High-Risk Surgery

KNOWUN NS?

FLOTRAC SENSOR • PRESEP OXIMETRY CATHETER • EV1000 CLINICAL PLATFORM

Clarity in Fluid Optimization

graphiCal trend sCreen physiOlOgy sCreen

Determine the Appropriate Intervention

Determine if Patient is Fluid-Responsive

> 15% = Fluid

< 10% = No FluidSVV

% Change After Bolus< 10% = No Fluid> 10% = Fluid

SV

Monitoring and optimizing SV with the FloTrac

sensor enables an individualized approach for

delivering fluid, until SV reaches a plateau on

the Frank-Starling curve. This prevents

hypovolemia as well as excessive fluid

administration, which is a step in reducing

postoperative complications.

Stroke Volume Optimization7–15

For control-ventilated patients, SVV has proved

to be a highly sensitive and specific indicator for

pre-load responsiveness, serving as a marker on

the Frank-Starling curve. As a dynamic parameter,

SVV, which can be provided by the FloTrac sensor,

has the advantage of predicting whether a patient

will benefit from volume before the fluid is given.17,18

Stroke Volume Variation Optimization16

During surgery, as long as oxygen consumption

is stable, ScvO2 can be used as a surrogate for

DO2. The PreSep oximetry catheter provides

continuous ScvO2. An ScvO2 value of > 73%

can be targeted using fluid (including red blood

cells) and inotropic agents.

Central Venous Oxygen Saturation Optimization19

FLOTRAC SENSOR

PRESEP OXIMETRY CATHETER

EV1000 CLINICAL PLATFORM

Trusted by more clinicians and used on over

1 million patients, the FloTrac sensor is less

invasive and easily connects to any existing

arterial catheter. Studies indicate that hemodynamic

management can be more dynamically assessed through

the use of Stroke Volume (SV) and Stroke Volume Variation

(SVV)2 –6; the FloTrac sensor automatically calculates SV and SVV

every 20 seconds, as well as Continuous Cardiac Output (CCO)

and Systemic Vascular Resistance (SVR). Guiding with these

parameters gives you the ability to drill down on the root cause

of inadequate oxygen delivery, making the FloTrac sensor the

easy and reliable solution for guiding therapeutic intervention.

KNOW AN INTEGRATED SYSTEM FOR

HEMODYNAMIC MANAGEMENT

Mean arterial pressure and central venous pressure have historically been the primary parameters utilized for assessing fluid responsiveness. But to minimize unknowns and more accurately determine your patient’s fluid status, it’s crucial to see the bigger picture with integrated, goal-directed hemodynamic management and advanced hemodynamic parameters, such as SV, SVV and ScvO2.

The hemodynamic management system from Edwards Lifesciences is designed to intuitively display advanced hemodynamic management parameters.1 Featuring the FloTrac sensor, PreSep oximetry catheter and EV1000 clinical platform, the system provides dynamic indicators of fluid responsiveness and helps verify the efficacy of fluid therapy.

By utilizing SV, SVV and ScvO2, you can assess your patient’s condition with assurance. And because it’s from Edwards Lifesciences, creator of the gold-standard Swan-Ganz catheter and a pioneer in hemodynamic management, you can rely on the system to provide clarity in the moments that matter most.

The FloTrac sensor can help you confirm that your patient

is receiving optimal fluid therapy, while the PreSep oximetry

catheter continuously monitors and provides critical

information on the balance between oxygen delivery

and consumption.

Information from both can be displayed on the EV1000 clinical

platform, which presents the physiologic status of the patient

in an entirely new and meaningful way. The platform allows

you to choose your own personal view, while at-a-glance

visuals let you make faster, more informed decisions and

determine best courses of action.

An advanced solution for guiding therapy

> 73% = Limited Organ Dysfunction

< 73% = Organ Dysfunction PossibleScvO2

Evaluate the Balance Between Oxygen Delivery and Consumption

1. Marik P, et al. Does central venous pressure predict fluid responsiveness? A systemic review of the literature and the Tale of Seven Mares. Chest. 2008;134;172–178.

2. Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–2647.

3. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121(6):2000–2006.

4. McGee WT. A simple physiologic algorithm for managing hemodynamics using stroke volume and stroke volume variation: physiologic optimization program. J Intensive Care Med. 2009;24(6):352–360.

5. Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpeel P. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology. 1998;89(6):1313–1321.

6. Michard F, Boussat S, Chemia D, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med. 2000;162(1):134–138.

7. Cecconi M, Fasano N, Langiano N, et al. Goal directed haemodynamic therapy during elective total hip arthrosplasty under regional anaesthesia. Crit Care. 2011;15:R132

8. 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.

9. 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.

10. 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. 2002;88(1):65–71.

11. 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. 2002;57(9):845–849.

12. 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 optimisation of circulatory status after cardiac surgery. BMJ. 2004;329:358.

13. 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.

14. 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.

15. 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.

16. Benes J, Chytra I, Altmann P, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care. 2010;14:R118.

17. Michard F, Teboul JL: Predicting fluid responsiveness in ICU patients: A critical analysis of the evidence. Chest 2002; 121:2000–2008

18. Feissel M, Teboul JL, Merlani P, et al: Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive Care Med 2007; 33:993–999

19. Donati A, Loggi S, Preiser JC, 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.

20. Rhodes A, Cecconi M, Hamilton M, et al. Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study. Intensive Care Med. 2010;36(8):1327–1332

21. 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(6):1392–1402.

References:

Figure 1. Improved Survival for Protocol Patients20

Clinical evidence indicates that goal-directed

hemodynamic management of high-risk surgical

patients not only improves short-term outcomes but

also increases long-term survival (Figure 1).20,21 And along

with educational tools and support, the hemodynamic

management system lets you, the clinician, integrate

goal-directed therapy directly into your practice for

greater clarity and improved outcomes for your patients.

KNOW IMPROVED OuTCOMES

FOR YOuR PATIENTS—

TODAY AND TOMORROw

Edwards Lifesciences Irvine, USA I Nyon, Switzerland I Tokyo, Japan I Singapore, Singapore I São Paulo, Braziledwards.com

For professional use. CAUTION: Federal (United States) law restricts this device to sale by or on the order of a physician. See instructions for use for full prescribing information, including indications, contraindications, warnings, precautions and adverse events.

Edwards Lifesciences devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity.

Edwards, Edwards Lifesciences, the stylized E logo, EV1000, FloTrac, PreSep and Swan-Ganz are trademarks of Edwards Lifesciences Corporation. © 2012 Edwards Lifesciences Corporation. All rights reserved. AR07859

Visit www.Edwards.com/ECCS to learn more.

0 2,000 4,000 6,000

P = 0.0046

Control

protocol

perc

ent

surv

ival

0

2

0

4

0

6

0

8

0

1

00

time (days)

Helping to advance the care of the critically ill for 40 years, Edwards Lifesciences seeks to provide the valuable information

you need, the moment you need it. Through continuing collaboration with you, ongoing education and our never-ending quest

for advancement, our goal is to deliver clarity in every moment.