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  • Hemodynamic Pocket Card

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    Theresa Evila
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    This document provides guidance on optimizing stroke volume and fluid management for patients during and after surgery based on changes in stroke volume (SV). It recommends using a 10% increase in SV in response to a fluid challenge or passive leg raise as an indicator that a patient is fluid responsive and would benefit from additional fluid. For patients who are not fluid responsive based on this criterion, fluid administration should be discontinued and SV monitored for signs of fluid loss. Stroke volume variation (SVV) is also presented as a reliable indicator of preload responsiveness for patients on controlled ventilation, with an SVV over 13% indicating fluid responsiveness. The goal is to provide fluid to increase SV until the plateau of the Frank-Starling curve is

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    This document provides guidance on optimizing stroke volume and fluid management for patients during and after surgery based on changes in stroke volume (SV). It recommends using a 10% increase in SV in response to a fluid challenge or passive leg raise as an indicator that a patient is fluid responsive and would benefit from additional fluid. For patients who are not fluid responsive based on this criterion, fluid administration should be discontinued and SV monitored for signs of fluid loss. Stroke volume variation (SVV) is also presented as a reliable indicator of preload responsiveness for patients on controlled ventilation, with an SVV over 13% indicating fluid responsiveness. The goal is to provide fluid to increase SV until the plateau of the Frank-Starling curve is

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    7 views2 pages

    Hemodynamic Pocket Card

    Uploaded by

    Theresa Evila
    This document provides guidance on optimizing stroke volume and fluid management for patients during and after surgery based on changes in stroke volume (SV). It recommends using a 10% increase in SV in response to a fluid challenge or passive leg raise as an indicator that a patient is fluid responsive and would benefit from additional fluid. For patients who are not fluid responsive based on this criterion, fluid administration should be discontinued and SV monitored for signs of fluid loss. Stroke volume variation (SVV) is also presented as a reliable indicator of preload responsiveness for patients on controlled ventilation, with an SVV over 13% indicating fluid responsiveness. The goal is to provide fluid to increase SV until the plateau of the Frank-Starling curve is

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    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


    challenge over 5 –10 min* Yes

    Yes No
    SV increase >10% SV reduction >10%

    No Monitor stroke volume for


    clinical signs of fluid loss

    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 challenge
    Monnet X, Teboul JL. Passive Leg Raising. Intensive Care Med. 2008 Apr; 34 (4): 659-63.

    Frank-Starling curve
    Relationship between preload status and
    fluid-induced increases in stroke volume.
    Stroke volume Discontinue Increasing SV with fluid until
    Continue fluid
    fluid the plateau of the Frank-Starling
    Continue ∆SV < 10% curve is reached has been shown
    fluid ∆SV > 10% to improve the outcome of
    high-risk surgery patients.
    ∆SV > 10% Lopes MR, et al. Goal-directed
    ∆P = fluid-induced increase in preload fluid management based on pulse
    pressure variation monitoring
    during high-risk surgery: a pilot
    randomized controlled trial.
    Preload Critical Care. 2007 Oct;11(5):R100.
    Parameter Normal Range
    CO (cardiac output) 4.0 - 8.0 L/min
    CI (cardiac index) 2.5 - 4.0 L/min/m2
    SV (stroke volume) 60 - 100 mL/beat
    SVI (stroke volume index) 33 - 47 mL/beat/m2
    SVR (systemic vascular resistance) 800 - 1200 dyn-s/cm5
    SVRI (systemic vascular resistance index) 1970-2390 dyn-s/cm5/m2
    SVV (stroke volume variation) <13%

    Stroke volume variation optimization


    Stroke volume variation (SVV) is a reliable indicator of preload
    responsiveness on control-ventilated patients.

    Not meeting perfusion requirements

    Volume responsive SVV>13%

    Yes No

    Volume SVI normal SVI low SVI high


    challenge

    Pressor Inotrope Diuretic

    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.

    Stroke Volume Variation (on control-ventilated patients)


    Variation in arterial pulsations caused by heart-lung changes during
    positive pressure ventilation.
    25 25

    20
    20
    SVmax Airway
    Airway pressure
    pressure
    SVmax 15
    15
    SVmin
    SVmin Arterial
    Arterial pressure
    pressure
    10 10

    5
    5
    SVmax-SVmin
    SVmax-SVmin
    0 %SVV%SVV
    = =
    0
    SVmean
    SVmean
    -5 -5
    0 0
    1000 1000
    2000 2000
    3000 3000
    4000 4000
    5000 5000
    6000 6000
    7000 7000

    Expiration
    Expiration Inspiration
    Inspiration
    controlled
    controlled ventilation
    ventilation controlled
    controlled ventilation
    ventilation

    Edwards, Edwards Lifesciences and the stylized E logo are


    trademarks of Edwards Lifesciences Corporation or its affiliates.
    All other trademarks are the property of their respective owners.

    © 2019 Edwards Lifesciences Corporation.


    All rights reserved. PP--US-3400 v1.0

    Edwards Lifesciences • edwards.com


    One Edwards Way, Irvine CA 92614 USA

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