optimal volume range. The control to reduce variability in
parameters in the OR
used in a clinician-directed PGDT
protocol are key to optimal volume
monitoring solutions that can be utilized perioperatively from the OR to the ICU.
Edwards’ hemodynamic monitoring solutions provide
advanced hemodynamic parameters shown to be more
informative in determining fluid responsiveness than
conventional pressure-based parameters, such as mean
arterial pressure (MAP) and central venous pressure (CVP). 1,2
Each of Edwards’ monitoring solutions offers continuous
dynamic and flow-based information which may be used in
Perioperative Goal-Directed Therapy (PGDT) to
consistently maintain your moderate to high-risk surgery
patients in the optimal volume range. 3
A clinician-directed treatment protocol, which
defines and treats to a goal, using advanced
hemodynamic parameters, with the objective
of consistently maintaining patients in the
optimal volume range during surgery.
Based on the complexity of each procedure, and patient risk factors, choose your preferred dynamic and
flow-based parameters and the appropriate Edwards’ hemodynamic monitoring solution to suit your
clinical approach and your moderate to high-risk surgical patients’ needs.
Edwards delivers an array of product support, tools and educational resources to help you advance patient care by extending
the benefits of reduced variability in volume administration to a broader range of patients, and more moderate
to high-risk surgical procedures.
30+ randomized controlled trials and 14+ meta-analyses have demonstrated clinical benefits of hemodynamic optimization utilizing a PGDT protocol and advanced parameters over standard volume management, including reducing post-surgical complications across a wide range of moderate to high-risk surgical populations. 4-7
Additionally, an extensive body of clinical evidence shows that goal-directed hemodynamic optimization of high-risk patients, initiated in the OR and continued in the ICU, not only improves short-term outcomes, but also increases long-term survival. 8-27
in the optimal volume range.
preload and stroke volume (SV)
Optimal volume management is possible when dynamic and
flow-based parameters are used within a protocol such as
Perioperative Goal-Directed Therapy (PGDT). 3,28-30
Managing volume administration is not the same as
consistently maintaining your patient in the optimal volume
in guiding volume administration.
Deviations from hemodynamic stability may increase with more invasive procedures
and/or more severe clinical conditions. Continuous access to advanced hemodynamic
parameters offers immediate insight into patient physiologic status, giving you the clarity to
make more informed volume administration decisions to help you consistently maintain your
patients in the optimal volume range.3,8,23,25,26,38-42
Conventional volume management, based on standard
monitoring including central venous pressure (CVP) , is
Clinical studies have shown CVP is not able to predict fluid
responsiveness1 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. 2
Stroke Volume Variation (SVV) has demonstrated a higher
sensitivity and specificity in the assessment of circulating
blood volume when compared to conventional indicators of
volume status (HR, MAP, CVP) . 16,20,32
Stroke Volume Optimization (SV) 11,16-19,21-26
Stroke volume measurement with the ClearSight and FloTrac
systems enables an individualized approach for administering
fluid until SV reaches a plateau on the Frank-Starling curve, to
prevent hypovolemia and excessive fluid administration.
Stroke Volume Variation Optimization (SVV) 25
For control-ventilated patients, SVV has proved to be a highly
sensitive and specific indicator for pre-load responsiveness,
serving as an accurate marker of patient status on the
Oxygen Delivery Optimization (DO 2 with CCO) 23
Continuous cardiac output (CCO) measured by the ClearSight
and FloTrac systems can be used (in combination with SaO 2
and hemoglobin) to monitor and optimize DO 2 with fluid
(including red blood cells) and inotropic agents.
|SV protocol studies||Abdominal||Bowel||Cardiac||Cystectomy||General||Hip||Trauma||Vascular|
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 Breathing 35,36
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.
Arrhythmias can dramatically affect SVV values. Thus, the utility of SVV as a guide for volume resuscitation is greatest in absence of arrhythmias.
