The document discusses the FloTrac system, which uses an existing arterial line to continuously monitor cardiac output (CO) and other hemodynamic values through advanced arterial waveform analysis. While the trends provided by FloTrac can be useful for estimating hemodynamic status, its specific CO and cardiac index values may not correlate exactly with pulmonary artery catheter measurements. FloTrac requires good arterial signal quality and its values could be affected by factors like arrhythmias, hemodynamic instability, or ventilator settings like PEEP. Clinical judgment is still needed to interpret the data from FloTrac.

1. FLOTRAC
BY
DR.VIJAYANAND PALANISAMY

2. • The Vigileo™/FloTrac™ system utilizes an existing radial or
femoral arterial line that is attached to its monitoring unit.

3. • The key findings that emerged from many
literature reviews indicated that the
Vigileo™/FloTrac™ system's specific values for CO
and CI may not correlate exactly with PAC with
100% accuracy. However, the trends of these
Vigileo™/FloTrac™ system derived values are
useful to estimate hemodynamic status.
Additionally, the SVV values are reliable for
gauging vascular fluid status and the adequacy of
need for additional intravascular fluid volume.

4. How to asses volume responsiveness?

6. Advantages
• Requires No Manual Calibration for CO Calculation.
• User enters Patient (Pt) Specific Data. ( age, gender, height,
weight to initiate the monitoring.)
 Non invasiveness
 Works through an already existing arterial line catheter
 Continuous CO monitoring
 No CVL is required
• Advanced Arterial Waveform Analysis ( PRAM) by FloTrac
Sensor.
1. Pt to pt differences in vasculature.
2. Real time changes in vascular tone.
3. Different arterial sites are acceptable.

7. Disadvantages
• Good Arterial Signal Quality is critical for accurate CO
calculation.
• Elevated levels of PEEP can erroneously increase SVV
and warrant for fluid resuscitation per the monitor but
may not actually be needed for the patient.
• Finally, large changes in vascular tone or vasodilation
may also correlate with an increased SVV
• does not account for differences in the pulse
pressure readings recorded from different arterial
cannulation sites.

8. • Moreover, increases in the pulse pressure may
not always reflect an increase in stroke volume.
In fact, to the contrary, it may actually reflect an
underlying decrease in the stroke volume–as
can be seen with utilization of vasopressors .
These phenomena have been inaccurately
delineated per the Flotrac™/Vigileo™ as Meng
et al. , demonstrated through the comparison
of phenylephrine and ephedrine administration
with total body tilting using the Esophageal
Doppler as the reference method.

9. Still Not Reliable
I. during Arrhythmias
II. For Hemodynamically Unstable Patients
III. Intra Aortic Balloon Pump in use.
IV. Ventricular Assist Devices in use.

10. contraindications
• No absolute contraindications but has
limitations that must be taken into account.
• Currently, the monitoring system is only
recommended for patients that are 100%
mechanically ventilated and not
spontaneously breathing

12. • Cost effectiveness should be a consideration
when determining which hemodynamic
system to use
• However, clinical judgment cannot be
substituted for data obtained from the system.