan M, Snowden C, Nesbitt I, Durkan G, Johnson M, Cosgrove J, Thorpe A (2011) A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy. J Urol 186:2201–2206PubMedCrossRefGoogle Scholar
  50. 50.
    Cecconi M, Fasano N, Langiano N, Divella M, Costa M, Rhodes A (2011) Goal directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. Crit Care 15(3):R132PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Brandstrup B, Svendsen PE, Rasmussen M, Belhage B, Rodt SA, Hansen B, Moller DR, Lundbech LB, Andersen N, Berg V, Thomassen N, Andersen ST, Simonsen L (2012) Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance? Br J Anaesth 109:191–199PubMedCrossRefGoogle Scholar
  52. 52.
    Bartha E, Arfwedson C, Imnell A, Fernlund ME, Andersson LE, Kalman S (2013) Randomized controlled trial of goal-directed haemodynamic treatment in patients with proximal femoral fracture. Br J Anaesth 110:545–553PubMedCrossRefGoogle Scholar
  53. 53.
    Scheeren TW, Wiesenack C, Gerlach H, Marx G (2013) Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. J Clin Monit Comput 27:225–233PubMedCrossRefGoogle Scholar
  54. 54.
    Salzwedel C, Puig J, Carstens A, Bein B, Molnar Z, Kiss K, Hussain A, Belda J, Kirov MY, Sakka SG, Reuter DA (2013) Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care 17:R191PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Bisgaard J, Gilsaa T, Ronholm E, Toft P (2013) Optimising stroke volume and oxygen delivery in abdominal aortic surgery: a randomised controlled trial. Acta Anaesthesiol Scand 57:178–188PubMedCrossRefGoogle Scholar
  56. 56.
    Bisgaard J, Gilsaa T, Ronholm E, Toft P (2013) Haemodynamic optimisation in lower limb arterial surgery: room for improvement? Acta Anaesthesiol Scand 57:189–198PubMedCrossRefGoogle Scholar
  57. 57.
    Bundgaard-Nielsen M, Jans O, Muller RG, Korshin A, Ruhnau B, Bie P, Secher NH, Kehlet H (2013) Does goal-directed fluid therapy affect postoperative orthostatic intolerance? A randomized trial. Anesthesiology 119:813–823PubMedCrossRefGoogle Scholar
  58. 58.
    Ramsingh DS, Sanghvi C, Gamboa J, Cannesson M, Applegate RL 2nd (2013) Outcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial. J Clin Monit Comput 27:249–257PubMedCrossRefGoogle Scholar
  59. 59.
    McKenny M, Conroy P, Wong A, Farren M, Gleeson N, Walsh C, O’Malley C, Dowd N (2013) A randomised prospective trial of intra-operative oesophageal Doppler-guided fluid administration in major gynaecological surgery. Anaesthesia 68:1224–1231PubMedCrossRefGoogle Scholar
  60. 60.
    Srinivasa S, Taylor MH, Singh PP, Yu TC, Soop M, Hill AG (2013) Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomy. Br J Surg 100:66–74PubMedCrossRefGoogle Scholar
  61. 61.
    Zakhaleva J, Tam J, Denoya PI, Bishawi M, Bergamaschi R (2013) The impact of intravenous fluid administration on complication rates in bowel surgery within an enhanced recovery protocol: a randomized controlled trial. Colorectal Dis 15:892–899PubMedCrossRefGoogle Scholar
  62. 62.
    Zheng H, Guo H, Ye JR, Chen L, Ma HP (2013) Goal-directed fluid therapy in gastrointestinal surgery in older coronary heart disease patients: randomized trial. World J Surg 37:2820–2829PubMedCrossRefGoogle Scholar
  63. 63.
    Goepfert MS, Richter HP, Zu Eulenburg C, Gruetzmacher J, Rafflenbeul E, Roeher K, von Sandersleben A, Diedrichs S, Reichenspurner H, Goetz AE, Reuter DA (2013) Individually optimized hemodynamic therapy reduces complications and length of stay in the intensive care unit: a prospective, randomized controlled trial. Anesthesiology 119:824–836PubMedCrossRefGoogle Scholar
  64. 64.
