Advanced hemodynamic parameters are more informative than conventional parameters and may alert you to critical changes in your high-acuity patient’s condition earlier. 1,2
Edwards’ advanced hemodynamic monitoring solutions provide the clarity you need to make proactive clinical decisions and address multiple pathologies, earlier, for your high-acuity patients. 3,4
Advanced Hemodynamic Parameters
Our broad portfolio offers choices to suit your clinical approach and your patients’ needs. Edwards’ noninvasive, minimally-invasive and comprehensive hemodynamic monitoring solutions enable you to escalate monitoring in response to changing patient acuity, to help guide your treatment strategy.
ClearSight Finger Cuff
CCO, SV, SVV, SVR, SVI, SVRI, cBP
CCO, SV, SVV, SVR, SVI, SVRI
Edwards Oximetry Central Venous Catheter
Swan-Ganz Pulmonary Artery Catheter
CO, CCO, SV, SVV, SVR, SVI, SVRI, SvO2, RVEF, RVEDV, PAOP, PADP
EV1000 Clinical Platform
Edwards’ hemodynamic monitoring solutions provide advanced hemodynamic parameters shown to be more dynamic, sensitive and specific than conventional vital signs or pressure-based parameters.1,2,5 This valuable clinical insight is useful to proactively determine appropriate interventions at appropriate magnitudes, for more informed management of your high-acuity ICU patients.
Advanced hemodynamic parameters allow you to continuously monitor the balance between oxygen delivery and oxygen consumption, and offer the ability to help investigate the root cause of an imbalance through analysis of the components of stroke volume (preload, afterload, and contractility).
Understanding the interplay among parameters affecting DO2 and VO2 may enable you to compensate for imbalances that vary from obvious to hidden – helping you prevent over, under or inappropriate resuscitation.
Additionally, utilizing advanced hemodynamic parameters may help you identify effects of pathologies, or technologies (PEEP, RRT, ventilation), which can confound hemodynamics.
Through early identification of imbalances and root cause analysis, patients can be treated appropriately and interventions assessed, thus potentially avoiding tissue hypoxia, organ dysfunction and crisis interventions.
Flow parameters include cardiac output (CO) and cardiac index (CI), stroke volume (SV) and stroke volume index (SVI), and oxygen delivery (DO2). Mixed venous oximetry (SvO2) can be used as an indirect marker of oxygen delivery by determining the “adequacy of oxygen delivery” against oxygen consumption (VO2). 7,8 Central venous oximetry (ScvO2) can also be used in determining the adequacy of oxygen delivery with the understanding it usually differs +7% higher than SvO2 and this difference can widen greatly in shock states. However, ScvO2 trends with SvO2 90% of the time. 9
Stroke Volume (SV) and Stroke Volume Variation (SVV)
Continuous, flow-based parameters may alert you to changing patient acuity earlier than traditional indicators. 1,2,10,11 Evidence demonstrates flow-based parameters SVV and SV are specific and sensitive to volume status, compared with traditional indicators such as Central Venous Pressure (CVP) and Mean Arterial Pressure (MAP). 1,2,5,10,11
The noninvasive ClearSight finger cuff and minimally-invasively FloTrac sensor, when used with the EV1000 clinical platform, provide continuous access to informative SV and SVV parameters. The FloTrac sensor provides continuous blood pressure (cBP) via the arterial line.
Oxygen Delivery Optimization (DO2) with Continuous Cardiac Output (CCO)
Continuous cardiac output (CCO) measured by the noninvasive ClearSight Finger Cuff and minimally-invasive FloTrac Sensor can be used (in combination with SaO2 and hemoglobin) to monitor and optimize DO2 with fluid (including red blood cells) and inotropic agents. 12
Central Venous Oxygen Saturation (ScvO2)
ScvO2 is a global indicator of oxygen imbalance, making continuous ScvO2 monitoring key to the early assessment of the adequacy of the balance of oxygen delivery and consumption. 3,4
Continuous ScvO2 measurements delivered by the Edwards Oximetry Central Venous Catheter enable real-time assessment and proactive identification of the root cause of oxygen imbalance and tissue hypoxia.
Mixed Venous Oxygen Saturation (SvO2)
SVO2 is a global indicator of a threat to tissue oxygenation, and may alert you to a change in your patient’s condition sooner than conventional monitoring methods. 3,4
The Swan-Ganz pulmonary artery catheter offers continuous parameters on three major integrated elements – flow, pressure, oxygen delivery and consumption – for a comprehensive hemodynamic profile delivered by a single device.
