You may
have more
complications
than you think.
Variability in volume administration suggests patients aren’t being managed in the optimal volume range
– a contributing factor to post-surgical complications.2,3

Start here. Know more about your true complication rate. Understand how controlling variability and keeping patients in the optimal volume range can help reduce post-surgical complications.
You can take
action now to
reduce
complications.
You may avoid a number of preventable post-surgical complications by maintaining your patient in the optimal volume range through Perioperative Goal-Directed Therapy (PGDT) protocols which utilize dynamic and flow-based hemodynamic parameters.1,4,7,17,18
Edwards' Enhanced
Surgical Recovery
Program can help
you implement PGDT.
The 4-step process can help your hospital implement evidence-based Perioperative Goal-Directed Therapy (PGDT) in your moderate and high-risk surgery procedures to reduce post-surgical complications,2,5,6 associated costs1,7,8 and standardize care.
See what you can do right now to impact post-surgical complications
by controlling variability in volume administration:
Is variability in volume administration
raising your complication rate?
Complications from excessive and insufficient volume administration.2,3
Both hypo- and hypervolemia may deleteriously affect organ function. Are you consistently maintaining your patients in the optimal volume range? Or is there inexplicable variability in volume administration by procedure? By surgical team?

Identifying variability in volume administration is action you can take now to start reducing your complication rate. Determine if volume administration is consistent across the same procedure, or if volume administration levels vary from clinician to clinician. To start now, contact us
Complications have a human cost.
      Independent of preoperative
  patient risk, the occurrence of even a
single post-surgical complication
within 30 days reduced median
patient survival by 69%.9
The most important determinant
of
post-surgical survival was the
occurrence of any complication
within 30 days
post-surgery.9
Complications are not exceptions.
Complications occur in 25% of moderate to high-risk surgeries.4
4
You can impact variability.
You can help reduce post-surgical complications by maintaining patients in the
optimal volume range using dynamic and flow-based hemodynamic parameters
to guide volume administration.1,4,7,18,17
Excessive volume administration: 2,3
  • Pulmonary edema, prolonged mechanical ventilation1,17
  • GI dysfunction (abdominal compartment syndrome, ileus, anastomotic leak)18
  • Hemodilution and coagulopathy*
Insufficient volume administration: 2,3
  • Low preload, low cardiac output, low BP, low perfusion 2
  • Arrhythmia (hypovolemia) 2
  • GI dysfunction (postoperative ileus, PONV, upper GI bleeding, anastomotic leak 18
  • Infectious complication (tissue hypoperfusion) 2
  • Acute renal insufficiency or failure 2
Volume administration variability and the impact
on morbidity rates are often underestimated by
clinicians when not measured from objective data.
The odds of patients developing at least one post-surgical complication increase
with co-morbidities (patient risk) and the complexity and duration
of the surgical procedure (procedure risk). 4,20
See the risks by:
Procedure10
Patient11
Complication rates depend on the surgical procedure10
ProcedureMorbidity rate %
Esophagectomy55.1
Pelvic exenteration 45.0
Pancreatectomy34.9
Colectomy28.9
Gastrectomy28.7
Liver resection27
Complication rates depend on the patient11
Risk factorOdd Ratio
ASA 4/5 VS ½1.9
ASA 3 VS ½1.5
Dyspnea at rest vs. none1.4
History of COPD1.3
Dyspnea with minimal
exertion vs. none1.2
You can take action now
to reduce complications
by controlling volume administration variability
in moderate to high-risk surgeries.
Dynamic and flow-based parameters are shown to be more informative in
determining fluid responsiveness than conventional, pressure-based parameters.12
Perioperative Goal-Directed Therapy (PGDT) is a clinician-directed treatment
protocol
which utilizes key hemodynamic parameters to help guide optimal volume
administration and support individualized patient care.
A large body of evidence shows clinical and
economic benefits of hemodynamic optimization
through PGDT.
