Cardiac complications associated with goal-directed therapy in high-risk surgical patients: A meta-analysis

British Journal of Anaesthesia

Volumn 112, Issue 4, 2014, Pages 648-659

  Arulkumaran, N ^a   Corredor, C ^a   Hamilton, M A ^a   Ball, J ^a   Grounds, R M ^a   Rhodes, A ^a   Cecconi, M ^a  

^a ST GEORGE S HOSPITAL   (United Kingdom)

Author keywords

cardiovascular complications; goal directed; haemodynamic monitoring; high risk surgery; perioperative

Indexed keywords

INOTROPIC AGENT;

COMPUTER PROGRAM; FLUID THERAPY; GOAL DIRECTED THERAPY; HEART ARRHYTHMIA; HEART MUSCLE ISCHEMIA; HEART OUTPUT; HUMAN; LUNG EDEMA; META ANALYSIS; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; RISK FACTOR; SYSTEMATIC REVIEW;

CARDIOVASCULAR COMPLICATIONS; GOAL-DIRECTED; HAEMODYNAMIC MONITORING; HIGH-RISK SURGERY; PERIOPERATIVE;

CARDIOTONIC AGENTS; CARDIOVASCULAR DISEASES; FLUID THERAPY; HUMANS; MONITORING, PHYSIOLOGIC; PERIOPERATIVE CARE; POSTOPERATIVE COMPLICATIONS; RANDOMIZED CONTROLLED TRIALS AS TOPIC;

EID: 84897003760     PISSN: 00070912     EISSN: 14716771     Source Type: Journal    
DOI: 10.1093/bja/aet466     Document Type: Review

References (107)

