Adequate perfusion requires adequate arterial pressure and cardiac output (CO)
Cardiac Output (CO) = Stroke Volume x Heart Rate
Maintaining patients in the optimal volume range is key. Using dynamic and flow-based parameters to guide fluid administration helps maintain patients in the optimal volume range.1
Preload: the tension of myocardial fibers at the end of diastole, as a result of volume in the ventricle
Stroke Volume (SV): volume of blood pumped from the left ventricle per heartbeat
When managing perfusion, stroke volume can be optimized using the patient’s own Frank-Starling curve — a plot of stroke volume (SV) vs. preload.
The patient’s location on his or her Frank-Starling curve can be determined by measuring ∆SV in response to change in preload using:
Dynamic and flow-based parameters are more informative than conventional parameters in determining fluid responsiveness and may help you avoid excessive and insufficient fluid administration.7
Clinical studies have shown that conventional volume management methods, based on conventional parameters, are misleading and insensitive.6
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.6,8,9
Post-surgical complications have an impact on human life.10
Major complications occur in approximately 16% of surgeries.10
Independent of preoperative patient risk, the occurrence of even a single post-surgical complication within 30 days reduced median patient survival by 69%.11
Hemodynamic optimization through PGDT is demonstrated to reduce complications like acute kidney injury (AKI) and surgical site injury (SSI), as well as reduce length of stay, and associated costs in your moderate to high-risk surgery patients.12,13
Hemodynamic optimization through PGDT can:
Reduce post-surgical complications by an average of 32%14
Average reduce length of stay: 1+ days14, 15
Approximate extra cost of treating one post-operative complication: $18,00016
PGDT is a treatment protocol using dynamic and flow-based hemodynamic parameters with the objective of making the appropriate volume management decisions (e.g. fluid only when needed). PGDT can be implemented in a single procedure or as part of a larger initiative such as Enhanced Recovery After Surgery pathways.
50+ randomized controlled trials and 14+ meta-analyses have demonstrated clinical benefits of hemodynamic optimization over standard volume management.
With a long-term commitment to improving the quality of care for surgical and critical care patients through education, Edwards Clinical Education meets you no matter where you are in the learning process — with a continuum of resources and tools that continuously support you as you solve the clinical challenges facing you today, and in the future.
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