Oesophageal Doppler Stroke Volume Optimisation

Oesophageal Doppler Stroke Volume Optimisation ,[object Object],[object Object],[object Object]

CardioQ Specifications ,[object Object],[object Object],[object Object],[object Object],[object Object]

Post operative morbidity Prospective study of 443 major surgery patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],11 healthy volunteers. Blood volume reduced by 15-20%. All subjects developed CNS symptoms. Change from baseline - 5% - 6% 0% +7% - 9% - 40%*** Price HL et al. Circulation Research 1966;5:469-474 Covert Compensated Hypovolemia

25-30% Haemorrhage in Man 2 1 0 1 2 0 1 8 0 1 5 0 9 0 6 0 3 0 B a s e H e a r t r a t e S y s B P T i m e ( m i n u t e s ) 8 0 0 m l 8 0 0 m l Hamilton-Davies et al Intensive Care Med 23(3):276-281,1997 Controlled haemorrhage Re-transfusion 0 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0 1 6 0

25-30% Haemorrhage in Man Hamilton-Davies et al Intensive Care Med 23(3):276-281,1997 Controlled haemorrhage Re-transfusion Base 800ml 800ml Gastric pHi 7 . 0 0 7 . 0 5 7 . 1 0 7 . 1 5 7 . 2 0 7 . 2 5 7 . 3 0 7 . 3 5 7 . 4 0 7 . 4 5 T i m e ( m i n u t e s ) a e m o r r h a g e 2 1 0 1 2 0 1 8 0 1 5 0 9 0 6 0 3 0

Circulatory changes during laparotomy Can.J. Anaes 2002 49(3) 302-308 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Circulatory changes during laparotomy in rabbits Can.J. Anaes 2002 49(3) 302-308 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Frank Starling Curve Cardiac Function Curve Oesophageal Doppler Monitoring Stroke Volume End-Diastolic Volume  < 10%  > 10%  0%

[object Object],[object Object],[object Object],[object Object],CABG (Archives of Surg 1995 130: 423) #Neck of Femur BMJ 1997;315:909 - 12. Major General Surgery Anesthesiol, 97(4), 820-826, 2002 Optimising stroke volume during surgery

[object Object],[object Object],[object Object],[object Object]

Worthing Optimisation Research in Major Surgery (WORMS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Worthing Optimisation Research in Major Surgery (WORMS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Worthing Optimisation Research in Major Surgery (WORMS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Worthing Optimisation Research in Major Surgery (WORMS) ,[object Object],[object Object],[object Object]

Patient characteristics Control Median (IQR) Protocol Median(IQR) Age (years) Mean (sd) 69.6 (10.2) 69.1 (12.3) Physiological Possum 18 (7.0) 17 (6.5) Operative Possum 16 (9.0) 15.5 (7.0) BMI 26 (7.25) 24.5 (6.75)

Operative data Control Median(IQR) Protocol Median(IQR) Blood loss (ml) 500 (975) 500 (700) Per-operative crystalloid (ml) 3000 (1187) 3000 (1750) Per-op. colloid * (ml) Range 1500 (0 – 4000) 2000 p<0.001 (500-5000 ) Urine output 1 st 36 hours * 2754 (1453) 3649 (2000) p<0.01

Haemodynamic data Control Median (IQR) Protocol Median(IQR) Stroke Volume (ml) p<0.001) 77 (25) 99 (43) * Cardiac Output (l.min -1 ) p<0.02 5.6 (2.9) 7.25 (2.37) * Oxygen Delivery (ml.min.m 2 ) p<0.011 445 (200) 535 (229) *

Haemodynamic data Control Median (IQR) Protocol Median(IQR) CVP overall (mmHg) 13 (5) 14 (5) CVP End of surgery (mmHg) 13 (5.5) 13 (4.5)

Post-operative Progress Control Median (IQR)days Protocol Median (IQR)days Flatus passed 4 (2) 3 (2) Bowels open 5 (2) 4 (3) Full diet 7 (2) 6 (2) Discharge 11.5 (4.75) 10 (5.75)

GI Morbidity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Mortality ,[object Object],[object Object],[object Object],[object Object],[object Object]

Total bed occupancy ,[object Object],[object Object],[object Object]

Can you give too much fluid? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Too much fluid? ,[object Object],[object Object],[object Object],[object Object],[object Object]

WORMS ,[object Object],[object Object]

IPPV IPPV & PEEP HEAD DOWN Reliable CVP? HEAD UP

Haemodynamic values at start and end of surgery

CVP ,[object Object],[object Object],[object Object],[object Object],[object Object]

Elderly Laparoscopic Gastrectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Orthopaedic patients ,[object Object],[object Object],[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Oesophageal Doppler Stroke Volume Optimisation

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Oesophageal Doppler Stroke Volume Optimisation