***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Acute hemodynamic instability increases morbidity and mortality . We investigated whether early non-invasive cardiac output monitoring enhances hemodynamic stabilization and improves outcome . Methods A multicenter , r and omized controlled trial was conducted in three European university hospital intensive care units in 2006 and 2007 . A total of 388 hemodynamically unstable patients identified during their first six hours in the intensive care unit ( ICU ) were r and omized to receive either non-invasive cardiac output monitoring for 24 hrs ( minimally invasive cardiac output/MICO group ; n = 201 ) or usual care ( control group ; n = 187 ) . The main outcome measure was the proportion of patients achieving hemodynamic stability within six hours of starting the study . Results The number of hemodynamic instability criteria at baseline ( MICO group mean 2.0 ( SD 1.0 ) , control group 1.8 ( 1.0 ) ; P = .06 ) and severity of illness ( SAPS II score ; MICO group 48 ( 18 ) , control group 48 ( 15 ) ; P = .86 ) ) were similar . At 6 hrs , 45 patients ( 22 % ) in the MICO group and 52 patients ( 28 % ) in the control group were hemodynamically stable ( mean difference 5 % ; 95 % confidence interval of the difference -3 to 14 % ; P = .24 ) . Hemodynamic support with fluids and vasoactive drugs , and pulmonary artery catheter use ( MICO group : 19 % , control group : 26 % ; P = .11 ) were similar in the two groups . The median length of ICU stay was 2.0 ( interquartile range 1.2 to 4.6 ) days in the MICO group and 2.5 ( 1.1 to 5.0 ) days in the control group ( P = .38 ) . The hospital mortality was 26 % in the MICO group and 21 % in the control group ( P = .34 ) . Conclusions Minimally-invasive cardiac output monitoring added to usual care does not facilitate early hemodynamic stabilization in the ICU , nor does it alter the hemodynamic support or outcome . Our results emphasize the need to evaluate technologies used to measure stroke volume and cardiac output -- especially their impact on the process of care -- before any large-scale outcome studies are attempted . Trial Registration The study was registered at Clinical Trials.gov ( Clinical Trials identifier NCT00354211 CONTEXT Previous studies indicate that industry-sponsored trials tend to draw proindustry conclusions . OBJECTIVE To explore whether the association between funding and conclusions in r and omized drug trials reflects treatment effects or adverse events . DESIGN Observational study of 370 r and omized drug trials included in meta-analyses from Cochrane review s selected from the Cochrane Library , May 2001 . From a r and om sample of 167 Cochrane review s , 25 contained eligible meta-analyses ( assessed a binary outcome ; pooled at least 5 full-paper trials of which at least 1 reported adequate and 1 reported inadequate allocation concealment ) . The primary binary outcome from each meta- analysis was considered the primary outcome for all trials included in each meta- analysis . The association between funding and conclusions was analyzed by logistic regression with adjustment for treatment effect , adverse events , and additional confounding factors ( method ological quality , control intervention , sample size , publication year , and place of publication ) . MAIN OUTCOME MEASURE Conclusions in trials , classified into whether the experimental drug was recommended as the treatment of choice or not . RESULTS The experimental drug was recommended as treatment of choice in 16 % of trials funded by nonprofit organizations , 30 % of trials not reporting funding , 35 % of trials funded by both nonprofit and for-profit organizations , and 51 % of trials funded by for-profit organizations ( P<.001 ; chi2 test ) . Logistic regression analyses indicated that funding , treatment effect , and double blinding were the only significant predictors of conclusions . Adjusted analyses showed that trials funded by for-profit organizations were significantly more likely to recommend the experimental drug as treatment of choice ( odds ratio , 5.3 ; 95 % confidence interval , 2.0 - 14.4 ) compared with trials funded by nonprofit organizations . This association did not appear to reflect treatment effect or adverse events . CONCLUSIONS