    Zhang J, Chen CQ, Lei XZ, Feng ZY, Zhu SM (2013) Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study. Clinics 68:1065–1070PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Phan TD, D’Souza B, Rattray MJ, Johnston MJ, Cowie BS (2014) A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an enhanced recovery after surgery program. Anaesth Intensive Care 42:752–760PubMedGoogle Scholar
  66. 66.
    Pearse RM, Harrison DA, MacDonald N, Gillies MA, Blunt M, Ackland G, Grocott MP, Ahern A, Griggs K, Scott R, Hinds C, Rowan K, Group OS (2014) Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA 311:2181–2190PubMedCrossRefGoogle Scholar
  67. 67.
    Peng K, Li J, Cheng H, Ji FH (2014) Goal-directed fluid therapy based on stroke volume variations improves fluid management and gastrointestinal perfusion in patients undergoing major orthopedic surgery. Med Princ Pract 23:413–420PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Pestana D, Espinosa E, Eden A, Najera D, Collar L, Aldecoa C, Higuera E, Escribano S, Bystritski D, Pascual J, Fernandez-Garijo P, de Prada B, Muriel A, Pizov R (2014) Perioperative goal-directed hemodynamic optimization using noninvasive cardiac output monitoring in major abdominal surgery: a prospective, randomized, multicenter, pragmatic trial: POEMAS Study (PeriOperative goal-directed thErapy in Major Abdominal Surgery). Anesth Analg 119:579–587PubMedCrossRefGoogle Scholar
  69. 69.
    van Beest PA, Vos JJ, Poterman M, Kalmar AF, Scheeren TW (2014) Tissue oxygenation as a target for goal-directed therapy in high-risk surgery: a pilot study. BMC Anesthesiol 14:122PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Lai CW, Starkie T, Creanor S, Struthers RA, Portch D, Erasmus PD, Mellor N, Hosie KB, Sneyd JR, Minto G (2015) Randomized controlled trial of stroke volume optimization during elective major abdominal surgery in patients stratified by aerobic fitness. Br J Anaesth 115:578–589PubMedCrossRefGoogle Scholar
  71. 71.
    Mikor A, Trasy D, Nemeth MF, Osztroluczki A, Kocsi S, Kovacs I, Demeter G, Molnar Z (2015) Continuous central venous oxygen saturation assisted intraoperative hemodynamic management during major abdominal surgery: a randomized, controlled trial. BMC Anesthesiol 15:82PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Parke RL, McGuinness SP, Gilder E, McCarthy LW, Cowdrey KA (2015) A randomised feasibility study to assess a novel strategy to rationalise fluid in patients after cardiac surgery. Br J Anaesth 115:45–52PubMedCrossRefGoogle Scholar
  73. 73.
    Fellahi JL, Brossier D, Dechanet F, Fischer MO, Saplacan V, Gerard JL, Hanouz JL (2015) Early goal-directed therapy based on endotracheal bioimpedance cardiography: a prospective, randomized controlled study in coronary surgery. J Clin Monit Comput 29:351–358PubMedCrossRefGoogle Scholar
  74. 74.
    Moppett IK, Rowlands M, Mannings A, Moran CG, Wiles MD, Investigators N (2015) LiDCO-based fluid management in patients undergoing hip fracture surgery under spinal anaesthesia: a randomized trial and systematic review. Br J Anaesth 114:444–459PubMedCrossRefGoogle Scholar
  75. 75.
    Ackland GL, Iqbal S, Paredes LG, Toner A, Lyness C, Jenkins N, Bodger P, Karmali S, Whittle J, Reyes A, Singer M, Hamilton M, Cecconi M, Pearse RM, Mallett SV, Omar RZ (2015) Individualised oxygen delivery targeted haemodynamic therapy in high-risk surgical patients: a multicentre, randomised, double-blind, controlled, mechanistic trial. Lancet Respir Med 3:33–41PubMedCrossRefGoogle Scholar
  76. 76.