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 Tone 35,36
The effects of vasodilatation therapy may increase SVV and should be considered before treatment with additional volume.
|SVV protocol studies||Abdominal||Abdominal and vascular||Cardiac||Thoracic|
|DO 2 protocol studies||Abdominal||General||General and Vascular||Hepatectomy||Hip||Trauma||Vascular|
valuable insight to help guide volume administration.
offer advanced hemodynamic monitoring,
noninvasively, to a broader range of patients who may
be at risk for post-surgical complications. Learn more
hemodynamic monitoring solution trusted on over 2
million patients worldwide and used by more clinicians
than any other volume management solution.*
The Swan-Ganz pulmonary artery catheter gives you the clarity of a comprehensive hemodynamic profile delivered by
a single monitoring solution. It allows you to continually assess flow, pressure and oxygen delivery and consumption, to assist your early evaluation. For a continuous view of cardiac function that can enable earlier intervention in your critically complex patients, choose the parameters that best suit your clinical approach and your patient's need. Learn more
The EV1000 clinical platform clearly and simply presents your patient’s physiologic
status, giving you the clarity to make more informed volume administration
decisions. Get continuous access to clinically validated parameters * by using the
EV1000 clinical platform with the ClearSight system , FloTrac sensor , PreSep and
Edwards oximetry central venous catheter and VolumeView set.
A choice of hemodynamic monitoring options
to meet your clinical needs.
published. For a full listing of all studies, please contact your Edwards Lifesciences
through more informed volume administration.
solution to help my
hospital extend advanced
to more patients.
1. Marik & Cavallazzi. Does central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea
for some common sense. Crit Care Med 2013
2. Le Manach et al. Can changes in arterial pressure be used to detect changes in cardiac output during volume
expansion in the perioperative period? Anesthesiology 2013
3. Bellamy MC. Wet, dry or something else? Br J Anaesth 2006;97(6):755-757
4. 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
5. Giglio MT, Marucci M, Testini M, Brienza N. Goal-directed haemodynamic therapy and gastrointestinal complications in
major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth 2009; 103: 637–46
6. Dalfino L, Giglio MT, Puntillo F, Marucci M, Brienza N. Haemodynamic goal-directed therapy and postoperative
infections: earlier is better. A systematic review and meta-analysis. Crit Care 2011; 15: R154
7. Corcoran T et al. Perioperative Fluid Management Strategies in Major Surgery: A Stratified Meta-Analysis. Anesthesia –
8. Shoemaker WC, et al. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical
patients. Chest. 1988;23:1176–1186.
9. Boyd O, et al. A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality
in high-risk surgical patients. JAMA. 1993;270(22):2699–2707.
10. Mythen M, Webb A. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion
during cardiac surgery. Arch Surg. 1995;130(4):423–429.
11. Sinclair S, James S, Singer M. Intraoperative intravascular volume optimization and length of hospital stay after repair of
proximal femoral fracture: randomised controlled trial. AMJ.1997;315:909–912.
12. Ueno S, et al. Response of patients with cirrhosis who have undergone partial hepatectomy to treatment aimed at
achieving supranormal oxygen delivery and consumption. Surgery.1998;123(3):278–86.
13. Wilson J, Woods I, Fawcett J, Whall R, Dibb W, Morris C, et al. Reducing the risk of major elective surgery: randomised
controlled trial of preoperative optimisation of oxygen delivery. BMJ. 1999;318:1099–103.
14. Lobo SM, Salgado PF, Castillo VG, et al. Effects of maximizing oxygen delivery on morbidity and mortality in high-risk
surgical patients. Crit Care Med. 2000;28:3396–3404.
15. Pölönen P, Ruokonen E, Hippeläinen M, Pöyhönen M, Takala J. A prospective, randomized study of goal-oriented
hemodynamic therapy in cardiac surgical patients. Anesth Analg.2000;90:1052–1059.
16. Gan T, Soppitt A, Maroof M, et al. Goal-directed intraoperative fluid administration reduces length of hospital stay after
major surgery. Anesthesiology. 2002;97(4):820–826.