Difference between SvO2 and ScvO2
Since SvO2 and ScvO2 are affected by the same four factors (cardiac output, hemoglobin, oxygenation, oxygen consumption), and trend together clinically, they are considered nearly interchangeable. 15,16 The exception is when calculating global physiologic profiles that use SvO2 as VO2. 9
The ranges are different due to sampling from different areas. ScvO2 is a measurement of blood returning from the upper extremities and the head measured from the superior vena cava. ScvO2 is a regional reflection of the balance DO2 and VO2. 9
SvO2 is a measurement of blood returning from the superior/inferior vena cava and coronary sinus measured at the pulmonary artery. SvO2 is a global indicator of the balance between DO2 and VO2, as it is a reflection of all venous blood, IVS, SVC and CS. 9
When is Change Significant?
ScvO2 and SvO2 are not static and fluctuate approximately + 5%. These values may show significant changes with activities or interventions such as suctioning; however, the values should recover within seconds. 17
Slow recovery is an ominous sign of the cardiopulmonary system’s struggle to respond to a sudden increase in oxygen demand. 17 When monitoring ScvO2 , clinicians should look for changes of + 5-10% that are sustained for more than 3-5 minutes, and then investigate each of the four factors that influence ScvO2 (cardiac output, hemoglobin, oxygenation, oxygen consumption). 17
Extra Vascular Lung Water (EVLW) and Pulmonary Vascular Permeability Index (PVPI) may alert you to the extent of pulmonary edema. Global End Diastolic Volume (GEDV) and Global Ejection Fraction (GEF) may inform proactive clinical decisions to improve contractility. 13,14
CLINICAL USES OF SVO2/SCVO2 MONITORING 9
BALANCE OF OXYGEN DELIVERY AND CONSUMPTION
If a patient escalates in severity of illness, your hemodynamic monitoring strategy may need to escalate, as well.
The noninvasive ClearSight finger cuff, minimally-invasive FloTrac sensor, and comprehensive Edwards Oximetry Central Venous Catheter and Swan-Ganz pulmonary artery catheter allow you to adapt your hemodynamic monitoring approach to meet individual patient needs, and offer the flexibility to allow you to scale up or down based on changing patient conditions.
A range of monitoring choices
|FloTrac Sensor||Edwards Oximetry|
Central Venous Catheter
Your hospital may have implemented Perioperative Goal-Directed Therapy (PGDT) utilizing advanced hemodynamic parameters in moderate to high-risk surgery to reduce volume administration variability, which has been shown to reduce post-surgical complications. 18-22
Edwards’ range of hemodynamic monitoring solutions can be used in PGDT – and from the OR to the ICU – to provide an immediate and intuitive view of your post-surgical patients’ hemodynamic condition.
Utilizing a single hemodynamic monitoring platform may decrease volume variability, by enabling hospital teams to make proactive clinical decisions guided by informative hemodynamic parameters. Edwards’ solutions offer the clarity for shared recognition of critical changes throughout the continuum of care.
CLOSED BLOOD SAMPLING (CBS)
Implementing evidence-based Closed Blood Sampling (CBS) in your ICU may reduce blood loss,23-25 iatrogenic anemia,23,25-27 and reduce transfusion needs and related complications24,26 compared to conventional blood sampling. Clinical studies versus conventional blood sampling procedures show CBS may lower contamination risk and may present the potential for reduction in catheter-related bloodstream infections (CRBSI).28,29
VAMP Plus System
VAMP Jr. System
To minimize blood loss during sampling, VAMP (Venous Arterial Blood Management and Protection) closed blood sampling systems incorporate an in-line reservoir that allows clinicians to reinfuse rather than discard the clearing volume. Needle-less VAMP Systems are designed to reduce infection, needle sticks, and blood waste associated with conventional blood sampling methods.23,28-30
The minimally-invasive FloTrac sensor may be paired with VAMP closed blood management systems to improve blood conservation while monitoring and managing high-risk patients with advanced hemodynamic parameters.
Edwards’ foundational hemodynamic monitoring solution, TruWave disposable pressure transducers, can be paired with VAMP closed blood sampling systems to create a single, integrated pressure monitoring and closed blood sampling system. VAMP Systems and TruWave transducers enable safe, simple and reliable closed blood sampling for effective patient blood management,25,29 and are compatible with Edwards’ advanced hemodynamic monitoring solutions.