    Correa-Gallego C, Tan KS, Arslan-Carlon V, Gonen M, Denis SC, Langdon-Embry L, Grant F, Kingham TP, DeMatteo RP, Allen PJ, D’Angelica MI, Jarnagin WR, Fischer M (2015) Goal-directed fluid therapy using stroke volume variation for resuscitation after low central venous pressure-assisted liver resection: a randomized clinical trial. J Am Coll Surg 221:591–601PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Kumar L, Kanneganti YS, Rajan S (2015) Outcomes of implementation of enhanced goal directed therapy in high-risk patients undergoing abdominal surgery. Indian J Anaesth 59:228–233PubMedPubMedCentralCrossRefGoogle Scholar
  78. 78.
    Funk DJ, HayGlass KT, Koulack J, Harding G, Boyd A, Brinkman R (2015) A randomized controlled trial on the effects of goal-directed therapy on the inflammatory response open abdominal aortic aneurysm repair. Crit Care 19:247PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Stens J, de Wolf SP, van der Zwan RJ, Koning NJ, Dekker NA, Hering JP, Boer C (2015) Microcirculatory perfusion during different perioperative hemodynamic strategies. Microcirculation 22:267–275PubMedCrossRefGoogle Scholar
  80. 80.
    Hand WR, Stoll WD, McEvoy MD, McSwain JR, Sealy CD, Skoner JM, Hornig JD, Tennant PA, Wolf B, Day TA (2016) Intraoperative goal-directed hemodynamic management in free tissue transfer for head and neck cancer. Head Neck 38(Suppl 1):E1974–E1980PubMedCrossRefGoogle Scholar
  81. 81.
    Broch O, Carstens A, Gruenewald M, Nischelsky E, Vellmer L, Bein B, Aselmann H, Steinfath M, Renner J (2016) Non-invasive hemodynamic optimization in major abdominal surgery: a feasibility study. Minerva Anestesiol 82:1158–1169PubMedGoogle Scholar
  82. 82.
    Kapoor PM, Magoon R, Rawat R, Mehta Y (2016) Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: “a clinical outcome and biomarker-based study”. Ann Card Anaesth 19:638–682PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Osawa EA, Rhodes A, Landoni G, Galas FR, Fukushima JT, Park CH, Almeida JP, Nakamura RE, Strabelli TM, Pileggi B, Leme AC, Fominskiy E, Sakr Y, Lima M, Franco RA, Chan RP, Piccioni MA, Mendes P, Menezes SR, Bruno T, Gaiotto FA, Lisboa LA, Dallan LA, Hueb AC, Pomerantzeff PM, Kalil Filho R, Jatene FB, Auler Junior JO, Hajjar LA (2016) Effect of perioperative goal-directed hemodynamic resuscitation therapy on outcomes following cardiac surgery: a randomized clinical trial and systematic review. Crit Care Med 44:724–733PubMedGoogle Scholar
  84. 84.
    Schmid S, Kapfer B, Heim M, Bogdanski R, Anetsberger A, Blobner M, Jungwirth B (2016) Algorithm-guided goal-directed haemodynamic therapy does not improve renal function after major abdominal surgery compared to good standard clinical care: a prospective randomised trial. Crit Care 20:50PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Luo J, Xue J, Liu J, Liu B, Liu L, Chen G (2017) Goal-directed fluid restriction during brain surgery: a prospective randomized controlled trial. Ann Intensive Care 7:16PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Stens J, Hering JP, van der Hoeven CWP, Boom A, Traast HS, Garmers LE, Loer SA, Boer C (2017) The added value of cardiac index and pulse pressure variation monitoring to mean arterial pressure-guided volume therapy in moderate-risk abdominal surgery (COGUIDE): a pragmatic multicentre randomised controlled trial. Anaesthesia 72:1078–1087PubMedCrossRefGoogle Scholar
  87. 87.
