Targeted Volume Management

The right amount of the right fluid at the right time

Targeted Volume Management

The right amount of the right fluid at the right time

The CardioQ-ODM™ in Surgery

A unique solution

The CardioQ-ODM™ in Surgery

A unique solution

ProblemProblem

Perioperative Fluid ManagementA fundamental influence on surgical outcome

Why?- Nil by mouth- Anaesthetic- Surgery

Hypovolaemiathe primary cause of non-surgicalpost-operative complications

SolutionSolution

Targeted Volume ManagementThe right amount of the right fluid at the right time

Why?- Fuller recovery- Faster recovery- Home earlier

ToolTool

CardioQ-ODMVolume management tailored to individual patient need

Why?- It’s easy- It’s safe- It works

TechnologyTechnology

Intervene- Early- Quickly- Safely

EvidenceEvidence

• 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 SurgeryRCTs in Major Surgery

-100 -75 -50 -25 0 25 50 75 100

p=0.027 Noblett et al

p=0.02 Chen Shi et al

p=0.042 Wakeling et al

p=0.05 Gan et al

p=0.078 Venn et al

p=0.01 Mythen & Webb

% Reduction - Protocol vs. Control

Reduction in complications

RCTs in Major SurgeryRCTs in Major Surgery

-50 -30 -10 10 30 50

p=0.003 Noblett et al

p=0.05 Wakeling et al

p=0.03 Gan et al

p=0.035 Venn et al

p=0.05 Sinclair et al

p=0.011 Mythen & Webb

% Reduction - Protocol vs. Control

Reduction in Length of Stay

0

Unique Evidence BaseUnique 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 theright fluid at the right time

The Aims of TVMThe 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 TVMKey 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?Is it worth it?

• Surgical teams that do this• Have lower mortality rates• Have lower readmission rates• Have shorter lengths of stay

0

5

10

15

Days

UK 01F'man 01SEIC/CH2CQ open

CQ lapC'hagenUK 05

Length of stay

TVM in Evidence-based ProtocolsTVM in Evidence-based Protocols

Targeted Volume ManagementTargeted Volume Management

-100 -75 -50 -25 0 25 50 75 100

p=0.027 Noblett et al

p=0.02 Chen Shi et al

p=0.042 Wakeling et al

p=0.05 Gan et al

p=0.078 Venn et al

p=0.01 Mythen & Webb

% Reduction - Protocol vs. Control

Reduced complications

-50 -30 -10 10 30 50

p=0.003 Noblett et al

p=0.05 Wakeling et al

p=0.03 Gan et al

p=0.035 Venn et al

p=0.05 Sinclair et al

p=0.011 Mythen & Webb

% Reduction - Protocol vs. Control

Reduced Length of Stay

The right amount of theright fluid at the right time