Understanding the connections between hemodynamic parameters, fluid administration, perfusion, and patient outcomes.

In surgical and critically ill patients, studies show that optimizing fluid management leads to improved patient outcomes.1,2 Yet traditional volume management methods, based on conventional parameters such as heart rate and arterial and right-heart pressures, may not provide adequate insight to optimize flow for each individual patient.3 In fact, 50% of patients given fluids show no increase in stroke volume.4 Advanced hemodynamic parameters such as stroke volume (SV) and stroke volume variation (SVV), are key to optimal fluid administration.

SVV has been proven to be a highly sensitive and specific indicator for preload responsiveness when managing perfusion. As a dynamic parameter, SVV has been shown to be an accurate predictor of fluid responsiveness in loading conditions induced by mechanical ventilation.5-7

To maintain adequate perfusion in the operating room and ICU, it’s important to understand what works and why.

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At Edwards Lifesciences, we offer a wealth of educational resources on fluid management —including webinars, videos, and PDF references. Edwards Clinical Education resources are available on mobile, tablet, and desktop platforms to meet you wherever you go.

References:
  1. Bellamy MC, Wet Dry or Something Else? British Journal of Anaesthesia, 2006: 755-7.
  2. Cannesson M., Arterial Pressure Variation and Goal-Directed Fluid Therapy, Journal of Cardiothoracic and Vascular Anesthesia, 24.3 (2010): 487-497.
  3. Le Manach Y, et al. Can Changes in Arterial Pressure be Used to Detect Changes in Cardiac Output during Volume Expansion in the Perioperative Period?. Anesthesiology 2012;117(6):1165-1174.
  4. Marik P, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature. Critical Care Medicine. (2009): 37(9):2642-2647.
  5. Berkenstadt H, Margalit N, Hadani M, et al. “Stroke Volume Variation as a Predictor of Fluid Responsiveness in Patients Undergoing Brain Surgery.” Anesthesia and Analgesia 2001;92:984-9
  6. 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
  7. 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.

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References:
  1. Bellamy MC, Wet Dry or Something Else? British Journal of Anaesthesia, 2006: 755-7.
  2. Cannesson M., Arterial Pressure Variation and Goal-Directed Fluid Therapy, Journal of Cardiothoracic and Vascular Anesthesia, 24.3 (2010): 487-497.
  3. Le Manach Y, et al. Can Changes in Arterial Pressure be Used to Detect Changes in Cardiac Output during Volume Expansion in the Perioperative Period?. Anesthesiology 2012;117(6):1165-1174.
  4. Marik P, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature. Critical Care Medicine. (2009): 37(9):2642-2647.
  5. Berkenstadt H, Margalit N, Hadani M, et al. “Stroke Volume Variation as a Predictor of Fluid Responsiveness in Patients Undergoing Brain Surgery.” Anesthesia and Analgesia 2001;92:984-9
  6. 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
  7. 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.

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