Twenty-nine studies (4,805 patients) were included. Fourteen studies had Jadad scores of at least 3.
Mortality: Use of pre-emptive haemodynamic intervention was associated with a 52% reduction in mortality (OR 0.48, 95% CI 0.33 to 0.78; Ι²=34%, 29 RCTs, 4,805 patients).
Use of pre-emptive haemodynamic intervention was associated with significant reductions in mortality in studies using a pulmonary artery catheter (OR 0.35, 95% CI 0.19 to 0.65; 15 RCTs, 3,511 patients), fluids and inotropes as opposed to intravenous fluids alone (OR 0.47, 95% CI 0.29 to 0.76; 19 RCTs, 4,105 patients), cardiac index or oxygen delivery as the end-point (OR 0.38, 95% CI 0.21 to 0.68; 17 RCTs, 3,350 patients) and supranormal resuscitation targets (OR 0.29, 95% CI 0.18 to 0.47; eight RCTs, number of patients not reported).
Morbidity: Use of pre-emptive haemodynamic intervention was associated with a 57% reduction in overall rates of surgical complications (OR 0.43, 95% CI 0.34 to 0.53; Ι²=2%, 23 RCTs, 2,392 patients).
Subgroup analysis did not significantly affect the overall result.
Sensitivity analysis revealed no effect of pre-emptive haemodynamic intervention on mortality in trials with a Jadad score of 3 or more; trials with a Jadad score below 3 were associated with significant reductions in mortality. Study quality had no influence on morbidity outcomes. Results for a time-dependent analysis were reported.