Comparison of the diagnostic accuracy of dynamic and static preload indexes to predict fluid responsiveness in mechanically ventilated, isoflurane anesthetized dogs
| Autor: | Carolina Hagy Girotto, Guillermo Carlos Veiga de Oliveira, Tábata L. Dalmagro, Natache A. Garofalo, Francisco J. Teixeira-Neto, Nathalia Celeita-Rodríguez, Ivan Felismino Charas dos Santos |
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| Přispěvatelé: | Universidade Estadual Paulista (Unesp) |
| Rok vydání: | 2018 |
| Předmět: |
Cardiac output
040301 veterinary sciences Ovariectomy Population volume expansion goal-directed fluid therapy preload indexes Hysterectomy 0403 veterinary science 03 medical and health sciences 0302 clinical medicine Dogs 030202 anesthesiology Plethysmograph Medicine Animals Prospective Studies education Tidal volume education.field_of_study General Veterinary Isoflurane business.industry Central venous pressure Hemodynamics Stroke Volume 04 agricultural and veterinary sciences Stroke volume Respiration Artificial ROC curve analysis Pulse pressure Body Fluids Preload Anesthesia Anesthetics Inhalation Female business |
| Zdroj: | Scopus Repositório Institucional da UNESP Universidade Estadual Paulista (UNESP) instacron:UNESP |
| ISSN: | 1467-2995 |
| Popis: | Made available in DSpace on 2019-10-06T15:39:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-05-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Ministry of Science and Technology Objective: To compare the diagnostic accuracy of pulse pressure variation (PPV), stroke volume variation from pulse contour analysis (SVV PCA ), plethysmographic variability index (PVI), central venous pressure (CVP) and global end-diastolic volume index measured by transpulmonary thermodilution (GEDVI TPTD ) to predict fluid responsiveness (FR) in dogs. Study design: Prospective study. Animals: A group of 40 bitches (13.8–26.8 kg) undergoing ovariohysterectomy. Methods: Anesthesia was maintained with isoflurane under volume-controlled ventilation (tidal volume 12 mL kg –1 ; inspiratory pause during 40% of inspiratory time; inspiration:expiration ratio 1:1.5). Transpulmonary thermodilution cardiac output was recorded through a femoral artery catheter. FR was evaluated by a fluid challenge (lactated Ringer's, 20 mL kg –1 over 15 minutes) administered once (n = 21) or twice (n = 18) before surgery. Individuals were responders if stroke volume index measured by transpulmonary thermodilution increased >15% after the last fluid challenge. Results: Of the 39 animals studied, 21 were responders and 18 were nonresponders. Area under the receiver operating characteristics curve (AUROC) was 0.976, 0.906, 0.868 and 0.821 for PPV, PVI, CVP and SVV PCA , respectively (p < 0.0001 from AUROC = 0.5). GEDVI TPTD failed to predict FR (AUROC: 0.660, p = 0.078). Best cut-off thresholds discriminating responders and nonresponders, with respective zones of diagnostic uncertainty (gray zones) were: PPV >16% (15–16%), PVI >11% (10–13%), SVV PCA >10% (9–18%) and CVP ≤1 mmHg (0–3 mmHg). Percentage of animals within gray zone limits was 13% (PPV), 28% (PVI), 51% (SVV PCA ) and 67% (CVP). Conclusions and clinical relevance: PPV has better diagnostic accuracy to predict FR (conclusive results in nearly 90% of population) than other preload indexes in healthy dogs. When invasive blood pressure is unavailable, PVI will predict FR with reasonable accuracy (conclusive results in approximately 70% of the population). PPV and PVI values above gray zone limits (>16% and >13%, respectively) can reliably predict responders to volume expansion. Faculdade de Medicina Universidade Estadual Paulista (UNESP) Faculdade de Medicina Veterinária e Zootecnia Universidade Estadual Paulista (UNESP) Faculdade de Medicina Universidade Estadual Paulista (UNESP) Faculdade de Medicina Veterinária e Zootecnia Universidade Estadual Paulista (UNESP) CNPq: 306342/2015-4 |
| Databáze: | OpenAIRE |
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