Conclusions in trials funded by for-profit organizations may be more positive due to biased interpretation of trial results . Readers should carefully evaluate whether conclusions in r and omized trials are supported by data BACKGROUND Some observational studies suggest that the use of pulmonary-artery catheters to guide therapy is associated with increased mortality . METHODS We performed a r and omized trial comparing goal -directed therapy guided by a pulmonary-artery catheter with st and ard care without the use of a pulmonary-artery catheter . The subjects were high-risk patients 60 years of age or older , with American Society of Anesthesiologists ( ASA ) class III or IV risk , who were scheduled for urgent or elective major surgery , followed by a stay in an intensive care unit . Outcomes were adjudicated by observers who were unaware of the treatment-group assignments . The primary outcome was in-hospital mortality from any cause . RESULTS Of 3803 eligible patients , 1994 ( 52.4 percent ) underwent r and omization . The base-line characteristics of the two treatment groups were similar . A total of 77 of 997 patients who underwent surgery without the use of a  pulmonary-artery catheter ( 7.7 percent ) died in the hospital , as compared with 78 of 997 patients in whom a pulmonary-artery catheter was used ( 7.8 percent)--a difference of 0.1 percentage point ( 95 percent confidence interval , -2.3 to 2.5 ) . There was a higher rate of pulmonary embolism in the catheter group than in the st and ard-care group ( 8 events vs. 0 events , P=0.004 ) . The survival rates at 6 months among patients in the st and ard-care and catheter groups were 88.1 and 87.4 percent , respectively ( difference , -0.7 percentage point [ 95 percent confidence interval , -3.6 to 2.2 ] ; negative survival differences favor st and ard care ) ; at 12 months , the rates were 83.9 and 83.0 percent , respectively ( difference , -0.9 percentage point [ 95 percent confidence interval , -4.3 to 2.4 ] ) . The median hospital stay was 10 days in each group . CONCLUSIONS We found no benefit to therapy directed by pulmonary-artery catheter over st and ard care in elderly , high-risk surgical patients requiring intensive care Introduction Several studies have shown that goal -directed hemodynamic and fluid optimization may result in improved outcome . However , the methods used were either invasive or had other limitations . The aim of this study was to perform intraoperative goal -directed therapy with a minimally invasive , easy to use device ( FloTrac/Vigileo ) , and to evaluate possible improvements in patient outcome determined by the duration of hospital stay and the incidence of complications compared to a st and ard management protocol . Methods In this r and omized , controlled trial 60 high-risk patients scheduled for major abdominal surgery were included . Patients were allocated into either an enhanced hemodynamic monitoring group using a cardiac index based intraoperative optimization protocol ( FloTrac/Vigileo device , GDT-group , n = 30 ) or a st and ard management group ( Control-group , n = 30 ) , based on st and ard monitoring data . Results The median duration of hospital stay was significantly reduced in the GDT-group with 15 ( 12 - 17.75 ) days versus 19 ( 14 - 23.5 ) days ( P = 0.006 ) and fewer patients developed complications than in the Control-group [ 6 patients ( 20 % ) versus 15 patients ( 50 % ) , P = 0.03 ] . The total number of complications was reduced in the GDT-group ( 17 versus 49 complications , P = 0.001 ) . Conclusions In high-risk patients undergoing major abdominal surgery , implementation of an intraoperative goal -directed hemodynamic optimization protocol using the FloTrac/Vigileo device was associated with a reduced length of hospital stay and a lower incidence of complications compared to a st and ard management protocol .Trial Registration Clinical trial registration information : Unique identifier : The objective was to compare the impact of an early goal -directed hemodynamic therapy based on cardiac output monitoring ( Endotracheal Cardiac Output Monitor , ECOM ) with a st and ard of care on postoperative outcome following coronary surgery . This prospect i ve , controlled , parallel-arm trial r and omized 100 