Randomized Controlled Trials Meta-Analyses
30+ Randomized Controlled Trials and 14+ Meta-Analyses have demonstrated
clinical benefits of hemodynamic optimization over standard volume management,
including reduction of avoidable and costly complications across a wide range of
moderate to high-risk surgical populations.5,6,13-19
Evaluate clinical evidence supporting Perioperative Goal-Directed Therapy (PGDT)
Randomized Controlled Trials
Meta-Analyses
30+ Randomized Controlled Trials demonstrate benefit
More than 3,000 patients have been enrolled in these 32 positive RCTs.
# Title, Author and YearMain Benefits
1 Individually optimized hemodynamic therapy reduces complications and length of stay in the Intensive Care Unit. Goepfert 2013 Morbidity
2 Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Salzwedel 2013 Morbidity
Hospital LOS
3 Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive. Zhang 2013 Morbidity
4 Goal-directed fluid therapy in gastrointestinal surgery in older coronary heart disease patients: randomized trial. Zheng 2013 Morbidity
Hospital LOS
5 Haemodynamic optimisation in lower limb arterial surgery: room for improvement? Bisgaard 2012 Morbidity
6 Outcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial. Ramsingh 2012 Morbidity
Hospital LOS
7 Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. Scheeren 2012 Morbidity
8 Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. Cecconi 2011 Morbidity
9 A double-blind randomized controlled clinical trial to assess the effect of doppler optimized intraoperative fluid management on outcome following radical cystectomy. Pillai 2011 Morbidity
10 Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Benes 2010 Morbidity
11 Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery: a randomised controlled trial. Jhanji 2010 Morbidity
12 Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial. Mayer 2009 Morbidity
Hospital LOS
13 Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients: a randomized controlled trial. Chytra 2007 Morbidity
Hospital LOS
14 Goal-directed intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients. Donati 2007 Morbidity
Hospital LOS
15 Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Lopes 2007 Morbidity
Hospital LOS
16 Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Noblett 2006 Morbidity
Hospital LOS
17 Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial. Pearse 2005 Morbidity
Hospital LOS
18 Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Wakeling 2005 Morbidity
Hospital LOS
19 Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. McKendry 2004 Hospital LOS
20 Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Conway 2002 Morbidity
21 Goal-directed Intraoperative fluid administration reduces length of hospital stay after major surgery. Gan 2002 Morbidity
Hospital LOS
22 Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Venn 2002 Morbidity
23 Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Lobo 2000 Morbidity
Mortality
(16vs50%)
24 A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Polonen 2000 Morbidity
Hospital LOS
25 Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimization of oxygen delivery. Wilson 1999 Morbidity
Hospital LOS
Cost-savings
26 Response of patients with cirrhosis who have undergone partial hepatectomy to treatment aimed at achieving supranormal oxygen delivery and consumption. Ueno 1998 Morbidity
27 Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. Sinclair 1997 Hospital LOS
28 Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Mythen 1995 Morbidity
Hospital LOS
29 A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk patients. Boyd 1993 Morbidity
Mortality
(6vs22%)
Cost-savings
30 Prospective trial of supranormal values as goals of resuscitation in severe trauma. Fleming 1992 Morbidity
31 Perioperative optimization of cardiovascular hemodynamics improves outcomes in peripheral vascular surgery. Berlauk 1991 Morbidity
32 Prospective trial of supranormal values of survivors as therapeutic goals in high-risk patients. Shoemaker 1988 Morbidity
Mortality
(21vs34%)
Cost-savings
Hemodynamic optimization through PGDT is
demonstrated to reduce complications,5,6
Length of Stay (LOS) and associated costs in your
moderate to high-risk surgery patients.1,7
Approximate extra cost of treating 1+ complication

