Pulmonary hypertension attenuates the dynamic preload indicators increase during experimental hypovolemia

Bouchacourt, Juan Pablo; Riva, Juan; Grignola, Juan C.

doi:10.1186/s12871-017-0329-z

Cited by 5 publications

(7 citation statements)

References 34 publications

(42 reference statements)

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“…In this setting, intravascular volume dehydration should be needed to avoid exacerbating bi-ventricular cardiac dysfunction because of less chance of improvement on RV contractility over a wide range of filling pressures due to flatter Starling curve of RV than the LV [ 43 ]. This may lead to RV global dysfunction and secondarily with LV systolic dysfunction, making the animals none or less responsive to fluid loading [ 44 ], as demonstrated in the Control group.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, this study was carried out before and after abdominal wall closure for ethical aspects of veterinary patients’ safety. While previous studies have suggested that dynamic preload indicators such as PPV and SVV are able to predict fluid responsiveness during major abdominal surgery [ 60 , 61 ], there are still some controversies regarding the predictive values of fluid responsiveness compared to values obtained in the ICU setting [ 44 ]. Future studies are expected to establish the utility of EV-based goal-directed therapy in larger populations to ensure adequate hemodynamic stabilities throughout the phase of surgical anesthesia and improved outcomes of the emergency canine patients.…”

Section: Discussionmentioning

confidence: 99%

“…dysfunction and secondarily with LV systolic dysfunction, making the animals none or less responsive to fluid loading [44], as demonstrated in the Control group. In this regard, our results suggest that supplementary inotropic support improved fluid responsiveness to dogs with MMVD-related PH.…”

Section: Plos Onementioning

confidence: 95%

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Noninvasive assessment of fluid responsiveness for emergency abdominal surgery in dogs with pulmonary hypertension: Insights into high-risk companion animal anesthesia

2020

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Objective Optimizing cardiac stroke volume during high-risk surgical anesthesia is of particular interest with regard to a therapeutic target to reduce the incidence of postoperative complications. However, intensive fluid management in critically ill small animals with pulmonary hypertension (PH) has been empirically performed, and thus it can be challenging. Stroke volume variation (SVV) has been used as a dynamic preload predictor of fluid responsiveness. We hypothesized that if SVV exhibited robust reliability in the setting of hemodynamically unstable condition, it would provide more precise information on fluid resuscitation to translate it into veterinary anesthesia. Thus the aim of this study was to investigate the utility of SVV measured by the electrical velocimetry (EV) method for predicting fluid responsiveness in dogs with PH. Methods Sixteen dogs undergoing emergency abdominal surgery and diagnosed with PH secondary to myxomatous mitral valve disease (MMVD) on preoperative transthoracic echocardiogram were included. Dogs were randomly assigned to 2 groups with and without inotropic cardiac support with dobutamine. Hemodynamic measurements including stroke volume and SVV derived from the EV device were performed under general anesthesia before (baseline) and after surgery (fluid challenge with a colloid solution defined by a SV increase of ≥ 10%). Results In both groups, SVV elevated significantly after abdominal surgery compared with baseline. In dobutamine infused group, the SVV values decreased significantly after fluid challenge ( P < 0.05) with a greater number of responders than saline infused control group ( P < 0.01). Receiver operating curve analysis of SVV confirmed high positive predictive value for dogs during dobutamine infusion ( P < 0.05; cut-off value of 15%; specificity 90%, sensitivity 82%). Conclusions Noninvasive EV monitoring may be useful for the prediction of fluid responsiveness in critically ill dogs with left-sided heart failure-related PH. This normalization of dynamic preload indices, which could be achieved more precisely under inotropic support, may prevent further detrimental consequence of fluid loading.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Noninvasive assessment of fluid responsiveness for emergency abdominal surgery in dogs with pulmonary hypertension: Insights into high-risk companion animal anesthesia

2020

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“…It is well known that the presence of RV failure should be suspected when a patient has significant variations of stroke volume or pulse pressure but does not respond to fluids [ 73 ]. However, the performance of the stroke volume variation and pulse pressure variation could depend on the volume status: during normovolemia their high values failed to predict volume responsiveness (false positive) [ 74 ]; by contrast, during hypovolemia their normal values predict volume unresponsiveness (true negative), avoiding dangerous fluid loading [ 75 ].…”

Section: Treatmentmentioning

confidence: 99%

Acute Right Ventricular Dysfunction in Intensive Care Unit

Grignola

Domingo

2017

BioMed Research International

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The role of the left ventricle in ICU patients with circulatory shock has long been considered. However, acute right ventricle (RV) dysfunction causes and aggravates many common critical diseases (acute respiratory distress syndrome, pulmonary embolism, acute myocardial infarction, and postoperative cardiac surgery). Several supportive therapies, including mechanical ventilation and fluid management, can make RV dysfunction worse, potentially exacerbating shock. We briefly review the epidemiology, pathophysiology, diagnosis, and recommendations to guide management of acute RV dysfunction in ICU patients. Our aim is to clarify the complex effects of mechanical ventilation, fluid therapy, vasoactive drug infusions, and other therapies to resuscitate the critical patient optimally.

