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CME: POP Physiologic Optimization Program: Physiology Based Fluid Management


Program Description / Statement of Need:

In this online CME self-learning program:

Fluid management for the critically ill is very significant in critical care medicine. Most people use traditional methods to assess the fluid status of an individual based on their clinical and hemodynamic data, and these have proven very unreliable over the years. Hemodynamic monitoring by itself does not improve outcomes; instead, related treatment requires a protocol based on physiology.  Physiologic Optimization Program helps to measure the cardiac performance to determine their responsiveness to fluid. This will help to maintain organ perfusion and function. Ultimately if there is no perfusion benefit, volume is possibly or likely harmful. An individual Starling curve can be plotted to determine the optimal stroke volume for a given stroke volume variation. This will help to determine the need for fluid resuscitation or de-resuscitation based on the individuals physiologic parameters. As part of the physiologic optimization program, an algorithm has been developed using stroke volume variation as a predictor of volume responsiveness and stroke volume as a cardiac performance measure together to optimize hemodynamics under a variety of conditions.


The literature suggests that there is a gap between the actual and optimal treatment of patients in critical care with regards to fluid status and fluid need. Traditionally, practitioners believe a little volume is good but more is better and they can swell patients to get well.  At the same time, emerging data indicate the healthcare professional retains a unique position in the effort to improve adherence to therapy and mortality by using physiologic optimization to assess the fluid status and fluid management.




-      Establishing the need for physiologic optimization in fluid resuscitation

-      Stroke volume variation and the Frank-Starling curve

-      Treatment algorithm: following each arm to its natural end

-      Patient case(s)

-      Predictors of in-hospital mortality

-      Summary of the evidence


Target Audience:

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

Program Objectives:

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

    • Describe the relationship between volume resuscitation, cardiac performance, oxygen delivery, and outcomes in critical illness
    • Define goal-directed de-resuscitation and describe its purpose
    • Describe the potential effects of volume management on renal function in critical illness
    • Apply the Physiologic Optimization Program described in this learning activity to a given critically ill patient



    Release Date: February 15, 2012
    Expiration Date: February 15, 2014

    Faculty: William T. McGee M.D., M.H.A.

    Faculty Disclosure and Resolution of COI:

     As a provider of continuing medical education, it is the policy of 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 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 ScientiaCME.


    Faculty Disclosure: William T. McGee, MD, discloses that he receives honoraria and expense reimbursement from Edwards Lifesciences.


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


    Commercial Support Disclosure: This program is supported by 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

This program is supported by Educational Grants from Edwards Lifesciences


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