EV1000 Clinical Platform
Edwards Oximetry Central Venous Catheter
Tools and Resources
Edwards offers a host of educational resources and tools – in person, in print and online – to support your understanding of hemodynamic and volumetric parameters to help you make proactive clinical decisions to improve patient care.
Edwards equips clinicians with relevant, science-based information regarding the clinical application of advanced hemodynamic and volumetric parameters. Online educational content is presented in sequential learning order to facilitate understanding.
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- McGee, WT. A Simple Physiologic Algorithm for Managing Hemodynamics Using Stroke Volume and Stroke Volume Variation: Physiologic Optimization Program. J intensive Care 2009 Nov-Dec;24(6):352-60 DOI: 10.1177/0885066609344908
- 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
- Pearse, R.M., Rhodes, A. Mixed and Central Venous Oxygen Saturation. Yearbook of Intensive Care and Emergency Medicine, 2005. p. 592-602
- Leadwig, Emma & Lewis, Peter A. Central venous oxygen saturation monitoring. British Journal of Cardiac Nursing, 2009. 4(2): p. 75-79.
- Truijen, J et al. Noninvasive Continuous Hemodynamic Monitoring. Journal of Clinical Monitoring and Computing 2012;26(4):267-268.
- Michard & Biais. Rational fluid management: dissecting facts from fiction. Br J Anaesth 2012
- Rady MY: Resuscitation of the Critically Ill in the ED: Responses of Blood Pressure, Heart Rate, Shock Index, Central Venous Oxygen Saturation, and Lactate. Am J Emerg Med 1996, 218-225.
- Pinsky MR: Hemodynamic monitoring in the intensive care unit. Clin Chest Med 2003, 549-560.
- Zaja J. Venous oximetry. Signa Vitae 2007; 2(1):6-10.
- Marik & Cavallazzi. Does central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med 2013 22.
- 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.
- 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.
- Cheatham ML, et al., “Right Ventricular End-diastolic Volume Index as a Predictor of Preload Status in Patients on Positive End-expiratory Pressure”, Critical Care Medicine, 1998;26:1801-1806.
- Kushimoto et al. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/ acute respiratory distress syndrome. Critical Care. 2012
- Reinhart K, Kuhn HJ, Hartog C, et al. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 2004; 30:1572-8. 16. Ladakis C, Myrianthefs P, Karabinis A, et al. Central venous and mixed venous oxygen saturation in critically ill patients. Respiration 2001; 68:279-85.
- Edwards Lifesciences white paper, Theory and Clinical Application of Continuous Fiberoptic Central Venous Oximetry (ScvO2) Monitoring.
- 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
- Ghaferi, A. et al. Variation in Hospital Mortality Associated with Inpatient Surgery. N Engl J Med 2009
- Corcoran et al. Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg 2012
- 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
- 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
- Peruzzi, W.T., et al., A clinical evaluation of a blood conservation device in medical intensive care unit patients. Critical Care Medicine, 1993. 21(4): p. 501-6.
- MacIsaac, C.M., et al., The influence of a blood conserving device on anaemia in intensive care patients. Anaesth Intensive Care, 2003. 31(6): p. 653-7
- Mahdy, S., et al., Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study. Middle East J Anesthesiol, 2009. 20(2): p. 219-23.
- Rezende E, F.M., Manoel Da Silva Junior J, et al, Closed system for blood sampling and transfusion in critically ill patients. Rev Bras Ter Intensiva, 2010. 22: p. 5
- Mukhopadhyay, A., et al., The use of a blood conservation device to reduce red blood cell transfusion requirements: a before and after study. Critical Care, 2010. 14(1): p. R7.
- Oto, J., et al., Comparison of bacterial contamination of blood conservation system and stopcock system arterial sampling lines used in critically ill patients. American Journal of Infection Control, 2012. 40(6): p. 530-4.
- Tang, M., et al., Closed Blood Conservation Device for Reducing Catheter-Related Infections in Children After Cardiac Surgery. Critical Care Nurse, 2014. 34(5): p.53-61. 30. O’Hare, D. and R.J. Chilvers, Arterial blood sampling practices in intensive care units in England and Wales. Anaesthesia, 2001. 56(6): p. 568-71.
- Dougherty L. Central venous access devices. Nurs Stand. 2000;14(43):45-50. [PubMed] Moureau N, Poole S, Murdock MA, Gray SM, Semba CP. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. J Vasc Interv Radiol. 2002;13(10):1009–