Average in U.S.
Demonstrated value of hemodynamic
optimization through PGDT.
ProcedureTitle, Author and Year
Abdominal Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Salzwedel 2013
Abdominal Goal-directed fluid therapy in gastrointestinal surgery in older coronary heart disease patients: randomized trial. Zheng 2013
Abdominal Outcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial. Ramsingh 2012
Abdominal Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. Scheeren 2012
Abdominal Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery: a randomised controlled trial. Jhanji 2010
Abdominal Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial. Mayer 2009
Abdominal and Vascular Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Benes 2010
Bowel Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Noblett 2006
Bowel Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Wakeling 2005
Bowel Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Conway 2002
Cardiac Individually optimized hemodynamic therapy reduces complications and length of stay in the Intensive Care Unit. Goepfert 2013
Cardiac Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. McKendry 2004
Cardiac A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Polonen 2000
Cardiac Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Mythen 1995
Cystectomy A double-blind randomized controlled clinical trial to assess the effect of doppler optimized intraoperative fluid management on outcome following radical cystectomy. Pillai 2011
General Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Lopes 2007
General Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial. Pearse 2005
General Goal-directed Intraoperative fluid administration reduces length of hospital stay after major surgery. Gan 2002
General Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Lobo 2000
General A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk patients. Boyd 1993
General Prospective trial of supranormal values of survivors as therapeutic goals in high-risk patients. Shoemaker 1988
General and Vascular Goal-directed intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients. Donati 2007
General and Vascular Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimization of oxygen delivery. Wilson 1999
Hepatectomy Response of patients with cirrhosis who have undergone partial hepatectomy to treatment aimed at achieving supranormal oxygen delivery and consumption. Ueno 1998
Hip Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. Cecconi 2011
Hip Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Venn 2002
Hip Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. Sinclair 1997
Thoracic Intraoperative fluid management in open gastrointestinal surgery: goal-directed versus restrictive. Zhang 2013
Trauma Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients: a randomized controlled trial. Chytra 2007
Trauma Prospective trial of supranormal values as goals of resuscitation in severe trauma. Fleming 1992
Vascular Haemodynamic optimisation in lower limb arterial surgery: room for improvement? Bisgaard 2012
Vascular Perioperative optimization of cardiovascular hemodynamics improves outcomes in peripheral vascular surgery. Berlauk 1991
Reduction inAverage odd or risk ratio
(confidence interval)
Author
(reference)
Acute kidney injury 0.64 (0.50-0.83)
0.67 (0.46-0.98)
0.71 (0.57-0.90)
Brienza
Corcoran
Grocott
Arrythmias 0.54 (CI: 0.35-0.85) Arulkumaran
Cardiovascular complications 0.54 (CI: 0.38-0.76) Arulkumaran
Complications 0.45 (CI: 0.34-0.60) Cecconi
Hospital length of stay -2.44 (CI: -4.03 to -0.84)
NA
-2.34 (CI: -2.91 to -1.77)
Aya
Bungaard-Nielsen
Phan
Ileus NA Bungaard-Nielsen
Minor GI complications 0.29 (0.17-0.50) Giglio
Major GI complications 0.42 (0.27-0.65) Giglio
Mortality 0.67 (0.55-0.82) Gurgel
Mortality Rate 0.61 (0.46-0.81) Poeze
Organ dysfunction 0.62 (0.55-0.70) Gurgel
Postoperative complications 0.33 (CI: 0.15-0.73) Aya
Postoperative morbidity 0.37 (CI: 0.27-0.50) Phan
Post-op nausea & vomiting NA Bungaard-Nielsen
Pneumonia 0.74 (0.57-0.96)
0.71 (0.55-0.92)
Corcoran
Dalfino
Respiratory failure 0.51 (0.28-0.93) Grocott
Surgical site infection 0.58 (0.46-0.74)
0.65 (0.50-0.84)
Dalfino
Grocott
Tissue hypoxia NA Srinivasa
Total morbidity rate NA
0.68 (0.58-0.80)
0.44 (0.35-0.55)
Bungaard-Nielsen
Grocott
Hamilton
Urinary tract infection 0.44 (0.22-0.88) Dalfino
versus conventional care.
Conventional volume management, based on standard monitoring, including central venous
pressure (CVP), is suboptimal.21,22 Clinical studies have shown CVP is not able to predict fluid
responsiveness21 and that changes in blood pressure cannot be used to track changes in
stroke volume (SV) or in cardiac output (CO) induced by volume expansion.22
Where do you want to be?
Optimal Volume Range
Hemodynamic optimization through
Perioperative Goal-Directed Therapy
(PGDT) can help ensure your patient is
maintained in the optimal volume range
and may help reduce post-surgical
complications.2 To examine individualized
therapy for your moderate to high-risk patients.
Run the volume
optimization simulation.
Complications from excessive and
insufficient volume administration
2,3
Maintaining patients in the optimal volume range
is key.