1. Pearse RM, Moreno RP, Bauer P, et al. Mortality after surgery in Europe: A 7 day cohort study. Lancet 2012; 380: 1059-65
2. Cullinane M, Gray A, Hargraves C, Lansdown M, Martin I, Schubert M.Whooperateswhen?II. The2003report of the National Confidential Enquiry into Peri-operative Deaths. Available from http://www.ncepod.org.uk/2003wow.htm (accessed April 2012
3. Jhanji S, Thomas B, Ely A, Watson D, Hinds CJ, Pearse RM. Mortality and utilisation of critical care resourcesamongst high-risk surgical patients in a large NHS trust. Anaesthesia 2008; 63: 695-700
4. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long-Term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 2005; 242: 326-41
5. Pearse RM, Harrison DA, James P, et al. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care 2006; 10: R81
6. Shoemaker WC, Appel PL, Kram HB. Role of oxygen debt in the development of organ failure sepsis, and death in high-risk surgical patients. Chest 1992; 102: 208-15
7. Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-Analysis on the use of preemptive hemodynamic intervention to improve postoperativeoutcomesinmoderateandhigh-risk surgical patients. Anesth Analg 2011; 112: 1392-402
8. Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993-2004. J Am Med Assoc 2007; 298: 423-9
9. Bellamy MC. Wet, dry or something else? Br J Anaesth 2006; 97: 755-7
10. Lefebre C, Manheimer E, Glanville J. Searching for studies. In: Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions, Version 501 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cohcrane-handbook.org (accessed April 2013
11. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 [updated March 2011]. Available from http://www.cochrane-handbook.org (accessed April 2012
12. JadadAR, MooreRA, Carroll D, et al. Assessing the qualityof reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996; 17: 1-12
13. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-Analyses. Br Med J 2003; 327: 557-60
14. Bundgaard-Nielsen M, Ruhnau B, Secher NH, Kehlet H. Flowrelated techniques for preoperative goal-directed fluid optimization. Br J Anaesth 2007; 98: 38-44
15. Donati A, Cornacchini O, Loggi S, et al. A comparisonamongportal lactate, intramucosal sigmoid Ph, and deltaCO2(PaCO22regional Pco2) as indices of complications in patients undergoing abdominal aortic aneurysm surgery. Anesth Analg 2004; 99: 1024-31
16. Dueck MH, Klimek M, Appenrodt S, Weigand C, Boerner U. Trends but not individual values of central venous oxygen saturation agree with mixed venous oxygen saturation during varyinghemodynamic conditions. Anesthesiology 2005; 103: 249-57
17. Futier E, Robin E, Jabaudon M, et al. Central venous O saturation and venous-To-Arterial CO difference as complementary tools for goal-directed therapy during high-risk surgery. Crit Care 2010; 14: R193
18. Jorgensen CC, Bundgaard-Nielsen M, Skovgaard LT, Secher NH, Kehlet H. Stroke volume averaging for individualized goal-directed fluid therapy with oesophageal Doppler. Acta Anaesthesiol Scand 2009; 53: 34-8
19. Natalini G, Rosano A, Taranto M, Faggian B, Vittorielli E, Bernardini A. Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: A clinical trial. Anesth Analg 2006; 103: 1478-84
20. Schultz RJ, Whitfield GF, LaMura JJ, Raciti A, Krishnamurthy S. The role of physiologic monitoring in patients with fractures of the hip. J Trauma 1985; 25: 309-16
21. Sebat F, JohnsonD, Musthafa AA, et al.Amultidisciplinarycommunity hospital program for early and rapid resuscitation of shock in nontrauma patients. Chest 2005; 127: 1729-43
22. Shoemaker WC, Appel PL, Kram HB. Hemodynamic and oxygen transport responses in survivors and nonsurvivors of high-risk surgery. Crit Care Med 1993; 21: 977-90
23. Ramirez JM, Blasco JA, Roig JV, et al. Enhanced recovery in colorectal surgery: A multicentre study. BMC Surg 2011; 11: 9
24. O'Connell JB, Renlund DG, Robinson JA, et al. Effect of preoperative hemodynamic support on survival after cardiac transplantation. Circulation 1988; 78: III78-82
25. McKinley BA, Sucher JF, Todd SR, et al. Central venous pressure versus pulmonary artery catheter-directed shock resuscitation. Shock 2009; 32: 463-70
26. Fenwick E, WilsonJ, Sculpher M, Claxton K. Pre-operative optimisationemployingdopexamineoradrenaline for patientsundergoing major elective surgery: A cost-effectiveness analysis. Intensive Care Med 2002; 28: 599-608
27. Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction onpostoperative complications:comparison of two perioperative fluid regimens: A randomized assessor-blinded multicenter trial. Ann Surg 2003; 238: 641-8
28. Hauser CJ, Shoemaker WC, Turpin I, Goldberg SJ. Oxygen transport responses to colloids and crystalloids in critically ill surgical patients. Surg Gynecol Obstet 1980; 150: 811-6
