FloTrac Sensor

Clinical Utility
Fluid Imbalance Can Lead to Complications

Hypoperfusion Edema
Organ dysfunction Organ dysfunction
Adverse outcome Adverse outcome
Complications

Optimal

Hypovolemic Overloaded

Volume Load
The Value of Flow-based Parameters

Shows preload responsiveness if increased by 10% after:

- Fluid Challenge
- PLR

An indicator that predicts if a patient is preload responsive

Cardiac Output measured continuously can be used (in

combination with SaO2 and hemoglobin) to monitor and
calculate DO2
FloTrac Sensor Advanced Hemodynamic Parameters

Cardiac Output Cardiac Index

The amount of
blood that is Cardiac output
pumped by the Normal Range divided by the Normal range
heart per unit body surface 2.5-4.0
4.0-8.0 L/min area (BSA).
time, measured L/min/m2
in liters per
minute (l/min).

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FloTrac Sensor Advanced Hemodynamic Parameters

Stroke Volume
Stroke Volume
Index

The amount of
blood pumped Stroke Volume
by the left divided by the Normal range
Normal Range
ventricle of the body surface 33-47
heart in one 60-100
area (BSA) ml/m²/beat
contraction ml/beat

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FloTrac Sensor Advanced Hemodynamic Parameters

Systemic Vascular System Vascular

Resistance Resistance Index

A measure of
arteriolar
constriction or SVR multiplied
dilation throughout Normal Range by the body Normal Range
the body, calculated 800-1200 dynes- surface area 1970-2390
by dividing the sec/cm5 (BSA) dynes-
blood pressure by sec/cm5/m2
the cardiac output

6
FloTrac Sensor Advanced Hemodynamic Parameters

Stroke Volume Variation

The difference in Caused by blood

SV or arterial being shunted
pressure into & out of the The Normal
observed thoracic cavity &
range is
throughout a the chambers of
the heart by the 10-15%
respiratory cycle
while a patient is pressures (~13%)
mechanically associated with
ventilated ventilation

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An Individualized Approach to Fluid Administration

SV = (Cardiac Output/Heart Rate) x 1000

Adult Normal Range: 60 - 100 mL/beat

Frank-Starling Curve
 Give fluid until SV reaches a plateau
value along the Frank-Starling curve

 Help prevent hypovolemia

 Help prevent excessive fluid

administration
Stroke Volume Optimization

Changes in SV in response to a Passive Leg Raise can predict whether

fluid administration will affect cardiac output.

Methods:

 Fluid Challenge: observing changes in SV and CO after the administration of a

small volume of fluid will indicate whether additional fluid will increase cardiac
performance.

 Passive Leg Raises (PLR):

raising the legs acts as a self fluid challenge.
Stroke Volume Algorithm
Stroke Volume Optimization
% Change in Stroke Volume ( SV) is a sensitive method for
assessing preload responsiveness on all patients.

Monitor Stroke Volume

200 – 250 ml Fluid Yes

Challenge over 5 to 10
Minutes
SV Increase >10% Yes No SV Reduction >10%

No Monitor Stroke Volume

for Clinical Signs of
Fluid Loss

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Fluid Response Simulator – Normal Contractility

11
Fluid Response Simulator – Normal Contractility Post-
Bolus

12
Fluid Response Simulator – Decreased Contractility

13
Fluid Response Simulator – Decreased Contractility
Post-Bolus #1

14
Fluid Response Simulator – Decreased Contractility
Post-Bolus #2

15
Fluid Response Simulator – Decreased Contractility
Post-Bolus #3

16
Fluid Response Simulator -- ECCE
 [Link]/ecce

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Stroke Volume Variation (SVV) Optimization
Guiding Fluid Therapy in Controlled Ventilated Patients

How SVV is calculated:

References

1. Michard, Rational fluid management: dissecting facts from fiction, BJA, Volume 108, Number 3 2012.
2. 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.
3. Critical Care. 2010;14:R118.
4. 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.
5. Patent WO 2011/094487 A2, Elimination of the Effects of Irregular Cardiac Cycles in the Determination of Cardiovascular Parameters
6. Michard, Changes in Arterial Pressure during Mechanical Ventilation, Anesthesiology 2005; 103:419–28.
7. Fre´de´ric Michard, MD, PhD; and Jean-Louis Teboul, MD, PhD Predicting Fluid Responsiveness in ICU Patients* A Critical Analysis of the Evidence,
critical care review, 2000.
8. McGee, A Simple Physiologic Algorithm for Managing Hemodynamics Using Stroke Volume and Stroke Volume Variation: Physiologic Optimization
Program, J Intensive Care Med 2009; 24; 3522009
9. [Link]

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Thank you

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.

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All other trademarks are the property of their respective owners.
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