    Weinberg L, Ianno D, Churilov L, Chao I, Scurrah N, Rachbuch C, Banting J, Muralidharan V, Story D, Bellomo R, Christophi C, Nikfarjam M (2017) Restrictive intraoperative fluid optimisation algorithm improves outcomes in patients undergoing pancreaticoduodenectomy: A prospective multicentre randomized controlled trial. PLoS One 12:e0183313PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Kaufmann KB, Stein L, Bogatyreva L, Ulbrich F, Kaifi JT, Hauschke D, Loop T, Goebel U (2017) Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery—a single centre randomized parallel-arm trial. Br J Anaesth 118:852–861PubMedCrossRefGoogle Scholar
  89. 89.
    Elgendy MA, Esmat IM, Kassim DY (2017) Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: A prospective randomized trial. Egypt J Anaesth 33:263–269CrossRefGoogle Scholar
  90. 90.
    Kapoor PM, Magoon R, Rawat RS, Mehta Y, Taneja S, Ravi R, Hote MP (2017) Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass. Ann Card Anaesth 20:83–89PubMedPubMedCentralCrossRefGoogle Scholar
  91. 91.
    Xu H, Shu S-H, Wang D, Chai X-Q, Xie Y-H, Zhou W-D (2017) Goal-directed fluid restriction using stroke volume variation and cardiac index during one-lung ventilation: a randomized controlled trial. J Thorac Dis 9:2992–3004PubMedPubMedCentralCrossRefGoogle Scholar
  92. 92.
    Gomez-Izquierdo JC, Trainito A, Mirzakandov D, Stein BL, Liberman S, Charlebois P, Pecorelli N, Feldman LS, Carli F, Baldini G (2017) Goal-directed fluid therapy does not reduce primary postoperative ileus after elective laparoscopic colorectal surgery: a randomized controlled trial. Anesthesiology 127:36–49PubMedCrossRefGoogle Scholar
  93. 93.
    Kim HJ, Kim EJ, Lee HJ, Min JY, Kim TW, Choi EC, Kim WS, Koo BN (2018) Effect of goal-directed haemodynamic therapy in free flap reconstruction for head and neck cancer. Acta Anaesthesiol Scand 62:903–914PubMedCrossRefGoogle Scholar
  94. 94.
    Szturz P, Folwarczny P, Kula R, Neiser J, Sevcik P, Benes J (2018) Multi-parametric functional hemodynamic optimization improves postsurgical outcome after intermediate risk open gastrointestinal surgery, a randomized controlled trial. Minerva Anestesiol. PubMedCrossRefGoogle Scholar
  95. 95.
    Gerent ARM, Almeida JP, Fominskiy E, Landoni G, de Oliveira GQ, Rizk SI, Fukushima JT, Simoes CM, Ribeiro U Jr, Park CL, Nakamura RE, Franco RA, Candido PI, Tavares CR, Camara L, Dos Santos Rocha Ferreira G, de Almeida EPM, Filho RK, Galas F, Hajjar LA (2018) Effect of postoperative goal-directed therapy in cancer patients undergoing high-risk surgery: a randomized clinical trial and meta-analysis. Crit Care 22:133PubMedPubMedCentralCrossRefGoogle Scholar
  96. 96.
    Corbella D, Toppin PJ, Ghanekar A, Ayach N, Schiff J, Van Rensburg A, McCluskey SA (2018) Cardiac output-based fluid optimization for kidney transplant recipients: a proof-of-concept trial. Can J Anaesth. 65:873–883PubMedCrossRefGoogle Scholar
  97. 97.
