Starling Fluid Management Monitoring System
The Starling system is a 100% non-invasive fluid management monitoring system that provides clinicians with a dynamic assessment of fluid responsiveness quickly, accurately and precisely. The Starling system can be used across all care settings within the hospital to help determine whether fluid administration will be effective, enabling clinicians to personalize fluid therapy and potentially leading to improved patient outcomes.
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Overview
Meet the Starling Fluid Management Monitoring System
Using patented Bioreactance technology, the Starling Fluid Management Monitoring System represents the latest advancements in hemodynamic monitoring, providing easy-to-use, non-invasive technology that delivers accurate and precise data that takes the guesswork out of fluid assessment.
Fluid Responsiveness is Dynamic
Every patient has unique and constantly changing fluid management needs. Over 80% of hospitalized patients receive IV fluids.1 Yet studies show that administering too little or too much fluid can lead to serious complications and contribute to rising healthcare costs.2,3
Like IV medications, fluid administration is not a one-size-fits-all approach and should be dosed according to patient response. Assessing whether fluid may help or harm a patient is a critical step in optimizing treatment for the individual. The Starling system can accurately advise clinical staff on whether a patient will benefit from additional fluid, in a 100% non-invasive way.
More Informed Clinical Decision Making
No matter the site of care or the clinical challenge, effective fluid management is integral to achieving optimal clinical outcomes. Until now, the only choices for obtaining accurate, continuous hemodynamic measurements were invasive technologies that each carry their own set of risks.
With the Starling system, clinicians have all the important parameters continuously at their fingertips. Clinical status and the effect of interventions can be monitored at any time and treatment modified accordingly.
The Starling System is Easy to Use, Robust, Flexible—and 100% Non-Invasive
100% Non-Invasive
The Starling System supports individualized fluid therapy without requiring an invasive arterial or central line, potentially reducing the risk of hospital-acquired infections and other complications.4
Easy-to-Perform Dynamic Assessments
The Starling monitor guides clinicians through a step-by-step protocol for executing a passive leg raise or bolus test.
- All information, including dynamic assessment results, is included on a single screen.
- Enhanced algorithms enable a shorter dynamic assessment timeframe.
Real-Time, Continuous Information
The Starling System provides real-time, continuous information on Cardiac Index, Cardiac Output, Stroke Volume Index, Stroke Volume and Total Peripheral Resistance.
Starling’s Advanced Technology Meets the Dynamic and Real-Time Needs of Fluid Monitoring
~50%
Only about 50% of hemodynamically unstable patients will respond to IV fluid by increasing cardiac output and perfusion.5
72 hours
Fluid status changes over the first 72 hours.6 Using just blood pressure, urine output and heart rate to measure fluid responsiveness may provide delayed and inconclusive information.5,7
94%
The Starling fluid management monitoring system provides a full hemodynamic profile within seconds, with 94% sensitivity for predicting fluid responsiveness in critical care situations.8
100%
The Starling fluid management monitoring system also provides 100% specificity for predicting fluid responsiveness in critical care situations.8
Clinical Benefits of Measuring Flow and Volume Directly vs. Central Venous Pressure Measurements
Dynamic volume assessments with the Starling system
Central venous pressure measurements
| Dynamic volume assessments with the STARLING System | Central venous pressure measurements |
|---|---|
| Provides changes in stroke volume in response to fluid challenge | Central Venous Pressure (CVP) does not predict fluid responsiveness |
| Noninvasive, continuous, easy to use | Invasive |
| No central line | Invasive |
| Works on spontaneous breathing as well as mechanically ventilated patients9,10 | CVP impacted by mechanical ventilation and PEEP |
| Included as an option in NQ#0500/CM SEP-1 Severe Sepsis/Septic Shock Management Bundle | Included as an option in NQ#0500/CM SEP-1 Severe Sepsis/Septic Shock Management Bundle |
More Evidence for Starling Fluid Management Monitoring System
Starling Measurement of Stroke Volume vs. Conventional Pressure Measurements
Starling measures stroke volume, cardiac output and other hemodynamic parameters centrally, directly at the thorax. Instead of measuring pressure and converting volume (a process that requires an estimation of cardiovascular and peripheral vascular compliance), Starling measures flow and volume at the source: as blood leaves the left ventricle and passes through the aorta to the systemic circulatory system. Starling measures the “True Volume Event.”
