Pulse pressure variation as a guide for volume expansion in dogs undergoing orthopedic surgery

Fantoni, Denise Tabacchi; Ida, Keila Kazue; Gimenes, André Martins; Mantovani, Matheus Matioli; Castro, Jairo Lopes de; Patricio, Geni Cristina Fonseca; Ambrósio, Aline Magalhães; Otsuki, Denise Aya

doi:10.1016/j.vaa.2016.11.011

Cited by 28 publications

(28 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further prospective studies are required to confirm whether this approach could be valid in clinical cases. The literature indicates that in dogs not subjected to laparoscopy, the PPV cut-off value to discriminate “preload dependent” subjects is lower (11%–15%) [7,9,10] than the value found in this study. We can suppose that the difference is related to the impact of PP, which added an additional factor influencing the hemodynamic status compared to dogs not subjected to laparoscopy.…”

Section: Discussioncontrasting

confidence: 79%

“…These studies showed that changes in PPV and hypovolemic conditions occurred much earlier than changes in classical parameters such as arterial blood pressure, heart rate (HR), or central venous pressure [7,8]. In a clinical study in dogs, Fantoni et al [10] showed that PPV can predict fluid responsiveness in dogs undergoing orthopedic surgery, and they found a cut-off value of 15% distinguishing responders from non-responders. Drozdzynka et al [7] used a PPV of 13% as a cut-off for the intraoperative administration of a fluid bolus as part of a goal-directed protocol in dogs undergoing abdominal surgery, showing that a PPV ≥ 13% reliably predicted the cardiovascular response to fluid loading in 82.8% of canine cases undergoing abdominal surgery, in agreement with findings from human studies [2].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pulse Pressure Variation Can Predict the Hemodynamic Response to Pneumoperitoneum in Dogs: A Retrospective Study

Bella

Lacitignola

Fracassi

et al. 2019

Veterinary Sciences

View full text Add to dashboard Cite

Pneumoperitoneum may induce important hemodynamic alterations in healthy subjects. Pulse pressure variation (PPV) is a hemodynamic parameter able to discriminate preload dependent subjects. Anesthesia records of dogs undergoing laparoscopy were retrospectively evaluated. The anesthetic protocol included acepromazine, methadone, propofol and isoflurane administered with oxygen under mechanical ventilation. The hemodynamic parameters were considered five minutes before (BASE) and ten minutes after (P10) the pneumoperitoneum. Based on the cardiac index (CI) variation, at P10, dogs were classified as sensitive (S group, CI ≤ 15%) and non-sensitive (NO-S group). Data were analyzed with the ANOVA test and the ROC curve (p < 0.05). Fifty-five percent of dogs (S) had a reduction of CI ≥ 15% at P10 (2.97 ± 1.4 L/min/m2) compared to BASE (4.32 ± 1.62 L/min/m2) and at P10 in the NO-S group (4.51 ± 1.41 L/min/m2). PPV at BASE was significantly higher in the S group (22.4% ± 6.1%) compared to the NO-S group (10.9% ± 3.3%). The ROC curve showed a threshold of PPV > 16% to distinguish the S and NO-S groups. PPV may be a valid predictor of the hemodynamic response to pneumoperitoneum in dogs. A PPV > 16% can identify patients that may require fluid administration before the creation of pneumoperitoneum.

show abstract

Section: Discussioncontrasting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Pulse Pressure Variation Can Predict the Hemodynamic Response to Pneumoperitoneum in Dogs: A Retrospective Study

Bella

Lacitignola

Fracassi

et al. 2019

Veterinary Sciences

View full text Add to dashboard Cite

show abstract

“…New indices based on heart and lung interactions, known as "dynamic indices" were introduced and their superiority was demonstrated over the previous "static indices", such as central venous pressure (CVP) [8,27]. Examples of these new "dynamic" respiratory indices are the systolic pressure variation (SPV) [6,41], pulse pressure variation (PPV) [15,40,41], stroke volume variation (SVV) [41], pleth variability index (PVI) [40] and the collapsibility of the vena cava (cIVC) [16], which are all based on cardiac response in terms of SV and cardiac output variations, to interactions between the heart and lungs during mechanical ventilation or spontaneous breathing.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the caudal vena cava diameter to abdominal aortic diameter ratio and the caudal vena cava respiratory collapsibility for predicting fluid responsiveness in a heterogeneous population of hospitalized conscious dogs

