Evolving Current Clinical Practices


IV fluids are among the most commonly used interventions for hospitalized patients, yet 1 in 5 patients on IV fluid therapy suffer complications because fluids were delivered in the wrong volume or at the wrong time.1 The Starling system takes the guesswork out of fluid decisions with dynamic assessments to accurately identify the potential benefits or harms of administering IV fluids to an individual patient.

Nurse at a patients bedside


Every patient has unique and constantly changing fluid management needs. Over 80% of hospitalized patients receive IV fluids.4 Yet studies show that administering too little or too much fluid can lead to serious complications and contribute to rising healthcare costs.5,6

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 patient. The Starling system can accurately advise clinical staff on whether a patient will benefit from additional fluid, in a 100% non-invasive way. 

Starling’s advanced technology meets the dynamic and real-time needs of fluid monitoring.

IV fluids may cause harm.

Fluid is an important predictor of mortality. Only ~50% of hemodynamically unstable patients will respond to IV fluid by increasing cardiac output and perfusion.7

Fluid responsiveness is dynamic.

Fluid status changes over the first 72 hours.8 Using just blood pressure and heart rate to measure fluid responsiveness may provide limited and inconclusive information.9

Real-time, accurate data is needed.

The Starling system provides a full hemodynamic profile within seconds — with 94% sensitivity and 100% specificity for predicting fluid responsiveness in critical care situations.7

Bioreactance™ technology


The Starling system uses advanced, patented Bioreactance technology to take measures continuously and precisely, and it requires only four easy-to-place sensor pads. The sensors can be placed anywhere on the chest or back as long as two are positioned above the heart and two are below the heart.

The technology works by sending a small electrical current across the thorax, measuring the time delay or Phase Shift between the applied electrical current and the voltage on the thorax. These Phase Shifts correlate with the amount of blood volume change in the thorax; therefore, the Stroke Volume can be calculated.

The Starling system uses dynamic assessment to determine fluid responsiveness: watch how it works.

Nurse at a bedside with an icon in the left corner. Icon indicates a Passive Leg raise, raised at 45 degrees.


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 [1] a fluid bolus, or [2] a Passive Leg Raise, which 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. 


The Starling system 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), the Starling system measures flow and volume at the source — as blood leaves the left ventricle and passes through the aorta to the systemic circulatory system. As a result, the Starling system measures hemodynamic events with great accuracy.

When considering volume management needs of a patient, 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?”  This is a volume question. The Starling system provides a direct volume answer by measuring the true volume event — stroke volume measured continuously on a beat-by-beat basis.

Clinical benefits of measuring flow and volume directly vs 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 patients 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

Rx only. For safe and proper use of the products mentioned herein, please refer to the appropriate Operator's Manual or Instructions for Use.

Baxter, Starling and Bioreactance are trademarks of Baxter International Inc. or its subsidiaries.