FloTrac Vigileo Training

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FloTrac Sensor Vigileo Monitor
A New Platform for
Minimally
Invasive Hemodynamic Monitoring
Edwards Lifesciences LLC
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Disclaimer

• Despite an intense effort to find less invasive
  ways to measure cardiac output, there is NO data
  that conclusively proves that PA catheters harm
  patients.
• There is NO data to suggest that care is improved
  or outcomes differ with the utilization of
  monitors that assess cardiac function.

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Objectives

• Review a new technology that is being introduced
  to RIH
• Briefly touch on the validation of FloTrac
  Monitoring
• Detail the potential sources of AVOIDABLE error
  that exist with the FloTrac Sensor
• InService basic functions of the monitor (Steve
  Gomes)

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FloTrac

• Continuously computes stroke volume from arterial
  pressure signal
• Requires NO manual calibration
• Demographic Data
• Arterial waveform analysis
• Quantification of SVV
• Disposable Transducer
• Latex-Free
• 175 per

Pulse Pressure Variation
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How does FloTracs APCO algorithm work?
(Arterial Pressure-based Cardiac Output)
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The relationship of Pulse Pressure to Stroke
Volume

• CO SV x HR
• Aortic pulse pressure is proportional to SV and
  is inversely related to aortic compliance.
• If Compliance (and resistance) is constant a
  bigger SV will mean a greater PP.

PP Systolic - Diastolic
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Trending Stroke Volume

• Arterial pressure is sampled at 100 Hz
• Changes in stroke volume will result in
  corresponding changes in the pulse pressure
• A robust whole waveform measure of the pulse
  pressure is achieved by taking the standard
  deviation of the sampled points of each beat
• sd(AP) µ Pulse Pressure µ Stroke Volume
• SV estimates are calculated every 20 sec

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sd is a measure of variation of the AP
Therefore, with a constant vasculature
? AP Variation ? ? sd(AP) ? ? SV
? AP Variation ? ? sd(AP) ? ? SV
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Including the effect of vascular tone in the
calculation of flow
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The effect of compliance on PP
Age, gender and BSA factors
vs.

• Younger
• Male
• Higher BSA

• Older
• Female
• Lower BSA

vs.
vs.
For the same volume ?

• Compliance inversely affects PP
• The algorithm compensates for the effects of
  compliance on PP based on age, gender, and BSA

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Effect of vascular tone

• The algorithm looks for characteristic changes in
  the arterial pressure waveform that reflect
  changes in tone (i.e., MAP, Skewness, Kurtosis)
• Those changes are included in the continuous
  calculation of c

Skewness
Kurtosis
MAP
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(No Transcript)
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Requires NO manual calibration

• Other continuous monitoring technologies require
  calibration to accommodate for the effects of
  independent variables associated with changing
  vascular tone.
• The APCO algorithm compensates for the
  continuously changing effects of vascular tone
  via analysis of waveform characteristics directly
  correlated with vascular tone.

Continuous, patient-specific monitoring without
manual calibration
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Principle Elements of the APCO Algorithm

• Pulse pressure, the difference between systolic
  and diastolic pressure, is proportional to flow.
  The algorithm calculates the pulsatility from the
  systolic and diastolic pressures over time and
  calculates the standard deviation of the arterial
  pressure (20 seconds).
• Vascular compliance is correlated with (in order
  of significance) age, BSA, and gender. These
  patient specific variables provide a baseline for
  calculating the effect of compliance on flow.
• Effects of real time changes in peripheral
  resistance are included in the SV calculation by
  analysis of key waveform characteristics (e.g.,
  change in MAP, time from start to end of a pulse,
  distribution of pressure over a pulse wave, angle
  and shape of waveform).
• Pulse rate is measured directly from pulsatile
  signals sent from the FloTrac sensor.

SV
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Validation??

• A Pilot Assesment of the FloTrac Cardiac Output
  Monitoring System
• Intensive Care Med 2007

• Cardiac Output Determination From the Arterial
  Pressure Wave Clinical Testing of a Novel
  Algorithm That Does Not Require Calibration
• J of Cardiothorac and Vasc Anesth 2007

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Sources of Error and Their Impact on Comparison
Results
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Error Sources
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Impact of Incorrect Setup
Original comparison
Corrected for transducer height
Corrected for patient weight
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Error Sources
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Line Damping -gt CO Changes
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Error Sources
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Summary

• Technological differences must be taken into
  consideration when comparing the FloTrac sensor
  to thermodilution cardiac output
• Attention to detail and technique should be
  observed in order to obtain the most accurate
  data
• Even when technique is at its best, differences
  in data averaging can create periods of wide
  variation between values