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  • 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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