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CME: Fluid First: Using PLR and SVV to Optimize Volume


Program Description / Statement of Need:

In this online CME self-learning program:

Fluid administration is a first line intervention for patients with unstable cardiovascular status. However, two major problems exist with this intervention: only one half of the patients who receive fluid respond favorably and standard static parameters do not reliably assess the response to fluid. In patients with hemodynamic instability, dynamic parameters such as pulse pressure variation and stroke volume variation are shown to be better predictors of preload responsiveness than static parameters such as central venous pressures and pulmonary artery wedge pressures. Evidence incorporating dynamic parameters in decision–making algorithms favors improved patient outcomes. In addition, a simple maneuver such as passive leg raising is being promoted as a means of providing the patient with a “reversible physiologic” fluid challenge.




  • -      Fluid: the merits … and risks … of volume expansion
  • -      Monitoring indices: static vs. dynamic
  • -      Hemodynamic interplay: stroke volume and stroke volume variation
  • -      Prediction of fluid responsiveness
  • -      Risks of fluid therapy and altered stroke volume variation unrelated to fluid
  • -      The role of patient positioning
  • -      Summary of the evidence


Target Audience:

This program has been designed for a multidisciplinary physician and nurse audience including: Emergency Medicine / ICU / Anesthesia / Peri-op / Intensivists / Trauma / Critical Care

Program Objectives:

By the end of the session the participant will be able to:

    • Define the static and dynamic parameters used in assessing fluid status.
    • Describe the hemodynamic effects of the passive leg raising technique.
    • Cite research related to assessment of fluid responsiveness.



    Release Date: September 02, 2011
    Expiration Date: February 28, 2015

    Faculty: Jan Headley RN

    Faculty Disclosure and Resolution of COI:

    As an accredited provider of continuing medical education, it is the policy of the ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is not to prevent a person with a significant financial or other relationship from participating in CME activities, but rather to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity: for this CME activity, any COI has been resolved through content review by ScientiaCME.


    Faculty Disclosure: Jan Headley, RN, BS, discloses that she is employed by Edwards Lifesciences as Director of Professional Education.


    Disclosures of Educational Planners: Steven Sachse is an officer and part owner of ScientiaCME, LLC, which has received a grant from the commerical supporter of this program:  Edwards Lifesciences.


    Disclosures of Educational Reviewer: Charles Turck, PharmD is an officer and part owner of ScientiaCME, LLC, which has received a grant from the commerical supporter of this program:  Edwards Lifesciences.


    Commercial Support Disclosure: Supported through an educational grant from Edwards Lifesciences, a manufacturer of medical devices.


    Viewing Requirements:



    Windows 2000 or above
    Internet Explorer 5.5
    Adobe Acrobat Reader*

    Mac OS 10.2.8
    Adobe Acrobat Reader*
    Internet Explorer is not supported on the Macintosh


    *Required to view Printable PDF Version


    Privacy Policy



    -Read the learning objectives and faculty disclosures above

    -Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.

    -View the on-line program. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.

    -Take the post-test

    -Complete the program evaluation and CME registration. A CE certificate will be emailed to you.

    Perform Pre-Test (optional)
    Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

    Download the Presentation (optional)


    View the online program


    Perform Post-Test

    Complete the Symposium Evaluation and Request CE Certificate

Supported through an educational grant from Edwards Lifesciences


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