FloTrac System

Stroke Volume Optimization

% Change in Stroke Volume (SV) is a sensitive method for assessing preload responsiveness on all patients. Monitor Stroke Volume 200 250 ml Fluid Challenge Over 5 10 min* SV Increase >10%
NO YES NO YES

SV Reduction >10%

Monitor Stroke Volume for Clinical Signs of Fluid Loss

Oesophageal Doppler-guided uid management during major surgery: reducing postoperative complications and bed days. NHS Technology Adoption Centre. January 2012. *A passive leg raising maneuver over 1-2 min. can also be used as a uid challenge Monnet X, Teboul JL. Passive Leg Raising. Intensive Care Med. 2008 Apr; 34 (4): 659-63.

Stroke Volume Variation Optimization

Stroke Volume Variation (SVV) is a reliable indicator of preload responsiveness on control-ventilated patients with no icon displayed Not meeting perfusion requirements Volume Responsive SVV>13% Yes Volume Challenge SVI Normal (40-50) Pressor No SVI Low (<40) Inotrope SVI High (>50) Diuretic

McGee WT, A Simple Physiologic Algorithm for Managing Hemodynamics Using Stroke Volume and Stroke Volume Variation: Physiologic Optimization Program. J Intensive Care Med. 2009 Nov; 24 (6): 352-60.

PARAMeteR CO (Cardiac Output) CI (Cardiac Index) SV (Stroke Volume) SVI (Stroke Volume Index) SVR (Systemic Vascular Resistance) SVRI (Systemic Vascular Resistance Index) SVV (Stroke Volume Variation)

NoRMAL RAnGe 4.0 - 8.0 L/min 2.5 - 4.0 L/min/m2 60 - 100 mL/beat 33 - 47 mL/beat/m2 800 - 1200 dynes - sec/cm-5 1970-2390 dynes - sec/cm-5/m2 <13%

Stroke Volume Variation (on control-ventilated patients):

Variation in arterial pulsations caused by heart-lung changes during positive pressure ventilation. 25
25 25 20 15 10 5 0 0 -5 1000 1000 2000 2000 3000 3000 4000 4000 5000 5000 6000 6000 7000 7000 0 0 1000 2000 3000 4000 5000 6000 7000 20 20

SVmax SVmax 15 15 SVmax SVmin SVmin 10 10 SVmin

5 5 0 0 -5 -5

Airway Pressure Pressure Airway Airway Pressure Arterial Pressure Pressure Arterial Arterial Pressure

SVmax-SVmin SVmax-SVmin %SVV = = SVmax-SVmin %SVV SVmean %SVV = SVmean SVmean

Expiration Inspiration Expiration Inspiration Expiration Inspiration Controlled Ventilation Controlled Ventilation Controlled Ventilation Controlled Ventilation Controlled Ventilation Controlled Ventilation

Relationship between preload status and uid-induced increases in stroke volume.

Stroke Volume Continue Fluid Continue Fluid Discontinue Fluid

Frank-Starling Curve:

SV < 10% SV > 10%

SV > 10%
P = fluid-induced increase in preload

Increasing SV with uid until the plateau of the Frank-Starling curve is reached has been shown to improve the outcome of high-risk surgery patients. Michard F. Changes in arterial pressure during mechanical ventilation. Anesthesiology. 2005; 103: 419-28.

Preload

For professional use. CAUTION: Federal (United States) law restricts this device to sale by or on the order of a physician. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions and adverse events.
Edwards Lifesciences devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity. Edwards, Edwards Lifesciences, the stylized E logo, and FloTrac are trademarks of Edwards Lifesciences Corporation. 2012 Edwards Lifesciences Corporation. All rights reserved. AR08052

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