Proactively manage intraoperative hypotension (IOH)

The FloTrac system provides access to advanced hemodynamic parameters to allow you to evaluate hemodynamic instability and guide appropriate treatment.

Clarity through advanced hemodynamic monitoring parameters CO, SV, SVV and SVR provided by the FloTrac system can help you determine if the cause of IOH is preload, afterload or contractility.

If the underlying cause of hemodynamic instability is related to flow generation, continuous parameters provided by the FloTrac system can help you determine appropriate fluid therapy.

Continuous assessment of pressure and flow parameters offers proactive decision support to help proactively manage the duration and severity of IOH episodes.

Why is My Patient Hypotensive and Does it Matter? (ASA 2017)

Webinar

Guide individualized fluid management

When managing perfusion, stroke volume can be optimized using the patient’s own Frank-Starling curve – a plot of SV vs. preload. The patient’s location on the curve can be determined by measuring changes in SV in response to change in preload using a bolus fluid challenge or passive leg raise (PLR).

Dynamic and flow-based parameters are more informative than conventional parameters in determining fluid responsiveness and may help guide individualized volume administration in patients and avoid excessive and insufficient administration.¹

Additionally, stroke volume variation (SVV) has been proven to be a highly sensitive and specific indicator for preload responsiveness when managing volume. As a dynamic parameter, SVV has been shown to be an accurate predictor of fluid responsiveness in loading conditions induced by mechanical ventilation.^2-5

Frank-Starling relationship between preload and stroke volume (SV)

1. Cannesson, M. (2010) Arterial pressure variation and goal-directed fluid therapy. Journal of Cardiothoracic and Vascular Anesthesia, 24(3), 487-97.
2. Berkenstadt, H., et al. (2001) Stroke Volume Variation as a Predictor of Fluid Responsiveness in Patients Undergoing Brain Surgery. Anesthesia & Analgesia, 92, 984-9.
3. Cannesson, M. (2010) Arterial pressure variation and goal-directed fluid therapy. Journal of Cardiothoracic and Vascular Anesthesia, 24(3), 487-97.
4. Peng, K., Li, J., Cheng, H., Ji, FH. (2014) Goal-directed fluid therapy based on stroke volume variations improves fluid management and gastrointestinal perfusion in patients undergoing major orthopedic surgery. Medical Principles and Practice, 23(5), 413-20.
5. Michard, F., Mountford, W., Krukas, M., Ernst, F., Fogel, S. (2015) Potential return on investment for implementation of perioperative goal-directed fluid therapy in major surgery: a nationwide database study. Perioperative Medicine, 4,11.

Pressure and Flow (3 of 3)

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Hemodynamic Assessment and Fluid Management

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Optimizing fluid therapy with advanced monitoring

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Manage variability in volume administration

Advanced hemodynamic parameters provided by the FloTrac system may be used in Perioperative Goal-Directed Therapy (PGDT) protocols to help reduce variability in fluid administration and guide optimal volume management in patients at risk of developing complications.

Optimizing Perioperative Hemodynamic Management

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Continuous clarity into your patient’s Frank-Starling curve

The algorithm of the FloTrac system utilizes advanced waveform processing to adjust dynamically for vascular tone (resistance and compliance) in addition to patient specific variables (age, gender, body surface area, etc.) in order to calculate the key flow related parameters stroke volume and cardiac output.

The result is an enhanced ability to determine the adequacy of cardiac flow, which comprises the Y-axis of the Frank-Starling Curve.

Additionally, the FloTrac system measures preload responsiveness for the X-axis of the Frank-Starling curve through one of three distinct, practical methods:

• Stroke Volume Variation (SVV): For control-ventilated patients, SVV has been proven to be a highly sensitive and specific indicator for preload responsiveness.¹ As a dynamic parameter, SVV has the advantage of predicting whether a patient will benefit from volume before fluid is given.
• Passive Leg Raising (PLR): In situations where it is not possible to use SVV (i.e., during arrhythmias, when patients are not on control-mode of ventilation, or in patients at risk of complications from fluid loading), simply raising the legs has been proven clinically to act as a “self volume challenge” to indicate the patient’s status on the Frank-Starling curve.² If the patient is fluid-responsive, SV will increase substantially.
• SV Fluid Challenge: In the rare case when neither SVV nor PLR is feasible, the FloTrac system provides a highly efficient method for assessing fluid responsiveness via a standard fluid challenge.^3-5 The administration of a small volume of fluid (e.g., 250-500 mL) and observance of the corresponding change in SV and/or CO can indicate whether further volume will improve cardiac performance.

Methods for Assessing Fluid Responsiveness

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Fluid Response Simulator

Simulation

1. Hofer CK, Muller SM, Furrer L, Klaghofer R, Genoni M, Zollinger A. “Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting.” Chest 2005;128:848-854.
2. Monnet X, Rienzo M, Osman D, et al. “Passive leg raising predicts fluid responsiveness in the critically ill.” Crit Care Med 2006 Vol.34, No. 5.
3. Reuter DA, Felbinger TW, Schmidt C, et al. “Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery.” Intensive Care Med 2002;28:392-398.
4. Reuter DA, Felbinger T, Kilger F, Schmidt C, Lamm P, Goetz AE. “Optimizing fluid therapy in mechanically ventilated patients after cardiac surgery by online monitoring of left ventricular stroke volume variations: a comparison to aortic systolic pressure variations.” Br J Anaesth 2002;88:124-126.
5. Cannesson M, Attof Y, Rosamel P, et al. “Respiratory variations in pulse oximetry plethysmographic waveform amplitude to predict fluid responsiveness in the operating room.” Anesthesiology 2007;106:1105-1111.

FloTrac system algorithm version 4.0

Offers specific monitoring of a broader range of changing patient conditions

The 4.0 version of the FloTrac system algorithm uses expanded patient data to include more diverse clinical situations and high-risk surgical procedures, such as gastrointestinal, pancreaticoduodenectomy (whipple), kidney transplant, nephrectomy, hip replacement and esophagectomy.

To recognize and adjust for more patient conditions, the version 4.0 algorithm is modeled and compared across a wide range of hemodynamic values, patient profiles, pathologies and hemodynamic conditions.

Helps guide volume resuscitation despite most arrhythmias

Clinicians can now monitor and utilize SVV as a reliable indicator of preload responsiveness in most patients despite significant arrhythmias, even multiple premature atrial or ventricular contractions (PACs and PVCs).

Through continuous beat detection and analysis, the FloTrac system 4.0 algorithm allows for the ongoing use of Stroke Volume Variation as a reliable indicator of preload responsiveness. The FloTrac system algorithm enables the display and use of SVV in patients with multiple premature atrial or ventricular contractions and allows the clinician to guide volume resuscitation despite most arrhythmias.

Estimation of Stroke Volume Variation by the SVVxtra algorithm is based on detection of abnormal beats, interpolation of remaining beats, restoration of missing beats, and calculation of Stroke Volume Variation¹

1. Patent WO 2011/094487 A2, Elimination of the Effects of Irregular Cardiac Cycles in the Determination of Cardiovascular Parameters