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