Clinical evidence demonstrates that optimal volume management is possible
when dynamic parameters are used within a protocol such as PGDT.2,3,24,25 Both
hypo- and hypervolemia may deleteriously affect organ function and lead to post-
surgical complications.2,3

It is important to note, even protocolized treatment requires individualized
therapy, as clinicians utilize each patient’s individual Frank-Starling curve
toward the goal of maintaining volume administration in the optimal zone.2
Value of dynamic and flow-based parameters
versus conventional care.
In patients at risk of developing complications, hemodynamic optimization using dynamic and
flow-based hemodynamic parameters such as Stroke Volume (SV), stroke volume variation (SVV) and
cardiac output (CO) may be useful, when used in PGDT, to decrease post-surgical morbidity.12

Stroke Volume (SV) and cardiac output (CO) are useful to assess the effects of fluid administration.12

SVV has been shown to have a very high sensitivity and specificity in determining fluid
responsiveness when compared to conventional indicators of volume status (HR, MAP, CVP). 26-28
Learn more about:
SV
SVV
DO2
CO
SV protocol studiesAbdominalBowelCardiacCystectomyGeneralHipTraumaVascular
Bisgaard 2012 X
Scheeren 2012 X
Pillai 2011 X
Jhanji 2010 X
Chytra 2007 X
Noblett 2006 X
Wakeling 2005 X
McKendry 2004 X
Conway 2002 X
Gan 2002 X
Venn 2002 X
Sinclair 1997 X
Mythen 1995 X
SVV protocol
studies
AbdominalAbdominal and VascularCardiacThoracic
Goepfert 2013 X
Zhang 2013 X
Zheng 2013 X
Ramsingh 2012 X
Scheeren 2012 X
Benes 2010 X
Mayer 2009 X
Mechanical Ventilation32,33
Currently, literature supports the use of SVV only on patients who are 100% mechanically (control mode) ventilated with tidal volumes of more than 8cc/kg and fixed respiratory rates.

Spontaneous Breathing32,33
Currently, literature does not support the use of SVV with patients who are spontaneously breathing due to the irregular nature of rate and tidal volumes.

Arrhythmias32,33
Arrhythmias can dramatically affect SVV values. Thus, the utility of SVV as a guide for volume resuscitation is greatest in absence of arrhythmias.

PEEP32,33
Increasing levels of positive end expiratory pressure (PEEP) may cause an increase in SVV, the effects of which may be corrected by additional volume resuscitation if warranted.

Vascular Tone32,33
The effects of vasodilatation therapy may increase SVV and should be considered before treatment with additional volume.
DO2 protocol studiesAbdominalGeneralGeneral and VascularHepatectomyHipTraumaVascular
Bisgaard 2012 X
Cecconi 2011 X
Jhanji 2010 X
Pearse 2005 X
Lobo 2000 X
Wilson 1999 X
Ueno 1998 X
Boyd 1993 X
Fleming 1992 X
Shoemaker 1988 X
PGDT can be implemented in a
single procedure or as part of a
larger initiative within ERAS, ERP,
GIFTSUP, NSQIP or Perioperative
Surgical Home.

You can implement Perioperative Goal-Directed Therapy
(PGDT) in a single procedure, to assess impact on
complication reduction. PGDT can also be implemented as
part of a larger initiative, to standardize the patient care you
deliver in your OR.
What you can do right now
to impact post-surgical complications.
YOU can take action now to reduce
preventable post-surgical complications by
23-56%5,6 in your moderate to high-risk
patients.

