Use of aortic flow indexes derived from transthoracic echocardiography to evaluate response to a fluid challenge in anesthetized dogs,Veterinary Anaesthesia and Analgesia

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Use of aortic flow indexes derived from transthoracic echocardiography to evaluate response to a fluid challenge in anesthetized dogs
Veterinary Anaesthesia and Analgesia ( IF 1.7 ) Pub Date : 2021-01-12 , DOI: 10.1016/j.vaa.2020.12.006
Guillermo C V de Oliveira ₁ , Francisco J Teixeira-Neto ₂ , Tábata L Dalmagro ₃ , Angélica Alfonso ₁ , Nathalia Celeita-Rodríguez ₃ , César P C Lobo ₃ , Maria L G Lourenço ₁

Affiliation

Objective

To evaluate the ability of transthoracic echocardiographic aortic flow measurements to discriminate response to a fluid challenge (FC) in healthy anesthetized dogs.

Study design

Prospective experimental study.

Animals

A total of 48 isoflurane-anesthetized dogs (14.2–35.0 kg) undergoing elective surgery.

Methods

Fluid responsiveness was evaluated before surgery by FC (lactated Ringer’s 10 mL kg^–1 intravenously over 5 minutes). Percentage increases in transpulmonary thermodilution stroke volume (ΔSV_TPTD) >15% from values recorded before FC defined responders to volume expansion. A group of 24 animals were assigned as nonresponders (ΔSV_TPTD ≤15%). When ΔSV_TPTD was >15% after the first FC, additional FC were administered until ΔSV_TPTD was ≤15%. Final fluid responsiveness status was based on the response to the last FC. Percentage increases after FC in aortic flow indexes [velocity time integral (ΔVTI_FC) and maximum acceleration (ΔVmax_FC)] and in mean arterial pressure (ΔMAP_FC) were compared with ΔSV_TPTD.

Results

After one FC, 24 animals were responders. For nonresponders, ΔSV_TPTD was ≤15% after one, two and three FCs in eight/24, 15/24 and one/24 animals, respectively. The FC that defined responsiveness increased ΔSV_TPTD by 29 (18–53)% in responders and by 8 (–3 to 15)% in nonresponders [mean (range)]. The area under the receiver operating characteristics curve (AUROC) of ΔVTI_FC (0.901) was larger than the AUROCs of ΔVmax_FC (0.774, p = 0.041) and ΔMAP_FC (0.519, p < 0.0001). ΔMAP_FC did not predict responsiveness (p = 0.826). Best cut-off thresholds for discriminating responders, with respective zones of diagnostic uncertainty (gray zones) were >14.7 (10.8–17.6)% for ΔVTI_FC and >8.6 (–0.3 to 14.7)% for ΔVmax_FC. Animals within the gray zone were 17% (ΔVTI_FC) and 50% (ΔVmax_FC).

Conclusions and clinical relevance

Changes in VTI induced by FC can determine responsiveness with reasonable accuracy in dogs and could play an important role in goal-directed fluid therapy.

中文翻译：

使用源自经胸超声心动图的主动脉血流指数评估麻醉犬对液体挑战的反应

客观的

评估经胸超声心动图主动脉流量测量区分健康麻醉犬对液体挑战 (FC) 反应的能力。

学习规划

前瞻性实验研究。

动物

总共 48 只异氟醚麻醉的狗 (14.2–35.0 kg) 正在接受择期手术。

方法

在手术前通过 FC（5 分钟内静脉注射乳酸林格氏液 10 mL kg ^–1）评估液体反应性。经肺热稀释每搏输出量 (ΔSV _TPTD ) 的百分比增加> 15%，与 FC 定义的对容量扩张有反应之前记录的值相比。一组 24 只动物被指定为无反应者（ΔSV _TPTD ≤15%）。当第一次 FC 后ΔSV _TPTD > 15% 时，给予额外的 FC，直到 ΔSV _{TPTD ≤ 15} %。最终的液体反应状态基于对最后一次 FC 的反应。FC 后主动脉血流指数 [速度时间积分 (ΔVTI _FC ) 和最大加速度 (ΔVmax _FC ) 的百分比增加)] 和平均动脉压 (ΔMAP _FC ) 与 ΔSV _TPTD进行比较。

结果

1 次 FC 后，24 只动物是响应者。对于无反应者，_分别在 8/24、15/24 和 1/24 只动物中进行 1、2 和 3 次 FC 后ΔSV _{TPTD ≤ 15} %。定义反应性的 FC 使反应者的 ΔSV _TPTD增加了 29 (18–53)%，_而无反应者的ΔSV _TPTD增加了 8 (–3 到 15)% [平均值（范围）]。ΔVTI _FC (0.901)的受试者工作特征曲线 (AUROC) 下面积大于 ΔVmax _FC (0.774, p = 0.041) 和 ΔMAP _FC (0.519, p < 0.0001)的 AUROCs 。ΔMAP _FC不能预测反应性（p = 0.826）。最好截止用于区分应答者，具有诊断不确定性（灰色区域）是> 14.7（10.8-17.6）％为ΔVTI的各个区的阈值_FC和> 8.6（-0.3〜14.7）％为量ΔVmax _FC。灰色区域内的动物分别为 17% (ΔVTI _FC ) 和 50% (ΔVmax _FC )。