ABSTRACT
Purpose
To investigate the effects of goal-directed fluid therapy (GDFT) or conventional fluid
therapy (CFT) in improving postoperative outcomes in patients undergoing colorectal
surgeries.
Design
Evidence-Based Review.
Methods
Following the guidelines outlined in the PRISMA statement, a comprehensive search
was conducted using PubMed, Elsevier ScienceDirect, Oxford Academic, EBSCO, Google
Scholar, Cochrane Library, and gray literature. Only randomized controlled studies
and pre-appraised evidence such as systematic review with meta-analysis examining
the effects of GDFT and CFT in colorectal surgery were included. The quality appraisal
of the literature was conducted using the proposed algorithm described in the Johns
Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide.
Findings
Two systematic reviews with meta-analyses and four randomized controlled trials (RCT)
involving 2018 patients were included in this review. Overall, the use of GDFT did
not shorten the hospital length of stay (LOS), reduce 30–day mortality, lower overall
morbidity rates, or decrease incidence of postoperative ileus. Additionally, the return
of bowel function was not improved using GDFT or CFT. However, when GDFT was implemented
within enhanced recovery after surgery (ERAS) programs, there was a significant reduction
in hospital LOS. . When GDFT was used in a non-ERAS patient care setting, there was
a significant reduction in overall morbidity rate and faster time to first flatus.
All studies included in the review were categorized as Level I and rated Grade A,
implying strong confidence in the true effects of GDFT on all outcome measures in
the review.
Conclusions
The benefits of GDFT in colorectal surgery are still unclear. Considerable heterogeneity
based on the types of GDFT devices, patient outcome parameters, and fluid protocols
limit the application to clinical practice. Furthermore, there was limited data on
the effects of GDFT in high-risk patients for colorectal surgery.
Keywords
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Article info
Publication history
Published online: February 27, 2023
Publication stage
In Press Corrected ProofFootnotes
Funding: The authors of this manuscript did not receive any funding from any organizations commercial and non-commercial and have no relevant financial and nonfinancial relationships to disclose.
Conflict of Interest: None to report.
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© 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