    Calvo-Vecino JM, Ripolles-Melchor J, Mythen MG, Casans-Frances R, Balik A, Artacho JP, Martinez-Hurtado E, Serrano Romero A, Fernandez Perez C, Asuero de Lis S, Group FTI (2018) Effect of goal-directed haemodynamic therapy on postoperative complications in low-moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial). Br J Anaesth 120:734–744PubMedCrossRefGoogle Scholar
  98. 98.
    Holm C, Mayr M, Tegeler J, Horbrand F, Henckel von Donnersmarck G, Muhlbauer W, Pfeiffer UJ (2004) A clinical randomized study on the effects of invasive monitoring on burn shock resuscitation. Burns 30:798–807PubMedCrossRefGoogle Scholar
  99. 99.
    Lin SM, Huang CD, Lin HC, Liu CY, Wang CH, Kuo HP (2006) A modified goal-directed protocol improves clinical outcomes in intensive care unit patients with septic shock: a randomized controlled trial. Shock 26:551–557PubMedCrossRefGoogle Scholar
  100. 100.
    Chytra I, Pradl R, Bosman R, Pelnar P, Kasal E, Zidkova A (2007) Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients: a randomized controlled trial. Crit Care 11:R24PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Takala J, Ruokonen E, Tenhunen JJ, Parviainen I, Jakob SM (2011) Early non-invasive cardiac output monitoring in hemodynamically unstable intensive care patients: a multi-center randomized controlled trial. Crit Care 15:R148PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    Andrews B, Muchemwa L, Kelly P, Lakhi S, Heimburger DC, Bernard GR (2014) Simplified severe sepsis protocol: a randomized controlled trial of modified early goal-directed therapy in Zambia. Crit Care Med 42:2315–2324PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Zhang Z, Ni H, Qian Z (2015) Effectiveness of treatment based on PiCCO parameters in critically ill patients with septic shock and/or acute respiratory distress syndrome: a randomized controlled trial. Intensive Care Med 41:444–451PubMedCrossRefGoogle Scholar
  104. 104.
    Yu J, Zheng R, Lin H, Chen Q, Shao J, Wang D (2017) Global end-diastolic volume index vs CVP goal-directed fluid resuscitation for COPD patients with septic shock: a randomized controlled trial. Am J Emerg Med 35:101–105PubMedCrossRefGoogle Scholar
  105. 105.
    Popelut A, Valet F, Fromentin O, Thomas A, Bouchard P (2010) Relationship between sponsorship and failure rate of dental implants: a systematic approach. PLoS One 5:e10274PubMedPubMedCentralCrossRefGoogle Scholar
  106. 106.
    Bartels RH, Delye H, Boogaarts J (2012) Financial disclosures of authors involved in spine research: an underestimated source of bias. Eur Spine J 21:1229–1233PubMedCrossRefGoogle Scholar
  107. 107.
    DeGeorge BR Jr, Holland MC, Drake DB (2015) The impact of conflict of interest in abdominal wall reconstruction with acellular dermal matrix. Ann Plast Surg 74:242–247PubMedCrossRefGoogle Scholar
  108. 108.
    Wang AT, McCoy CP, Murad MH, Montori VM (2010) Association between industry affiliation and position on cardiovascular risk with rosiglitazone: cross sectional systematic review. BMJ 340:c1344PubMedPubMedCentralCrossRefGoogle Scholar
  109. 109.
    Viswanathan M, Carey T, Belinson S, Berliner E, Chang S, Graham E, Guise J, Ip S, Maglione M, McCrory D, McPheeters M, Newberry S, Sista P, White C (2014) A proposed approach may help systematic reviews retain needed expertise while minimizing bias from nonfinancial conflicts of interest. J Clin Epidemiol 67:1229–1238PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Department of Critical Care Medicine, Central South UniversityXiangya HospitalChangshaChina
  2. 2.Department of BiostatisticsYale University School of Public HealthNew HavenUSA
  3. 3.Cushing/Whitney Medical LibraryYale UniversityNew HavenUSA
  4. 4.Department of AnesthesiologyYale University School of MedicineNew HavenUSA

Personalised recommendations