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CME: Expanded Applications For Hemodynamic Monitoring: APCO and Dynamic Variables of Volume Status: Clinical Application


Program Description / Statement of Need:

In this online CME self-learning program:

Fluid administration is a cornerstone of intensive and perioperative care, with the ultimate goal being the maintenance of intravascular volume in a fashion that incurs the fewest complications.  There is a wide spectrum of risk inherent in different fluid managements strategies.  Clinical manifestations of under-resuscitation include complications ranging from the inconvenient and unpleasant (e.g., dizziness and post-operative nausea and vomiting) to those that acutely complicate the course of care such as: acute kidney injury and impaired wound healing as a result of inadequate blood flow to surgical anastamoses.  On the other hand, over-resuscitation engenders risks such as pulmonary edema and function and its ensuing complications, post-operative coagulopathy, abdominal compartment syndrome, gastrointestinal edema, impaired tolerance to enteral feeding, and increased bacterial translocation from the gut, which may in turn increase the risk of systemic inflammatory response syndromes and multiorgan system dysfunction.




  •  - Reasons for hemodynamic monitoring: when and why?
  •  - Specific questions to ask when monitoring hemodynamics
  •  - Role of fluid boluses
  •  - The interrelationship – or not – of preload responsiveness with:
  •        cardiac output, intravascular fluid loading, central venous pressure, pulmonary artery occlusion pressure,
  •        left ventricular end-diastolic area, right ventricular end-diastolic volume, intrathoracic blood volume,
  •        transesophageal echocardiography
  •  - Hemodynamic interrelationships: pulse pressure change vs. systolic pressure change
  •  - The roles of tidal volume and ventilation
  •  - Limitations of hemodynamic monitoring in practice
  •  - 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 effects of positive pressure ventilation on stroke volume variation.
    • Plot on a Starling curve a patient’s individual response to fluid.
    • Apply a simplified algorithm using stroke volume index and stroke volume variation as a means to improve cardiac performance.



    This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.


    Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Release Date: September 01, 2011
    Expiration Date: February 28, 2015

    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 Planner: 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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