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Future evolution of intraoperative goal directed fluid and hemodynamic therapy in children

Claudine Kumba

Background: Recently a systematic review and meta-analysis was conducted to determine the impact of intraoperative goal directed fluid and hemodynamic therapy (GDFHT) in children and postoperative outcome. This study is part of a vast and extended Thesis Project concerning the impact of Goal Directed therapies on postoperative outcome in the pediatric population. This systematic review and meta-analysis of 23 randomized and non randomized controlled trials in 3389 children, of which more than 90% of the studies (21 among the 23 studies) concerned pediatric cardiac surgical patients, revealed that trials where GDFHT aiming to determine the impact on postoperative outcome in children were not developed compared to what has been realized in adults. However this trial showed that a lot of studies concerning hemodynamic monitoring in children were prospective, retrospective, observational and non interventional. These studies demonstrated the existence of parameters or biomarkers of adverse postoperative outcome in pediatric cardiac surgical patients. Namely cerebral, renal, splanchnic regional oxygen saturation, serum lactate levels, mixed central venous oxygen saturation and arterial to venous carbon dioxide difference. Systematic reviews and meta-analysis with high level evidence studies can help to elaborate recommendations for improvement implementation programs for clinical practice.

Objective of this Editorial: To analyze the results, conclusions and future perspective of this recent systematic review and meta-analysis of the impact of intraoperative GDFHT on postoperative outcome in children.

Methods: Editorial concerning the recent systemetic review and meta-analysis of the impact of intraoperative GDFHT on postoperative outcome in children.

Results and Conclusion: This systematic review and meta-analysis of 23 non randomized and randomized controlled trials (RCT) evidenced that randomized controlled trials concerning the impact on perioperative GDFHT on postoperative outcome in children are lacking. Secondly, unoptimal intraoperative parameters mentioned above were predictors of adverse postoperative outcome in pediatric cardiac surgical patients. Finally RCT using these parameters in GDFHT protocols should be developed to clarify the influence of this therapy on postoperative outcome in children in cardiac and non cardiac surgical pediatric populations. In the present time there are no answers concerning the effect of intraoperative GDFHT on postoperative outcome in children. Thus research in this field is highly recommended.