A large body of clinical evidence demonstrates significant clinical benefits
may be realized from Perioperative Goal-Directed Therapy (PGDT).5,6

Reduce volume administration variability
Standardize care and ensure your patient is maintained in the optimal volume
range with a PGDT protocol using advanced hemodynamic parameters.1,2,7,17,18

Reduce Length of Stay (LOS)
Hemodynamic optimization through a PGDT protocol is shown to reduce
hospital LOS by 1.16 – 1.95 days1,7 in your moderate to high-risk surgery patients, which may allow you to treat more patients.
Vision inspires action.


Your leadership can be as simple as bringing your surgical team together –
anesthesiologist, CRNA, anesthesia tech – to understand the clinical benefits of
hemodynamic optimization through PGDT.

You can make a difference to help reduce complications, LOS and associated costs. Act now to
implement PGDT and reduce preventable complications that are impacting you, your hospital,
and your patients’ long-term quality of life.
Start here. Start now.


What can you do, specifically,
to help achieve this benefit?


3
essential steps
Ask your anesthesiologist and surgical team
to learn more about PGDT protocols.


Review the resources available.
Review these discussion points with your anesthesiologist:
  • 1
    Implications of being
    out of range
    Complications from excessive and insufficient volume administration may deleteriously affect organ function. As seen in Figure 1, a U-shaped relationship is classically described between the amount of volume administered and the morbidity rate.2
  • 2
    Advanced hemodynamic monitoring
    versus conventional care
    Conventional fluid management, based on clinical assessment, vital signs and/or central venous pressure (CVP) monitoring, is suboptimal. Clinical studies demonstrate that CVP is not reliable predicting fluid responsiveness21 and that changes in blood pressure cannot be used to track changes in stroke volume (SV) or in cardiac output (CO) induced by volume expansion.22
  • 3
    Advanced hemodynamic parameters, when used in
    PGDT, are key to optimal volume administration
    In patients at risk of developing complications, hemodynamic optimization using a Perioperative Goal-Directed Therapy protocol which includes advanced hemodynamic parameters such as stroke volume (SV), stroke volume variation (SVV) and cardiac output (CO) may be useful to decrease post-surgical morbidity.29
  • 4
    Meta-analyses of protocols using dynamic and flow-based
    hemodynamic parameters have shown significant benefits
YOU can take action now
to impact post-surgical complications.


Maintain your patient in the optimal volume range, consistently, by making an evidence-based
choice to utilize advanced hemodynamic parameters in combination with standard monitoring.
Advanced hemodynamic parameters are informative in determining fluid responsiveness and may
help you avoid patient complications from excessive and insufficient volume administration.1-4,7,17,18


Advanced hemodynamic parameters such as stroke volume variation (SVV) and stroke volume
(SV), when used in PGDT, are key to optimal volume administration.12 See for yourself.
A large body of clinical evidence demonstrates that
you may reduce post-surgical complications in
moderate to high-risk surgeries by hemodynamically
optimizing your patients using PGDT.1,7,17,18
Individualized patient care.

PGDT can guide you in tailoring volume
administration to each individual patient.
Evidence-based PGDT can be used
intraoperatively to guide volume administration
according to each patient’s unique
Frank-Starling curve.2 Download the PGDT
protocol summary
.
Conventional vital sign monitoring is suboptimal
in determining fluid responsiveness.
Conventional volume management, based on clinical assessment that stresses vital
signs – blood pressure, heart rate (HR), respiratory rate and temperature – and/or
central venous pressure (CVP) monitoring, is not sufficient for maintaining your
moderate to high-risk surgical patients in the optimal volume range.23