29. Hiltebrand LB, Kimberger O, Arnberger M, Brandt S, Kurz A, Sigurdsson GH. Crystalloids versus colloids for goal-directed fluid therapy in major surgery. Crit Care 2009; 13: R40
30. Holte K, Foss NB, Andersen J, et al. Liberal or restrictive fluidadministration in fast-Track colonic surgery: A randomized, double-blind study. Br J Anaesth 2007; 99: 500-8
31. Holte K, Hahn RG, Ravn L, Bertelsen KG, Hansen S, Kehlet H. Influence of 'liberal' versus 'restrictive' intraoperative fluid administration on elimination of a postoperative fluid load. Anesthesiology 2007; 106: 75-9
32. Holte K, Klarskov B, Christensen DS, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: A randomized, double-blind study. Ann Surg 2004; 240: 892-9
33. Holte K, Kristensen BB, Valentiner L, Foss NB, Husted H, Kehlet H. Liberal versus restrictive fluid management in knee arthroplasty: A randomized, double-blind study. Anesth Analg 2007; 105: 465-74
34. Lobo SM, Ronchi LS, Oliveira NE, et al. Restrictive strategy of intraoperative fluid maintenance during optimization of oxygendelivery decreases major complications after high-risk surgery. Crit Care 2011; 15: R226
35. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 2005; 103: 25-32
36. Futier E, Constantin JM, Petit A, et al. Conservative vs restrictive individualized goal-directed fluid replacement strategy in major abdominal surgery: A prospective randomized trial. Arch Surg 2010; 145: 1193-200
37. Boldt J, Papsdorf M, Piper S, PadbergW, Hempelmann G. Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery. Acta Anaesthesiol Scand 1998; 42: 941-7
38. Davies SJ, Yates D, Wilson RJ. Dopexamine has no additional benefit in high-risk patients receiving goal-directed fluid therapy undergoing major abdominal surgery. Anesth Analg 2011; 112: 130-8
39. McGinley J, Lynch L, Hubbard K, McCoy D, Cunningham AJ. Dopexamine hydrochloride does not modify hemodynamic response or tissue oxygenation or gut permeability during abdominal aortic surgery. Can J Anaesth 2001; 48: 238-44
40. Stone MD, Wilson RJ, Cross J, Williams BT. Effect of adding dopexamine to intraoperative volume expansion in patients undergoing major elective abdominal surgery. Br J Anaesth 2003; 91: 619-24
41. Takala J, Meier-Hellmann A, Eddleston J, Hulstaert P, Sramek V. Effect of dopexamine on outcome after major abdominal surgery: A prospective, randomized, controlled multicenter study. European Multicenter Study Group on Dopexamine in Major Abdominal Surgery. Crit Care Med 2000; 28: 3417-23
42. Kapoor PM, Kakani M, Chowdhury U, Choudhury M, Lakshmy R, Kiran U. Early goal-directed therapy in moderate to high-risk cardiac surgery patients. Ann Card Anaesth 2008; 11: 27-34
43. Magder S, Potter BJ, Varennes BD, Doucette S, Fergusson D. Fluids aftercardiac surgery:apilot studyof theuseof colloidsversus crystalloids. Crit Care Med 2010; 38: 2117-24
44. McKendry M, McGloin H, Saberi D, Caudwell L, Brady AR, Singer M. Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. Br Med J 2004; 329: 258
45. Mythen MG, Webb AR. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 1995; 130: 423-9
46. Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J. A prospective, randomizedstudyofgoal-orientedhemodynamic therapy in cardiac surgical patients. Anesth Analg 2000; 90: 1052-9
47. Smetkin AA, Kirov MY, Kuzkov VV, et al. Single transpulmonary thermodilution and continuous monitoring of central venous oxygen saturation during off-pump coronary surgery. Acta Anaesthesiol Scand 2009; 53: 505-14
48. Bechir M, Puhan MA, Neff SB, et al. Early fluid resuscitation with hyperoncotic hydroxyethyl starch 200/0.5 (10%) in severe burn injury. Crit Care 2010; 14: R123
49. Chytra I, Pradl R, Bosman R, Pelnar P, Kasal E, Zidkova A. Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-Trauma patients: A randomized controlled trial. Crit Care 2007; 11: R24
50. Fleming A, Bishop M, ShoemakerW, et al. Prospective trial of supranormalvalues as goals of resuscitation in severe trauma.ArchSurg 1992; 127: 1175-9; discussion 1179-81
51. Holm C, Mayr M, Tegeler J, et al. A clinical randomized study on the effects of invasive monitoring on burn shock resuscitation. Burns 2004; 30: 798-807
52. Ivatury RR, Simon RJ, Islam S, Fueg A, Rohman M, Stahl WM. A prospective randomized study of end points of resuscitation after major trauma: Global oxygen transport indices versus organ-specific gastric mucosal pH. J Am Coll Surg 1996; 183: 145-54
53. Miller PR, Meredith JW, Chang MC. Randomized, prospective comparison of increased preload versus inotropes in the resuscitation of trauma patients: Effects on cardiopulmonary function and visceral perfusion. J Trauma 1998; 44: 107-13