17. Venn R, Richardson P, Poloniecki J, Grounds M, Newman P. Randomized controlled trial to investigate influence of the
fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth.
18. Conway D, Mayall R, Abdul-Latif M, Gilligan S, Tackaberry C. Randomised controlled trial investigating the influence of
intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia.
19. McKendry M, McGloin H, Saberi D, Caudwell L, Brady A, Singer M. Randomised controlled trial assessing the impact of
a nurse delivered, flow monitored protocol for optimization of circulatory status after cardiac surgery. BMJ.
20. Pearse R, et al. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. Crit
21. Wakeling H, McFall M, Jenkins C, Woods W, Barclay G, Fleming S. Intraoperative oesophageal Doppler-guided fluid
management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth. 2005;95(5):634–642.
22. Noblett S, Snowden C, Shenton B, Horgan A. Randomized clinical trial assessing the effect of Doppler-optimized fluid
management on outcome after elective colorectal resection. BJS. 2006;93(9):1069–1076.
23. Donati A, Loggi S, Preiser J-C, Orsetti G, Munch C, Gabbanelli V, Pelaia P, Pietropaoli P. Goal-directed intraoperative
therapy reduces morbidity and length of hospital stay in high-risk surgical patients. Chest. 2007;132:1817–1824.
24. Chytra I, Pradl R, Bosman R, Pelnar P, Kasal E, Zidkova A. Esophageal Doppler-guided fluid management decreases
blood lactate levels in multiple-trauma patients: a randomized controlled trial. Crit Care. 2007;11:R24.
25. Benes J, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of
prospective randomized study. Crit Care. 2010;14:1-15.
26. Cecconi M, Fasano N, Langiano N, Divella M, Costa M, Rhodes A, Della Rocca G. Goal directed haemodynamic
therapy during elective total hip arthroplasty under regional anaesthesia. Crit Care. 2011;15:R132. doi:10.1186/cc10246.
27. Rhodes A, Cecconi M, Hamilton M, Poloniecki J, Woods J, et al. Goal-directed therapy in high-risk surgical patients: a
15-year follow-up study. Intensive Care Med. doi:10.1007/s00134-010-1869-6.
28. Cannesson M. Arterial pressure variation and goal-directed fluid therapy. J Cardiothorac Vasc Anesth
29. Berkenstadt H, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery.
Anesth Analg 2001;92:984-989.
30. Michard F. changes in arterial pressure during mechanical ventilation. Anesthesiology. 2005;103:419-428.
31. Michard & Biais. Rational fluid management: dissecting facts from fiction. Br J Anesth 2012.
32. O’Leary MJ: Preventing renal failure in the critically ill. BMJ 2001, 1437-1439
33. 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:
34. 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
Randomized Clinical Trial and Systemic Review. JAMA 2014 doi:10.1001/jama.2014.5305.
35. Michard F, Volume management using dynamic parameters: the good, the bad, and the ugly. Chest 2005;
36. Perel et al. Bench-to-bedside review: Functional hemodynamics during surgery – should it be used for all high-risk
cases? Critical Care 2013; 17:203
37. Boyd O, Jackson N. How is risk defined in high-risk surgical patient management? Crit Care. 2005;9(4):390-396.
38. Kuper M, Gold SJ, Callow C, et al. Intraoperative fluid management guided by oesophageal Doppler monitoring. BMJ.
39. Ramsingh DS, Sanghvi C, Gamboa J, et al. Outcome impact of goal directed fluid therapy during high risk abdominal
surgery in low to moderate risk patients: a randomized controlled trial [published December 2012]. J Clin Monit Comput.
40. Wang P, Wang HW, Zhong TD. Effect of stroke volume variability-guided intraoperative fluid restriction on
gastrointestinal functional recovery [published online ahead of print]. Hepatogastroenterology. 2012;59(120):2457-2460.
41. Bellamy MC. Wet, dry or something else? Br J Anaesth. 2006 Dec;97(6):755-7.
42. Benes J, Giglio M, Brienza N, Michard F. The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Crit Care. 2014 Oct 28;18(5):584.