The oesophageal Doppler monitor (ODM+) is a precise, minimally invasive method of measuring CO. The ODM+ was initially developed as a less invasive alternative to the pulmonary artery catheter, however, its ability to drive the flow-based treatment algorithms was soon recognised.
It is accepted that both excessive and inadequate fluid volumes are detrimental to patient outcome. Doppler-guided intraoperative fluid management (IOFM) is an important component of Enhanced Recovery (ERAS) programmes, and has been proven to improve outcome in a variety of patient groups. This decision tree is a consolidation of the evidence base surrounding Doppler-guided SV optimisation, and the use of vasoactive and inotropic interventions as part of a global haemodynamic protocol.
An expert panel of senior clinicians reviewed the available evidence and agreed on a rational approach to using Doppler flow based measurements to guide therapy. This decision tree is appropriate for patients both perioperatively and in critical care. It is applicable for those patients already being monitored with the ODM+, or for those where further haemodynamic monitoring is indicated as per trigger points.
The decision tree is evidence based, or it can be used as a foundation for the development of other protocols.
Using the Decision Tree
Navigation is by a series of Yes/No boxes. Actions are in blue boxes and questions in grey boxes.
Please note that caveats are presented which may lead to an alternative pathway, or can be ignored if not appropriate for the patient. Caveats are in red boxes with red pathways.
Where possible there are links to the evidence base. Linked items are underlined in yellow and are in the form of hyperlinks, which will open a new window with an explanation and references.
See the Glossary for a list of abbreviations and definitions.
If viewing on a mobile device, scroll to the bottom of the page and click ‘view on desktop’.
An ‘app’ for the iPhone is available, click here.
For further information please contact us.