Targeted Volume ManagementThe right amount of the right fluid at the right timeThe CardioQ-ODM in SurgeryA unique solution
ProblemWhy? Nil by mouth Anaesthetic SurgeryHypovolaemiathe primary cause of non-surgicalpost-operative complications
SolutionWhy? Fuller recovery Faster recovery Home earlier
ToolWhy? Its easy Its safe It works
TechnologyIntervene Early Quickly Safely
EvidenceLevel 1 grade A evidence demonstrates that TVM using ODMImproves the quality of recoveryReduces complicationsReduces length of hospital stayReduces critical care demandGood for all, crucial for some
RCTs in Major Surgery
RCTs in Major Surgery0
Unique Evidence BaseThe only intra-operative haemodynamic monitorProven in multiple RCTs to reduce complications and shorten lengths of hospital staySubject to 3 independent meta-analysesSubject to 2 independent Health Technology Assessments
Why does it work?
The right amount of theright fluid at the right time
The Aims of TVMTo achieve optimal filling of the vascular systemEliminate hypovolaemiaOptimise oxygen deliveryTo avoid excess crystalloid useAvoid tissue oedemaAvoid adverse impact of chloride on gut
Key Components of TVMDelivery of appropriate crystalloid volumes for maintenanceOesophageal 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 thisHave lower mortality ratesHave lower readmission ratesHave shorter lengths of stay
TVM in Evidence-based Protocols
Targeted Volume ManagementThe right amount of theright fluid at the right time
In Colorectal surgery:UK 1 = Length of stay national average LoS 2001 - 14 daysFreeman 1 = Freeman hospital LoS 2001 - 12 daysSEIC = Stoma education in the community programme RCT (Freeman Hospital)CH2 = Pre-operative carbohydrate loading RCT (Freeman Hospital)Combined impact - 9 days (redn. 3 days)CQ open - 7 days (the biggest single element reducing LoS)CQ Lap - 4 daysHenrik Kehlet - 3 days - (but with a 25-30% Readmission rate - Freeman is
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