Optimizing Fluid Management in Critical Care: Expert Consensus on the Clinical and Operational Impact of the Starling Fluid Management Monitoring System

INTRODUCTION: Effective fluid management is crucial for improving critical care outcomes and resource utilization. The Starling Fluid Management Monitoring System uses 100% non-invasive bioreactance technology to deliver precise hemodynamic assessments for fluid optimization in ICU, OT, and emergency settings. OBJECTIVES: We evaluated the system's clinical and operational impact, focusing on fluid responsiveness, user-friendliness, and its effectiveness in diverse patient populations. METHODS: The Expert Fluid Forum gathered 15 critical care specialists, collectively contributing over 450 man-years of experience in managing critically ill patients. A structured evaluation framework assessed ten clinical statements on the Starling system's benefits, applications, and effectiveness using a 5-point Likert scale. Statistical analysis with GraphPad version 10.4.1 defined strong consensus as a weighted score above 100. Key parameters included dynamic fluid assessments, personalized fluid therapy, and accuracy in mechanically ventilated and spontaneously breathing patients. RESULTS: The study findings revealed a strong consensus on the Starling system's utility in critical care. High weighted scores were observed for quick dynamic assessments (122.9), user-friendliness (121.7), and real-time decision-making support (121.0). These features enable clinicians to reduce risks of fluid overload, improve workflow efficiency, and enhance patient safety. The system demonstrated versatility across ICUs, OTs, and EDs (120.0) and provided the ability to deliver personalized fluid therapy (118.5), highlighting its adaptability to diverse clinical scenarios. The effectiveness of bioreactance technology was widely acknowledged, with a weighted score of 113.8. It was particularly valued for its reliability in assessing fluid responsiveness in both mechanically ventilated and spontaneously breathing patients (116.0). However, specific features such as stroke volume-guided therapy (109.2) and central flow measurement accuracy (106.7) garnered moderate support, with neutrality rates of 53.8% and 66.7%, respectively. These neutrality rates highlight opportunities for further exploration and education to increase awareness and understanding of these features’ potential. Overall, the mean response scores were notable: agree (83±22, 95% CI 69 to 99) and strongly agree (12±13, 95% CI 2.2 to 2.3), with statistically significant findings (p<0.0001). DISCUSSION: The Starling Fluid Management Monitoring System demonstrated substantial clinical utility, particularly in its ability to perform rapid dynamic assessments, support real-time decision-making, and provide user-friendly operation. Its adaptability across various care settings highlights its potential to improve outcomes for diverse patient populations. The system's non-invasive bioreactance technology further enhances its value by offering precise, reliable measurements without the risks associated with invasive monitoring methods. Nevertheless, higher neutrality rates for certain features, such as stroke volume-guided therapy and central flow measurements, point to areas for growth. These findings suggest the need for additional research to validate these features and educational initiatives to increase clinician familiarity and confidence in the system's capabilities. CONCLUSION: The Starling system holds significant promise for optimizing fluid management in critical care. Its ability to balance clinical precision with operational efficiency positions it as a valuable tool for improving outcomes and reducing complications associated with fluid therapy. By addressing identified gaps through enhanced validation and education, the system's impact can be further amplified and further strengthen its role in modern critical care practice.