54. Velmahos GC, Demetriades D, Shoemaker WC, et al. Endpoints of resuscitation of critically injured patients: Normal or supranormal? A prospective randomized trial. Ann Surg 2000; 232: 409-18
55. Bishop MH, Shoemaker WC, Appel PL, et al. Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 1995; 38: 780-7
56. Venn R, Steele A, Richardson P, Poloniecki J, Grounds M, Newman P. 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 2002; 88: 65-71
57. Sinclair S, James S, Singer M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: Randomised controlled trial. Br Med J 1997; 315: 909-12
58. Paul M, Dueck M, Joachim Herrmann H, Holzki J. A randomized, controlled study of fluid management in infants and toddlers during surgery: Hydroxyethyl starch 6% (HES 70/0.5 vs lactated Ringer's solution. Paediatr Anaesth 2003; 13: 603-8
59. Harvey S, Stevens K, Harrison D, et al. An evaluation of the clinical and cost-effectiveness of pulmonary artery catheters in patient management in intensive care: A systematic review and a randomised controlled trial. Health Technol Assess 2006; 10: Iii-iv, ix-xi, 1-133
60. Ichai C, Passeron C, Carles M, Bouregba M, Grimaud D. Prolonged low-dose dopamine infusion induces a transient improvement in renal function in hemodynamically stable, critically ill patients: A single-blind, prospective, controlled study. Crit Care Med 2000; 28: 1329-35
61. Jansen TC, van Bommel J, Schoonderbeek FJ, et al. Early lactateguided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med 2010; 182: 752-61
62. Jones AE, Shapiro NI, Trzeciak S, Arnold RC, Claremont HA, Kline JA. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: A randomized clinical trial. J Am Med Assoc 2010; 303: 739-46
63. Rhodes A, Cusack RJ, Newman PJ, Grounds RM, Bennett ED. A randomised, controlled trial of the pulmonary artery catheter in critically ill patients. Intensive Care Med 2002; 28: 256-64
64. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatmentof severe sepsisandseptic shock.NEngl JMed2001; 345: 1368-77
65. Rivers EP, Kruse JA, Jacobsen G, et al. The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock. Crit Care Med 2007; 35: 2016-24
66. Takala J, Ruokonen E, Tenhunen JJ, Parviainen I, Jakob SM. Early non-invasive cardiac output monitoring in hemodynamically unstable intensive care patients: A multi-center randomized controlled trial. Crit Care 2011; 15: R148
67. Gattinoni L, Brazzi L, Pelosi P, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 1995; 333: 1025-32
68. SandhamJD, Hull RD, Brant RF, et al.Arandomized, controlled trial of the use of pulmonary-Artery catheters in high-risk surgical patients. N Engl J Med 2003; 348: 5-14
69. Bender JS, Smith-Meek MA, Jones CE. Routine pulmonary artery catheterization does not reduce morbidity and mortality of electivevascular surgery: Results ofaprospective, randomizedtrial.Ann Surg 1997; 226: 229-36; discussion 236-7
70. Benes J, Chytra I, Altmann P, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: Results of prospective randomized study. Crit Care 2010; 14: R118
71. Berlauk JF, Abrams JH, Gilmour IJ, O'Connor SR, Knighton DR, Cerra FB. Preoperative optimization of cardiovascular hemodynamics improves outcomein peripheral vascular surgery.Aprospective, randomized clinical trial. Ann Surg 1991; 214: 289-97; discussion 298-9
72. Bonazzi M, Gentile F, Biasi GM, et al. 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 2002; 23: 445-51
73. Boyd O, Grounds RM, Bennett ED. A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. J Am Med Assoc 1993; 270: 2699-707
74. Buettner M, SchummerW, Huettemann E, Schenke S, van Hout N, Sakka SG. Influence of systolic-pressure-variation-guided intraoperative fluid management on organ function and oxygen transport. Br J Anaesth 2008; 101: 194-9
75. Cecconi M, Fasano N, Langiano N, et al. Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. Crit Care 2011; 15: R132
76. Challand C, Struthers R, Sneyd JR, et al. Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery. Br J Anaesth 2012; 108: 53-62
77. Conway DH, Mayall R, Abdul-Latif MS, Gilligan S, Tackaberry C. Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia 2002; 57: 845-9
78. Donati A, Loggi S, Preiser JC, et al. Goal-directed intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients. Chest 2007; 132: 1817-24
79. Forget P, Lois F, de Kock M. Goal-directed fluidmanagement based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management. Anesth Analg 2010; 111: 910-4
80. GanTJ, Soppitt A, Maroof M, et al. Goal-directed intraoperativefluid administrationreduceslength of hospital stayafter majorsurgery. Anesthesiology 2002; 97: 820-6