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“…The current study has several limitations. Pulmonary hypertension and right ventricular dysfunction can mask hypovolemia and normalize the values of dynamic preload indices 27 . We discarded a significant increase in pulmonary pressure by PHE administration since ∆SV EEOT and ∆AoF EEOT remained elevated after BW.…”

Section: Discussionmentioning

confidence: 99%

End-Expiratory Occlusion Test During Increase of Vasomotor Tone in a Rabbit Model of Hemorrhage

Bouchacourt

Grignola

2020

Sci Rep

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end-expiratory occlusion test (eeot) has been proposed as a preload responsiveness test that overcomes several limitations of pulse pressure (ppV) and stroke volume (SVV) variations. We compared the ability of EEOT versus SVV and PPV to predict fluid responsiveness during the increase of the vasomotor tone in a rabbit model of hemorrhage. ten rabbits were anesthetized, paralyzed, and mechanically ventilated during basal load (BL), after progressive blood withdrawal (BW), and after volume replacement. other two sets of data were obtained during vasomotor increase by phenylephrine (pHe) infusion in BL and BW. We estimated the change of stroke volume (∆SV eeot ) and aortic flow (∆Aof eeot ) during the eeot. ppV and SVV were obtained by the variation of beat-tobeat pp and SV, respectively. Baseline ppV, SVV, ∆SV eeot , and ∆Aof eeot increased significantly after BW, with a decrease of aortic flow (P < 0.05). PHE induced a significant decrease of PPV and SVV, but without affecting ∆SV eeot , and ∆Aof eeot . We conclude that ∆SV and ∆Aof during eeot kept the ability to predict fluid responsiveness during PHE infusion in a rabbit hemorrhage model. This result may suggest the advantage of EEOT with respect to SVV and PPV in predicting fluid responsiveness during vasomotor tone increase.The main goal of fluid therapy is to correct hypovolemia avoiding both under and over-resuscitation, as well as the excessive use of inotropic and vasopressor drugs. Moreover, the comorbidities and type of disease determine that not all patients are volume responsive. The preload responsiveness should be assessed to decide both to administer fluid in the early resuscitation phase of shock states and to stop fluid administration in the de-escalation phase of shock management 1 . Several indices are available at the bedside to predict fluid responsiveness. Dynamic parameters based on heart-lung interactions have been proposed to predict fluid responsiveness and to promote more rational fluid administration 2 . Nevertheless, respiratory variations of stroke volume (SVV), pulse pressure (PPV), and vena cava diameter have numerous limitations that reduce their accuracy and applicability in clinical scenarios 3 . By interrupting cyclic ventilation at end-expiration for a few seconds (end-expiratory occlusion, EEO), abolishing the inspiratory increase in intrathoracic pressure, and by passive leg raising tests, we can produce a self-volume challenge and increase cardiac output (CO) by a rapid and reversible increase of venous return (VR) in those patients preload-responsive 4,5 . Both tests have shown an excellent predictive value keeping their accuracy in patients with cardiac arrhythmias, with spontaneous breathing activity, with low compliance of the respiratory system and independently of positive end-expiratory pressure in acute respiratory distress syndrome patients 6,7 . However, passive leg raising presents some false negatives in patients with intra-abdominal pressure ≥16 mmHg, is contra-indicated to perform in patients with head trauma ...

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Pulmonary hypertension attenuates the dynamic preload indicators increase during experimental hypovolemia

Cited by 5 publications

References 34 publications

Noninvasive assessment of fluid responsiveness for emergency abdominal surgery in dogs with pulmonary hypertension: Insights into high-risk companion animal anesthesia

Noninvasive assessment of fluid responsiveness for emergency abdominal surgery in dogs with pulmonary hypertension: Insights into high-risk companion animal anesthesia

Acute Right Ventricular Dysfunction in Intensive Care Unit

End-Expiratory Occlusion Test During Increase of Vasomotor Tone in a Rabbit Model of Hemorrhage

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