Case Study | October 05, 2006

Stroke Volume Variation A Key Asset in Fluid Therapy

Device’s advanced physiologic monitoring guides treatment decisions in cases of hypotension.

Michael Burns, chief CRNA at Phelps County Regional Medical Center, Rolla, MO, primarily uses the FloTrac sensor technology from Edwards Lifesciences LLC (Irvine, CA) for cardiac patients having noncardiac surgery. Some cases dictate the need for more adv

Our anesthesia department was searching for a more accurate means of assessing volume status and predicting the response to fluid administration in this patient population. This population can be very challenging during vascular, trauma orthopedic, thoracic, general surgical and obstetric procedures.
Prior to FloTrac (Edwards Lifesciences, LLC Irvine, CA) we used CVP, urine output, blood pressure and heart rate. When arterial lines were placed we looked at the morphology of the waveform and the systolic variation with positive pressure ventilation. The FloTrac allowed for stroke volume variation (SVV) with positive pressure ventilation in a simple, accurate manner while acquiring other very useful information such as stroke volume, stroke volume index, cardiac output, cardiac index and systemic vascular resistance.
All this information could be obtained by the placement of an arterial line, which in most of these cases was already included as part of the monitoring in the anesthesia plan. All the parameters provided by this technology simplified the differential for hypotension during the perioperative period.
The FloTrac provides an accurate assessment of volume status through stroke volume variation with positive pressure ventilation. Stroke volume index provides for the assessment of left ventricular function. Together the decision of how to treat hypotension by either administrating more volume, less volume, inotropic, or vasopressors has been improved by providing accurate data through a simple intervention. This data permits earlier recognition for more advanced therapies and provides more confidence to the anesthesia provider that they are treating the hypotension in an appropriate manner.
A clinical example of the FloTrac sensor used at Phelps County Regional Medical Center was a 74-year-old female for splenectomy after a MVA secondary to PSVT. Upon arrival to the emergency department she was hypotensive and did not respond significantly to a one-liter bolus of crystalloids. Upon anesthesia arrival, large central access was obtained and a FloTrac sensor was placed. After additional fluid resuscitation her initial vitals included blood pressure of 110/64, heart rate of 105 and CVP of 12. Using a more traditional means of monitoring one would have assumed she was stable and normovolemic.
The FloTrac data at that same time allowed for early recognition of hypovolemia with normal vitals secondary to a SVV of 27 percent (SVV target is less than 13 percent), SVI of 28 and CI of 2.2. Additional fluids were administered and guided by the FloTrac data using a simple treatment algorithm. Prior to incision, the patient data included SVV of 13 percent, SVI 38, CI, 3.5, HR 88 and B/P of 110/54.
Throughout this case the FloTrac sensor data guided the fluid therapy, which resulted in an uneventful case with no episodes of hypotension or a need for vasopressors. During the course of this 61-minute procedure the patient received guided fluid administration and beta blocker therapy. She was extubated without difficulty at the completion of the case.
This is just an example of how the FloTrac technology is used at our facility. We have numerous examples during thoracic, laproscopic bowel or laproscopic nephrectomies. In these cases, one may choose the FloTrac less invasive monitoring to maintain normovolemia by altering the SVV goal to 15 percent versus 13 percent for greater assurance of hypervolemia prevention.

Related Content

First-in-Human Results Show Early Bird Device Effective in Early Detection of Internal Bleeding
News | Patient Monitors | June 18, 2019
New study results validate the effectiveness of the Saranas Early Bird Bleed Monitoring System to sense bleeding events...
Lexington Biosciences Concludes Initial HeartSentry Clinical Study
News | Patient Monitors | August 16, 2018
Lexington Biosciences Inc. recently announced the completion of the initial HeartSentry study conducted at San...
Itamar Medical Launches SleePath for AFib Patients at Heart Rhythm 2018
Technology | Patient Monitors | May 16, 2018
Itamar Medical Ltd. announced the launch of SleePath, the first integrated e-health sleep apnea care pathway monitoring...
News | Patient Monitors | March 09, 2018
Philips recently announced the integration of its IntelliVue Guardian with automated Early Warning Scoring (EWS) into...
Acarix, CADScor System, coronary artery disease detection, clinical study, ACC.17
News | Patient Monitors | March 30, 2017
Acarix AB recently announced the results from a new multi-center trial of its handheld CADScor System for non-invasive...
Corsens Medical, Corsens Cardiac Monitor, FDA 510(k) clearance
Technology | Patient Monitors | December 08, 2016
Corsens Medical Ltd. announced that it has received clearance for a Pre-Marketing Notification (510(k)) with the U.S....
Corsens Cardiac Monitor, FDA 510k pre-market notification
News | Patient Monitors | May 26, 2016
Corsens Medical Ltd. announced it has successfully completed filing of a Pre-Marketing Notification (510(k)) with the U...
Philips, FDA 510k clearance, Expression MR400, MRI patient monitor
Technology | Patient Monitors | February 11, 2016
Royal Philips announced U.S. Food and Drug Administration (FDA) 510(k) clearance for the Expression MR400, a new...
Profusa, integrated biosensors, long-term continuous monitoring
News | Patient Monitors | January 15, 2016
Biointegrated sensors for long-term, continuous tracking of body chemistry may make health and disease monitoring as...
sleep apnea, pulse oximetery, congestive heart failure, CHF, pulse-oximetry, Thomas Jefferson University
News | Patient Monitors | September 09, 2015
Researchers at Thomas Jefferson University showed that a simple questionnaire, evaluation and pulse-oximetry monitoring...