{"id":380,"date":"2017-01-16T14:16:31","date_gmt":"2017-01-16T14:16:31","guid":{"rendered":"http:\/\/www.deltexmedical.com\/decision_tree\/?page_id=380"},"modified":"2025-10-10T13:18:52","modified_gmt":"2025-10-10T12:18:52","slug":"stoke-volume-optimisation","status":"publish","type":"page","link":"https:\/\/www.deltex-academy.com\/decision_tree\/stoke-volume-optimisation\/","title":{"rendered":"Stoke Volume Optimisation"},"content":{"rendered":"<style>.entry-title {display:none;}<br \/><\/style>\n<style>.site-info {display: none;}<br \/><\/style>\n<h2 style=\"text-align: center;\"><strong><span style=\"color: #003087;\">STROKE VOLUME OPTIMISATION<\/span><\/strong><\/h2>\n<div class='content-column one_half'>\u200bStroke Volume Optimisation (SVO) is in its simplest form the administration of fluid\u00a0guided by an algorithm to maximise Stroke Volume <em>without<\/em> the risk of fluid overload. Crystalloids or colloids have both been used. While SVO almost always starts with a fluid challenge, SVO may also include the use of\u00a0<a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/vasoactive-and-inotropic-drugs\/\" target=\"_blank\" rel=\"noopener noreferrer\">inotropic and vasoactive drugs<\/a>.<\/p>\n<p>See also <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/new-accuracy-and-precision\/\" target=\"_blank\" rel=\"noopener noreferrer\">Accuracy &amp; Precision<\/a> and <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/improved-outcomes\/\" target=\"_blank\" rel=\"noopener noreferrer\">Improved Outcomes<\/a>.<\/div>\n<div class='content-column one_half last_column'><div style=\"padding-top:30px;padding-left:10px;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-381 size-full\" src=\"https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation1.png\" width=\"816\" height=\"550\" srcset=\"https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation1.png 816w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation1-300x202.png 300w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation1-768x518.png 768w\" sizes=\"auto, (max-width: 816px) 85vw, 816px\" \/><\/div><\/div><div class='clear_column'><\/div>\n<p>The optimisation of SV with fluid is based on the theory of the Frank-Starling curve. The Frank-Starling law describes the relationship between end-diastolic volume (i.e., preload) and the ejected SV. Therefore, in response to a fluid challenge:<\/p>\n<ul>\n<li>An increase in SV &gt;10% following a rapid fluid challenge (i.e., &lt;5 min) indicates the patient is on the lower portion of their individualised Frank-Starling curve and is therefore not optimally filled.<\/li>\n<li>An increase in SV &lt;10% following a rapid fluid challenge (i.e., &lt;5 min) indicates the patient is on the mid or upper portion of their curve and is therefore well filled.<\/li>\n<\/ul>\n<p>Guiding fluid management using the ODM+ is based on the administration of a fluid bolus and the measurement of the corresponding change in Doppler SV (&lt; or &gt;10%). This technique is unique to the Doppler technology and is evidence-based [1].<\/p>\n<p class=\"p1\">The minimum change in SV required to be effective at guiding SVO is dependent on the precision of the technology. A more <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/new-accuracy-and-precision\/\"><span class=\"s1\">precise<\/span><\/a> technology is able to detect smaller changes in SV in response to an intervention (e.g., fluid challenge) while allowing the user to remain highly confident that a real change has\u00a0occurred, and that change is not simply due to measurement error. Oesophageal Doppler technology is highly precise. With a focussed signal, 99% of the time a 10% change in SV is seen as significant and an actual increase in the patient&#8217;s SV has occurred.\u00a0Other CO measurement techniques with a lower precision (higher coefficient of variation) may not be effective in using this algorithm (10% change in SV) in assessing the response to a fluid challenge.<\/p>\n<p>The precision of the oesophageal Doppler also enables the detection of changes in SV in response to small (200-250 mL) boluses of fluid. These small fluid boluses enable the clinician to finely-tune fluid volume based on individual patient need. Technologies with poorer precision may need to use larger fluid challenges (e.g., 500 mL) and look for larger changes in SV (e.g., &gt;15%) in order to determine whether the patient in fluid responsive, which may result in over filling.<\/p>\n<div class='content-column one_third'><div style=\"padding-right:10px;\"><p>In the examples across, the average patient requires 565 mL of protocol (bolus) fluid (based on an average from the ODM outcome studies). The administration of three 200 mL boluses results in the treatment of this patient\u2019s hypovolaemia without significant overload (Figure 1). Compare this to the second example (Figure 2) whereby the same patient was administered two 500 mL fluid boluses. As a result, they received &gt;400 mL of unnecessary fluid.<\/p>\n<p>SVO guided by the precision of the ODM is the only algorithm + technology combination to consistently demonstrate improvements in patient <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/improved-outcomes\/\" target=\"_blank\" rel=\"noopener noreferrer\">outcome<\/a>.<\/div><\/div>\n<div class='content-column two_third last_column'><div style=\"padding-right:0px;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-383 size-full\" src=\"https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation2.png\" width=\"1068\" height=\"588\" srcset=\"https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation2.png 1068w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation2-300x165.png 300w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation2-768x423.png 768w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation2-1024x564.png 1024w\" sizes=\"auto, (max-width: 709px) 85vw, (max-width: 909px) 67vw, (max-width: 1362px) 62vw, 840px\" \/><br \/>\n<strong>Stroke Volume Optimisation with a precise technology enables the administration of small (200 mL) fluid boluses and small \u2018steps\u2019 up a patients Starling curve. As a result the patient is more likely to receive fluid based on exact need.<\/strong><br \/>\n<img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-382 size-full\" src=\"https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation3.png\" width=\"1078\" height=\"591\" srcset=\"https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation3.png 1078w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation3-300x164.png 300w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation3-768x421.png 768w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/stoke-volume-optimisation3-1024x561.png 1024w\" sizes=\"auto, (max-width: 709px) 85vw, (max-width: 909px) 67vw, (max-width: 1362px) 62vw, 840px\" \/><br \/>\n<strong>Stroke Volume Optimisation with a less precise technology may require the clinician to administer larger (500 mL) fluid boluses and therefore take larger \u2018steps\u2019 up a patients Starling curve. As a result the patient is more likely to receive more fluid than they need.<\/strong><\/div><\/div><div class='clear_column'><\/div>\n<h3><strong><span style=\"color: #003087;\">Reference<\/span><\/strong><\/h3>\n<ol>\n<li>Singer, M., J. Clarke, and E.D. Bennett, <i>Continuous hemodynamic monitoring by esophageal Doppler.<\/i> Crit Care Med, 1989. <b>17<\/b>(5): p. 447-52.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>STROKE VOLUME OPTIMISATION The optimisation of SV with fluid is based on the theory of the Frank-Starling curve. The Frank-Starling law describes the relationship between end-diastolic volume (i.e., preload) and the ejected SV. Therefore, in response to a fluid challenge: An increase in SV &gt;10% following a rapid fluid challenge (i.e., &lt;5 min) indicates the &hellip; <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/stoke-volume-optimisation\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Stoke Volume Optimisation&#8221;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-380","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages\/380","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/comments?post=380"}],"version-history":[{"count":5,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages\/380\/revisions"}],"predecessor-version":[{"id":1322,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages\/380\/revisions\/1322"}],"wp:attachment":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/media?parent=380"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}