Targeted Volume
Management
The right amount of the right fluid at the right time
The CardioQ-ODM™ in Surgery
A unique solution
Problem
Perioperative Fluid Management
A fundamental influence on surgical outcome
Hypovolaemia
the primary cause of non-surgical
post-operative complications
Why?
- Nil by mouth
- Anaesthetic
- Surgery
Solution
Targeted Volume Management
The right amount of the right fluid at the right time
Why?
- Fuller recovery
- Faster recovery
- Home earlier
Tool
CardioQ-ODM
Volume management tailored to individual patient need
Why?
- It’s easy
- It’s safe
- It works
Technology
Intervene
- Early
- Quickly
- Safely
Evidence
• Level 1 grade A evidence demonstrates
that TVM using ODM
•
•
•
•
Improves the quality of recovery
Reduces complications
Reduces length of hospital stay
Reduces critical care demand
Good for all, crucial for some
RCTs in Major Surgery
Reduction in complications
p=0.01 Mythen & Webb
p=0.078 Venn et al
p=0.05 Gan et al
p=0.042 Wakeling et al
p=0.02 Chen Shi et al
p=0.027 Noblett et al
-100
-75
-50
-25
0
25
50
% Reduction - Protocol vs. Control
75
100
RCTs in Major Surgery
Reduction in Length of Stay
p=0.011 Mythen & Webb
p=0.05 Sinclair et al
p=0.035 Venn et al
p=0.03 Gan et al
p=0.05 Wakeling et al
p=0.003 Noblett et al
-50
-30
-10
0
10
% Reduction - Protocol vs. Control
30
50
Unique Evidence Base
• The only intra-operative haemodynamic
monitor
• Proven in multiple RCTs to reduce
complications and shorten lengths of
hospital stay
• Subject to 3 independent meta-analyses
• Subject to 2 independent Health
Technology Assessments
Why does it work?
The right amount of the
right fluid at the right time
The Aims of TVM
• To achieve optimal filling of the vascular
system
• Eliminate hypovolaemia
• Optimise oxygen delivery
• To avoid excess crystalloid use
• Avoid tissue oedema
• Avoid adverse impact of chloride on gut
Key Components of TVM
• Delivery of appropriate crystalloid
volumes for ‘maintenance’
• Oesophageal Doppler-guided stroke
volume optimisation using colloids to
eliminate hypovolaemia
- Better outcomes
- Faster, fuller recovery
- Earlier home
Is it worth it?
• Surgical teams that do this
• Have lower mortality rates
• Have lower readmission rates
• Have shorter lengths of stay
TVM in Evidence-based Protocols
Length of stay
15
10
Days
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Targeted Volume Management
The right amount of the
right fluid at the right time
Reduced complications
-100
-75
-50
Reduced Length of Stay
p=0.01 Mythen & Webb
p=0.011 Mythen & Webb
p=0.078 Venn et al
p=0.05 Sinclair et al
p=0.05 Gan et al
p=0.035 Venn et al
p=0.042 Wakeling et al
p=0.03 Gan et al
p=0.02 Chen Shi et al
p=0.05 Wakeling et al
p=0.027 Noblett et al
p=0.003 Noblett et al
-25
0
25
50
% Reduction - Protocol vs. Control
75
100
-50
-30
-10
10
% Reduction - Protocol vs. Control
30
50