elective primary coronary artery bypass grafting patients to a study group ( ECOM ; n = 50 ) or a  control group  ( control ; n = 50 ) . In the ECOM group , hemodynamic therapy was guided by respiratory stroke volume variation and cardiac index given by the ECOM system . A st and ard of care was used in the control . Goal -directed therapy was started immediately after induction of anesthesia and continued until arrival in the intensive care unit ( ICU ) . The primary endpoint was the time when patients fulfilled discharge criteria from hospital ( possible hospital discharge ) . Secondary endpoints were the hospital discharge , the time to reach extubation , the length of stay in ICU , the number of major adverse cardiac events , and in-hospital mortality . Patients in the ECOM group received more often fluid loading and dobutamine . The time to reach extubation was reduced in the ECOM group : 510 min [ 360–1,110 ] versus 570 min [ 320–1,520 ] , P = 0.005 . No significant differences were found between both groups for possible hospital discharge [ Hazard Ratio = 0.96 ( 95 % CI 0.64–1.45 ) ] and hospital discharge [ Hazard Ratio = 1.20 ( 95 % CI 0.79–1.81 ) ] . A mini-invasive early goal -directed hemodynamic therapy based on ECOM can reduce the time to reach extubation but fails to significantly reduce the length of stay in hospital and the rate of major cardiac morbidity Background and Aims : Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients . We aim ed to assess the impact of goal directed therapy ( GDT ) targeting cardiac index ( CI ) and oxygen extraction ratio ( O 2 ER ) on outcomes of high-risk patients undergoing abdominal surgery . Methods : In a prospect i ve r and omised trial , forty patients ( American Society of Anaesthesiologists II and III ) undergoing major abdominal surgeries  were r and omised into two groups . In-Group A mean arterial pressure ≥ 65 mmHg , central venous pressure ≥ 8 - 10 mmHg , urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70 % were targeted intra-operatively and 12 h postoperatively . In-Group-B ( enhanced GDT ) , in addition to the monitoring in-Group-A , CI ≥ 2.5 L/min/m 2 and O 2 ER ≤ 27 % were targeted . The end-points were lactate levels and base deficit during and after surgery . The secondary end points were length of Intensive Care Unit ( ICU ) and hospital stay and postoperative complications . Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment . Results : Lactate levels postoperatively at 4 and 8 h were lower in-Group-B ( P < 0.05 ) . The mean base deficit at 3 , 4 , 5 and 6 h intra-operatively and postoperatively after 4 , 8 and 12 h were lower in-Group-B ( P < 0.05 ) . There were no significant differences in ICU stay ( 2.10 ± 1.52 vs. 2.90 ± 2.51 days ) or hospital stay ( 10.85 + 4.39 vs. 13.35 + 6.77 days ) between Group A and B. Conclusions : Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation Background Major abdominal surgery is associated with significant risk of morbidity and mortality in the perioperative period . Optimising intraoperative fluid administration may result in improved outcomes . Our aim was to compare the effects of central venous pressure ( CVP ) , and central venous oxygen saturation (ScvO2)-assisted fluid therapy on postoperative complications in patients undergoing high risk surgery . Methods Patients undergoing elective major abdominal surgery were r and omised into  control and ScvO2  groups . The target level of mean arterial pressure ( MAP ) was ≥ 60 mmHg in both groups . In cases of MAP < 60 mmHg patients received either a fluid or vasopressor bolus according to the CVP < 8 mmHg in the control group . In the ScvO2 group , in addition to the MAP , an ScvO2 of < 75 % or a > 3 % decrease indicated need for intervention , regardless of the actual MAP . Data are presented as mean ± st and ard deviation or median ( interquartile range ) . Results We observed a lower number of patients with complications in the ScvO2 group compared to the control group , however it did not reach statistical significance ( ScvO2 group : 10 vs. control group : 19 ; p = 0.07 ) . Patients in the ScvO2 group ( n = 3 
    Output:
    
No significant effect of GDHT was found on mortality .
Conclusions 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