Clinical studies have shown that CVP is not able to predict fluid responsiveness21 and
that changes in blood pressure cannot be used to track changes in stroke volume (SV)
or in cardiac output (CO) induced by volume expansion.22
Optimal Volume Range
Figure 1. Complications from excessive
and insufficient volume administration2,3
Dangers of being out of range
Complications from excessive and
insufficient volume administration may
deleteriously affect organ function.2,3 As
seen in Figure 1, a U-shaped relationship
is classically described between the
amount of volume administered and the
morbidity rate.2
View animation on physiologic
implications of appropriate resuscitation
Excessive volume administration: 2,3
  • Pulmonary edema, prolonged mechanical ventilation1,17
  • GI dysfunction (abdominal compartment syndrome, ileus, anastomotic leak)18
  • Hemodilution and coagulopathy*
Insufficient volume administration: 2,3
  • Low preload, low cardiac output, low BP, low perfusion 2
  • Arrhythmia (hypovolemia) 2
  • GI dysfunction (postoperative ileus, PONV, upper GI bleeding, anastomotic leak 18
  • Infectious complication (tissue hypoperfusion) 2
  • Acute renal insufficiency or failure 2
Learn more about:
SV
SVV
DO2
CO
SV protocol studiesAbdominalBowelCardiacCytectomyGeneralHipTraumaVascular
Bisgaard 2012 X
Scheeren 2012 X
Pillai 2011 X
Jhanji 2010 X
Chytra 2007 X
Noblett 2006 X
Wakeling 2005 X
McKendry 2004 X
Conway 2002 X
Gan 2002 X
Venn 2002 X
Sinclair 1997 X
Mythen 1995 X
SVV protocol
studies
AbdominalAbdominal and vascularCardiacThoracic
Goepfert 2013 X
Zhang 2013 X
Zhang 2013 X
Ramsingh 2012 X
Scheeren 2012 X
Benes 2010 X
Mayer 2009 X
Mechanical VentilationX5
Currently, literature supports the use of SVV only on patients who are 100% mechanically (control mode) ventilated with tidal volumes of more than 8cc/kg and fixed respiratory rates.

Spontaneous BreathingX5
Currently, literature does not support the use of SVV with patients who are spontaneously breathing due to the irregular nature of rate and tidal volumes.

ArrhythmiasX5
Arrhythmias can dramatically affect SVV values. Thus, the utility of SVV as a guide for volume resuscitation is greatest in absence of arrhythmias.

PEEPX5
Increasing levels of positive end expiratory pressure (PEEP) may cause an increase in SVV, the effects of which may be corrected by additional volume resuscitation if warranted.

Vascular ToneX5
The effects of vasodilatation therapy may increase SVV and should be considered before treatment with additional volume.
DO2 protocol studiesAbdominalGeneralGeneral and vascularHepatectomyHipTraumaVascular
Bisgaard 2012 X
Cecconi 2011 X
Jhanji 2010 X
Pearse 2005 X
Lobo 2000 X
Wilson 1999 X
Ueno 1998 X
Boyd 1993 X
Fleming 1992 X
Shoemaker 1988 X
Examine the issues and benefits of controlling
volume administration variability using advanced
hemodynamic parameters.
Vision inspires action.


Your leadership can make a difference.
Edwards’ Enhanced Surgical Recovery Program process can help your hospital implement PGDT.
Act now to consistently maintain your patient in the optimal range – and help reduce
preventable complications.
Start here. Start now.


What can you do, specifically,
to help achieve this benefit?


3
essential steps
Encourage your surgeon and your surgical team
to learn more about PGDT Protocols.

Review the educational resources
available to your Hospital Administrator
or Quality Officer
Review these
discussion points
with your surgeon:
Meta-analyses of protocols using dynamic and flow-based
hemodynamic parameters have shown significant benefits
Take action now to standardize care and make a
difference for your surgical team and your patients.