81. Harten J, Crozier JE, McCreath B, et al. Effect of intraoperative fluid optimisation on renal function in patients undergoing emergency abdominal surgery: A randomised controlled pilot study (ISRCTN 11799696). Int J Surg 2008; 6: 197-204
82. Jhanji S, Vivian-Smith A, Lucena-Amaro S, Watson D, Hinds CJ, Pearse RM. Haemodynamic optimisation improves tissue microvascular flowand oxygenation after major surgery: A randomised controlled trial. Crit Care 2010; 14: R151
83. Lobo SM, Lobo FR, Polachini CA, et al. Prospective, randomized trial comparingfluidsanddobutamineoptimization of oxygendelivery in high-risk surgical patients [ISRCTN42445141]. Crit Care 2006; 10: R72
84. Lobo SM, Salgado PF, Castillo VG, et al. Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med 2000; 28: 3396-404
85. Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO Jr, Michard F. Goal-directed fluid management based on pulse pressure variationmonitoring during high-risk surgery:a pilot randomized controlled trial. Crit Care 2007; 11: R100
86. Mayer J, Boldt J, Mengistu AM, Rohm KD, Suttner S. 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 2010; 14: R18
87. Noblett SE, Snowden CP, Shenton BK, Horgan AF. Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Br J Surg 2006; 93: 1069-76
88. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Early goal-directed therapyafter major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]. Crit Care 2005; 9: R687-93
89. Senagore AJ, EmeryT, Luchtefeld M, KimD, DujovnyN, HoedemaR. Fluid management for laparoscopic colectomy: A prospective, randomized assessment of goal-directed administration of balanced salt solution or hetastarchcoupled withanenhancedrecovery program. Dis Colon Rectum 2009; 52: 1935-40
90. ShoemakerWC, Appel PL, KramHB, WaxmanK, Lee TS. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988; 94: 1176-86
91. Szakmany T, Toth I, Kovacs Z, et al. Effects of volumetric vs. pressure-guided fluid therapy on postoperative inflammatory response: A prospective, randomized clinical trial. Intensive Care Med 2005; 31: 656-63
92. Ueno S, Tanabe G, Yamada H, et al. Response of patients with cirrhosis who have undergone partial hepatectomy to treatment aimed at achieving supranormal oxygen delivery and consumption. Surgery 1998; 123: 278-86
93. Valentine RJ, Duke ML, Inman MH, et al. Effectiveness of pulmonary artery catheters in aortic surgery: A randomized trial. J Vasc Surg 1998; 27: 203-11; discussion 211-2
94. Van Der Linden PJ, Dierick A, Wilmin S, Bellens B, De Hert SG. A randomized controlled trial comparing an intraoperative goaldirected strategywith routine clinical practice in patients undergoing peripheral arterial surgery. Eur J Anaesthesiol 2010; 27: 788-93
95. Wakeling HG, McFall MR, Jenkins CS, et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth 2005; 95: 634-42
96. Wenkui Y, Ning L, Jianfeng G, et al. Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy. Surgery 2010; 147: 542-52
97. Wilson J, Woods I, Fawcett J, et al. Reducing the risk of majorelective surgery: Randomised controlled trial of preoperative optimisation of oxygen delivery. Br Med J 1999; 318: 1099-103
98. ZieglerDW, Wright JG, ChobanPS, FlancbaumL.Aprospective randomized trial of preoperative 'optimization' of cardiac function in patients undergoing elective peripheral vascular surgery. Surgery 1997; 122: 584-92
99. Cecconi M, Corredor C, Arulkumaran N, et al. Clinical review: Goaldirected therapy-what is the evidence in surgical patients? The effect on different risk groups. Crit Care 2013; 17: 209
100. Hofer CK, Cecconi M, Marx G, della Rocca G. Minimally invasive haemodynamicmonitoring. Eur JAnaesthesiol2009;26:996-1002
101. Connors AF Jr, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial careof critically ill patients. SUPPORT Investigators. J AmMed Assoc 1996; 276: 889-97
102. Finfer S, Delaney A. Pulmonary artery catheters. Br Med J 2006; 333: 930-1
103. Cecconi M, Parsons AK, Rhodes A. What is a fluid challenge? Curr Opin Crit Care 2011; 17: 290-5
104. Hayes MA, Timmins AC, Yau EH, Palazzo M, Hinds CJ, Watson D. Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994; 330: 1717-22
105. Grocott MP, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K. Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery. Cochrane Database Syst Rev 2012; 11: CD004082
106. Guest JF, Boyd O, Hart WM, Grounds RM, Bennett ED. A cost analysis of a treatment policy of a deliberate perioperative increase in oxygen delivery in high risk surgical patients. Intensive Care Med 1997; 23: 85-90
107. Rhodes A, Cecconi M, Hamilton M, et al. Goal-directed therapy in high-risk surgical patients: A 15-year follow-up study. Intensive Care Med 2010; 36: 1327-32.