When considering volume management needs, the central question is to determine if fluids will improve or impede the goal of optimizing perfusion. “Will my patient respond to additional fluids by increasing cardiac output?” Starling provides a direct volume answer by measuring the true volume event: stroke volume measured continuously on a beat-by-beat basis.
Supporting SEP-1 Bundle Compliance
With fluids acting as the first line of treatment for sepsis, Starling plays a critical role in the management of septic patients. Starling is the only device with demonstrated outcomes data that will allow your hospital to meet the reassessment of volume status and tissue perfusion of the six-hour bundle—with a nurse-performed passive leg raise (PLR)!11,12
The PLR technique translocates 250-300 cc of blood from lower extremities into the heart, providing reversible challenge of the heart’s response to increased fluid load.16 The Starling system’s non-invasive monitoring technology provides real-time quantification of a patient’s fluid responsiveness.
Reducing Secondary Interventions Through Improved Outcomes
Backed by the Fluid Responsiveness Evaluation in Sepsis-associated Hypotension (FRESH) Trial, the Starling system is the only device to show proven outcomes via dynamic assessment in sepsis patients through a randomized, controlled study.13
Conducted among 124 patients across 13 hospital facilities, the FRESH Trial met its primary endpoint of significantly lower fluid balance at 72 hours or ICU discharge. It also demonstrated statistically significant outcomes in reduced initiation of mechanical ventilation and renal replacement therapy.
Published Data Highlight Clinical and Economic Benefits
With healthcare expenses continuing to rise, the pressure has never been greater on hospitals to proactively manage costs. A personalized and predictive model that can be leveraged to evaluate the cost effectiveness of purchasing non-invasive hemodynamic monitoring equipment can help in decision-making.
FRESH Trial Resources
Learn more about the groundbreaking FRESH trial and the impact of fluid management on sepsis patient outcomes.
FRESH Trial Paper
“Fluid Response Evaluation in Sepsis Hypotension and Shock”
FRESH Latham Editorial
A companion commentary to the original FRESH Trial Paper
FRESH Protocol
A visual decision tree for resuscitation using dynamic assessment
Proof Points
In a retrospective, matched, single-center study, researchers from the University of Kansas Health System evaluated stroke volume (SV) guided resuscitation in 100 ICU patients with severe sepsis and septic shock.14,15
2.89
days reduced length of stay in ICU14
51%
reduced risk of mechanical ventilation14
13.25%
reduced initiation of acute dialysis14
$14k+
savings per treated patient15
“We embarked on this study with the hypothesis that actively managing patients’ fluids was associated with improved clinical outcomes. The study demonstrated positive patient outcomes from actively monitoring resuscitation by optimizing stroke volume, which may be translated to significant cost savings to the hospitals caring for these very critical patients.”
Dr. Heath Latham, University of Kansas Health System
Features
Dynamic Assessments
Starling supports the use of dynamic assessments to determine fluid responsiveness. Watch how it works.
- Portable and lightweight touch screen monitor
- First results in approximately 48 seconds
- Guides clinician through step-by-step protocol for executing a PLR or bolus test
- User interface provides easy-to-read graphics and numbers with responsive touch control
- Numeric display for charting provides real-time continuous data with option to select data displayed every minute, five minutes, 15 minutes or hour
- Monitor fits on cart, table or IV pole
- Battery operation
- Seamlessly integrates with hospital EMR systems
Easy-to-Use, Flexible Interface
A critical component of the Starling system, the monitor offers a simple and customizable home screen that provides users the flexibility to choose their preferred view and parameters to be displayed on the screen. These include Cardiac Index, Cardiac Output, Stroke Volume Index, Stroke Volume and Total Peripheral Resistance, among other important parameters.
All information is provided on one screen, including dynamic assessment results, so users can quickly and easily assess if the patient is fluid responsive. When additional guidance is needed, Starling offers educational tools built right into the monitor — providing easy access to training videos, clinical tools and quick guides.
Determining Fluid Responsiveness
To determine fluid responsiveness, a dynamic assessment is performed, which challenges the heart with a small amount of fluid to gauge its response. Two ways of performing this fluid challenge are a fluid bolus or a passive leg raise (PLR). The PLR translocates 250-300 cc of blood from lower extremities into the heart, providing a reversible challenge of the heart’s response to increased fluid load.16
Order & Support
Learn More About Starling System
Ordering and Support Information for Starling System
Get additional ordering, customer, technical, and medical support information for Starling System by contacting Baxter using the links below.
