FloTrac System

Stroke Volume Optimization% Change in Stroke Volume (∆SV) is a sensitive method for

assessing preload responsiveness on all patients.

SV Reduction >10%

Monitor Stroke Volume

200 – 250 ml Fluid Challenge Over 5 – 10 min*

Monitor Stroke Volume for Clinical Signs of Fluid Loss

SV Increase >10% YES NO

NO

YES

Oesophageal Doppler-guided fluid management during major surgery: reducing postoperative complications and bed days. NHS Technology Adoption Centre. January 2012.

*A passive leg raising maneuver over 1-2 min. can also be used as a fluid challengeMonnet X, Teboul JL. Passive Leg Raising. Intensive Care Med. 2008 Apr; 34 (4): 659-63.

Stroke Volume Variation OptimizationStroke Volume Variation (SVV) is a reliable indicator of

preload responsiveness on control-ventilated patients with no icon displayed

McGee WT, A Simple Physiologic Algorithm for Managing Hemodynamics Using Stroke Volume and Stroke Volume Variation: Physiologic Optimization Program.

J Intensive Care Med. 2009 Nov; 24 (6): 352-60.

Volume Responsive SVV>13%

SVI High (>50)SVI Low (<40)SVI Normal (40-50)

Pressor Inotrope Diuretic

NoYes

Volume Challenge

Not meeting perfusion requirements

Stroke Volume Variation (on control-ventilated patients): Variation in arterial pulsations caused by heart-lung changes

during positive pressure ventilation.

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, and FloTrac are trademarks of Edwards Lifesciences Corporation. © 2012 Edwards Lifesciences Corporation. All rights reserved. AR08052

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NOrmal raNgE4.0 - 8.0 L/min

2.5 - 4.0 L/min/m2

60 - 100 mL/beat33 - 47 mL/beat/m2

800 - 1200 dynes - sec/cm-5

1970-2390 dynes - sec/cm-5/m2

<13%

ParamETErCO (Cardiac Output)CI (Cardiac Index)

SV (Stroke Volume)SVI (Stroke Volume Index)

SVR (Systemic Vascular Resistance)SVRI (Systemic Vascular Resistance Index)

SVV (Stroke Volume Variation)

Increasing SV with fluid until the plateau of the Frank-Starling curve is reached has been shown to improve the outcome of high-risk surgery patients. Michard F. Changes in arterial pressure during mechanical ventilation. Anesthesiology. 2005; 103: 419-28.

Frank-Starling Curve: Relationship between preload status and fluid-induced

increases in stroke volume.

Airway Pressure

Arterial Pressure

ExpirationControlled Ventilation

InspirationControlled Ventilation

25

20

15

10

5

0

-5

SVmax

SVmin

0 1000 2000 3000 4000 5000 6000 7000

%SVV = SVmax-SVmin

SVmean

Stroke VolumeContinueFluid

DiscontinueFluid

Continue Fluid

∆P = fluid-induced increase in preload

Preload

∆SV > 10%

∆SV > 10%∆SV < 10%

Airway Pressure

Arterial Pressure

ExpirationControlled Ventilation

InspirationControlled Ventilation

25

20

15

10

5

0

-5

SVmax

SVmin

0 1000 2000 3000 4000 5000 6000 7000

%SVV = SVmax-SVmin

SVmean

Airway Pressure

Arterial Pressure

ExpirationControlled Ventilation

InspirationControlled Ventilation

25

20

15

10

5

0

-5

SVmax

SVmin

0 1000 2000 3000 4000 5000 6000 7000

%SVV = SVmax-SVmin

SVmean