Rabozzi¹,

Oricco²,

Meneghini³

et al. 2020

The Journal of Veterinary Medical Science

View full text Add to dashboard Cite

Fluid responsiveness, defined as the response of stroke volume to fluid loading, is a tool to individualize fluid administration in order to avoid the deleterious effects of hypovolemia or hypervolemia in hospitalized patients. To evaluate the accuracy of two ultrasound indices, the caudal vena cava to abdominal aorta ratio (CVC/Ao) and the respiratory collapsibility of the caudal vena cava (cCVC), as independent predictors of fluid responsiveness in a heterogeneous population of spontaneously breathing, conscious, hospitalized dogs. A prospective, multicenter, observational, cross-sectional study was designed in twenty-five dogs. The accuracy of CVC/ Ao and cCVC in predicting fluid responsiveness was evaluated by the area under the receiver operating characteristic curve (AUROC) in a group of hospitalized dogs after receiving a mini-fluid bolus of 4 ml/kg of Hartmann's solution. Dogs with an increased aortic velocity time integral >15% were classified as fluid responders. Twenty-two dogs were finally included. Ten were classified as responders and 12 as non-responders. The AUROC curves were 0.88 for the CVC/Ao ratio (95% confidence interval, CI, 0.67-0.98; P=0.0001) and 0.54 for cCVC (95% CI 0.32-0.75; P=0.75). The CVC/Ao threshold optimized for best sensitivity (SE) and specificity (SP) values was 0.83 (SE 100%; SP 75%). In spontaneously breathing hospitalized dogs, the CVC/Ao measurement predicted stroke volume increase after a fluid bolus, while the respiratory variations in the cCVC did not discriminate between fluid responders and non-responders.

show abstract

“…Lower HR and respiratory rates in horses may also pose limitations ( 140 ). Among veterinary-pertinent studies ( 105 , 118 , 122 , 160 – 173 ), a recent investigation with hypotensive dogs found PPV ≥ 15% had 50% sensitivity and 96% specificity in predicting preload responsiveness, further estimating PPV ≥ 19.5 for 100% sensitivity (76% specificity) ( 171 ). Another investigation with healthy dogs disclosed cutoff values for ΔVPeak ≥ 9.4% (89% sensitivity, 100% specificity), SPV ≥ 6.7% (78% sensitivity, 93% specificity), and CVCDI ≥ 24% (78% sensitivity, 73% specificity), as being predictive of preload responsiveness ( 172 ).…”

Section: Considerations On Monitoring and Treatment Of Relative Hypovmentioning

confidence: 99%

“…and highly likely to be species-dependent, highlighting the importance of personalizing fluid resuscitation protocols. Taken together these studies suggest that: (1) goal-directed fluid therapy is superior to “rules of thumb” (e.g., 3 mL crystalloid/1 mL blood loss) or standardized formulas (3–10 mL/kg/h); (2) a balanced crystalloid solution ( 201 ), is the best first choice fluid unless laboratory data suggest otherwise; (3) monitoring techniques should include at least one validated dynamic index [e.g., PPV ( 165 , 170 , 171 , 173 )]; (4) an IV fluid bolus should not exceed 20–30 mL/kg ( 199 ); and (5) maximal rates of fluid administration should range from 0.02 (maintenance) to 1.0 mL/kg/min (resuscitation) during anesthesia ( 200 ).…”

Section: Considerations On Monitoring and Treatment Of Relative Hypovmentioning

confidence: 99%

Anesthesia-Associated Relative Hypovolemia: Mechanisms, Monitoring, and Treatment Considerations

Noel-Morgan

Muir

2018

Front. Vet. Sci.

View full text Add to dashboard Cite

Although the utility and benefits of anesthesia and analgesia are irrefutable, their practice is not void of risks. Almost all drugs that produce anesthesia endanger cardiovascular stability by producing dose-dependent impairment of cardiac function, vascular reactivity, and compensatory autoregulatory responses. Whereas anesthesia-related depression of cardiac performance and arterial vasodilation are well recognized adverse effects contributing to anesthetic risk, far less emphasis has been placed on effects impacting venous physiology and venous return. The venous circulation, containing about 65–70% of the total blood volume, is a pivotal contributor to stroke volume and cardiac output. Vasodilation, particularly venodilation, is the primary cause of relative hypovolemia produced by anesthetic drugs and is often associated with increased venous compliance, decreased venous return, and reduced response to vasoactive substances. Depending on factors such as patient status and monitoring, a state of relative hypovolemia may remain clinically undetected, with impending consequences owing to impaired oxygen delivery and tissue perfusion. Concurrent processes related to comorbidities, hypothermia, inflammation, trauma, sepsis, or other causes of hemodynamic or metabolic compromise, may further exacerbate the condition. Despite scientific and technological advances, clinical monitoring and treatment of relative hypovolemia still pose relevant challenges to the anesthesiologist. This short perspective seeks to define relative hypovolemia, describe the venous system’s role in supporting normal cardiovascular function, characterize effects of anesthetic drugs on venous physiology, and address current considerations and challenges for monitoring and treatment of relative hypovolemia, with focus on insights for future therapies.

show abstract

Pulse pressure variation as a guide for volume expansion in dogs undergoing orthopedic surgery

Cited by 28 publications

References 29 publications

Pulse Pressure Variation Can Predict the Hemodynamic Response to Pneumoperitoneum in Dogs: A Retrospective Study

Pulse Pressure Variation Can Predict the Hemodynamic Response to Pneumoperitoneum in Dogs: A Retrospective Study

Evaluation of the caudal vena cava diameter to abdominal aortic diameter ratio and the caudal vena cava respiratory collapsibility for predicting fluid responsiveness in a heterogeneous population of hospitalized conscious dogs

Anesthesia-Associated Relative Hypovolemia: Mechanisms, Monitoring, and Treatment Considerations

Contact Info

Product

Resources

About