U.S. Catalog
To buy this product, purchase OEM parts and accessories, or look for options and specs please visit U.S. Catalog.
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Starling Fluid Management Monitoring System
Resources
Resources Related to Starling Fluid Management Monitoring System
A Comprehensive Accessories Package
Components of the Starling system are designed to support the various clinical settings in which fluid management is critical. All of our accessories are designed with flexibility and portability in mind.
Starling Fluid IQ App for Personalized Fluid Management
Easily access information you need to know about using the Starling system. Review information on fluid management principles, perform dynamic assessments via a fluid challenge, interpret Starling system results, review case studies and more.
More Products
Other Information
Starling Fluid Management Monitoring System Indications for Use
The Starling with Non-Invasive Blood Pressure (NIBP) and SpO2 functionalities is a portable, hemodynamic monitoring noninvasive Cardiac Output monitoring device that monitors and displays a patient's Cardiac Output (CO) in Ltr/Min with a NIBP function that non-invasively measures and displays blood pressure (diastolic, systolic, and mean arterial pressure) and heart rate and with a SpO2 function that non-invasively measures and displays blood oxygen saturation (SpO2). The device displays associated hemodynamic parameters based on measurements or calculations of measurements already incorporated into the Starling. The Starling with NIBP and SpO2 functionalities is intended for use within hospitals and other healthcare facilities (e.g., outpatient clinics) that provide patient care.
Disclaimers
Rx only. For safe and proper use of product mentioned herein, please refer to the Instructions for Use or Operator Manual.
Baxter, IQX Infusion Platform, One-Link and Starling are trademarks of Baxter International Inc. or its subsidiaries. Any other trademarks, product names or brand images are the property of their respective owners.
References
- Yucha CB, Hastings-Tolsma M, Szevereny NM. Differences among intravenous extravasations using four common solutions. J Intraven Nurs. 1993;16(5):277-281.
- Kelm DJ, Perrin JT, Cartin-Ceba R, et al. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock. 2015;43(1):68-73.
- Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377.
- Lucet JC, Bouadma L, Zahar JR, et al. Infectious risk associated with arterial catheters compared with central venous catheters. Crit Care Med. 2010;38(4):1030-1035.
- Bentzer P, Griesdale D, Boyd J, McLean K, Sirounis D, Ayas N. Will this hemodynamically unstable patient respond to a bolus of intravenous fluids? JAMA. 2016;316(12):1298-1309.
- Douglas IS, Alapat PM, Corl K, et al. Physiology of fluid responsiveness in sepsis. Am J Respir Crit Care Med. 2020;201:A6002
- Convertino, VA et al. Stroke Volume and sympathetic responses to lower-body negative pressure reveal new insights to circulatory shock in humans. Autonomic Neuroscience: Basic and Clinical 111(2004) 127-134
- Marik PE, Levitov A, Young A, Andrews L. The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients. Chest. 2013;143(2):364-370.
- Duus N, Shogilev D, Skibsted S, et al. The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients. J Crit Care. 2015;30(1):217.e1-217.e5.
- Raval NY, Squara P, Clemen M, Yalamanchili K, Winklmaier M, Burkhoff D. Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique. J Clin Monit Comput. 2008;22(2):113-119.
- Calvo-Vecino JM, Ripollés-Melchor J, Mythen MG, et al. Effect of goal-directed haemodynamic therapy on postoperative complications in low-moderate risk surgical patients: a multicentre randomized controlled trial (FEDORA trial). Br J Anaesth. 2018;120(4):734-744.
- Sahatjian J, et al. Incorporating routine passive leg raise (PLR) assessments improves SEP-1 performance and patient care. Chest. 2019;165:A1675-A1676.
- Douglas IS, Alapat PM, Corl KA, et al. Fluid response evaluation in sepsis hypotension and shock: a randomized clinical trial. Chest. 2020;158(4):1431-1445.
- Latham H, et al. Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes. J Crit Care. 2017;42:42-46.
- Latham H, et al. Sepsis resuscitation based on stroke volume optimization improves outcome and reduces cost of care. Crit Care Med. 2018;(46):709.
- Monnet X, Teboul JL. Passive leg raising. Intensive Care Med. 2008;34:659-663.