A large body of clinical evidence demonstrates that hemodynamic optimization through PGDT
reduces post-surgical complications 5,6 and reduces LOS and associated costs
in your moderate to high-risk surgery patients.1,7

Hemodynamic optimization through PGDT
Reduced
complications by
23 - 56%.5,6
Reduced LOS by
1.16 – 1.95
days 1,7
Hemodynamic optimization through PGDT is
demonstrated to reduce costs and increase efficiency,
which may enable you to treat more patients6,30
Complications are costly.20
20
Approximate extra cost of treating 1+ complication

Average in U.S.
Estimate the
economic burden of
post-surgical
complications in your
own institution.

What could your hospital save in one
year by implementing PGDT in one
procedure?
Estimate the potential economic
benefits of hemodynamic optimization
through PGDT for your hospital.
Complications are
responsible for
prolonged LOS20 and
readmissions.31

Hemodynamic optimization through
PGDT is demonstrated to reduce
hospital length of stay by 1.16 – 1.95
days in moderate to high-risk
surgery patients.
1,7
Complications
impact patient
long-term survival.4,9

Independent of preoperative patient
risk, the occurrence of even a single
complication within 30 days reduced
median patient survival by 69%.
9

The most important determinant of
post-surgical survival
was the
occurrence of any complication within
30 days post-surgery.9
Vision inspires action.


Your leadership is vital.
With you as a champion, Edwards’ Enhanced Surgical Recovery Program can help
your hospital implement and sustain compliance of PGDT in your moderate
to high-risk surgery patients.

The program includes an online resource center with forms
and expansive educational tools.
Start here. Start now.


What can you do, specifically, to help your hospital
achieve this benefit?


2
essential steps
1.
Champion the implementation of an evidence-based protocol (PGDT) using
advanced hemodynamic parameters as SOP in your moderate to high-risk
surgeries

2.
Align your surgical teams in support of these parameters and protocols in
order to help reduce complications
The clinical expertise you need to implement
evidence-based protocols.


The Edwards’ Enhanced Surgical Recovery Program can help you align staff across
departments, deliver metric tracking tools, and facilitate peer-to-peer exchange of best practices.

Encourage your surgeons, anesthesiologists and CRNAs to learn more about the
significant clinical benefits of hemodynamic optimization through PGDT.
You can make a difference.
This program can help you implement Perioperative Goal-Directed Therapy
(PGDT) today in your moderate to high-risk surgeries. Start here. Start now.
The Edwards’ Enhanced Surgical Recovery Program is a 4-step process designed to help your surgical
team implement hemodynamic optimization through PGDT in your hospital.
  • Select surgical procedure(s)
  • Assess current morbidity rate and/or LOS
  • Estimate potential clinical and economic benefits of PGDT
  • Build core team
  • Choose PGDT treatment protocol
  • Choose a hemodynamic monitoring platform
  • Train and develop competence
  • Establish PGDT as new SOP and add to checklist
  • Analyze morbidity rates and/or LOS
  • Measure clinical and economic outcome benefits
When evidence
inspires action.

Your vision for reducing patient complications
begins with an evidence-based choice to
implement PGDT. Edwards’ Enhanced Surgical
Recovery Program process can help you
implement and sustain compliance of PGDT.
What your peers
are saying.

If you would like to join our
community (coming soon), please
sign up via the link below.
PGDT Protocols
*Data on file

References:
1.
Grocott et al. Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a
Cochrane systematic review. Br J Anaesth 2013
2.
Bellamy MC. Wet, dry or something else? Br J Anaesth 2006;97(6):755-757
3.
Cannesson M. Arterial pressure variation and goal-directed fluid therapy. J Cardiothorac Vasc Anesth
2010;24(3):487-497
4.
Ghaferi, A. et al. Variation in Hospital Mortality Associated with Inpatient Surgery. N Engl J Med 2009
5.
Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic
intervention to improve postoperative outcomes in moderate and high risk surgical patients. Anesth Analg 2011; 112:
1392–402
6.
Pearse M, Harrison D, MacDonald N, et al. For the OPTIMISE Study Group. Effect of a Perioperative, Cardiac
Output-Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastro-Intestinal Surgery: A
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