Use of aortic flow indexes derived from transthoracic echocardiography to evaluate response to a fluid challenge in anesthetized dogs

Oliveira, Guillermo Carlos Veiga de; Neto, Francisco José Teixeira; Dalmagro, Tábata L.; Alfonso, Angélica; Celeita-Rodríguez, Nathalia; Lobo, César Passareli Cândido; Lourenço, Maria Lúcia Gomes

doi:10.1016/j.vaa.2020.12.006

Cited by 4 publications

(11 citation statements)

References 28 publications

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“…This test allows determining the fluid responsiveness status of an individual without the need to administer fluids (11). In veterinary medicine, determination of fluid responsiveness has been restricted to the evaluation of changes in SV or CO in response to a fluid challenge in anesthetized or conscious dogs (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Section: What Is Fluid Responsiveness and How Can It Be Assessed?mentioning

confidence: 99%

“…A summary of studies evaluating responsiveness using fluid challenges in small animals is presented in Table 2. Several reports in veterinary medicine have evaluated fluid responsiveness via a fluid challenge approach in healthy/normovolemic dogs under anesthesia (12,15,16,(20)(21)(22). In other studies a fluid challenge has been administered in dogs anesthetized for orthopedic/oncologic surgery that presented intraoperative hypotension (mean arterial pressure < 65 mmHg) (13,18), or in dogs anesthetized for abdominal surgeries potentially associated with hemodynamic instability that were predicted as responders to volume expansion based on PPV values >13% (14).…”

Section: The Fluid Challenge Approach and The End-point Of Fluid Ressuscitationmentioning

confidence: 99%

“…Investigations have used the TPTD technique as a reference method to determine "true" fluid responsiveness status in humans (58,(77)(78)(79) and, more recently, in veterinary medicine (16,20,22). Averaging triplicate CO TPTD measurements results in adequate precision (i.e., variability of repeated measurements <10%) to evaluate fluid responsiveness.…”

Section: Transpulmonary Thermodilutionmentioning

confidence: 99%

“…The volume and duration of infusion of fluid challenges administered to small animal patients in the literature varies considerably. Fluid responsiveness status in dogs has been assessed via administration of LRS at doses ranging from 10 to 20 ml/kg administered over 5–15 min ( 13 , 14 , 16 , 18 , 20 , 22 ). In one study, a 10 ml/kg bolus of 6% hydroxyethyl starch (HES) was administered during 13 min in anesthetized dogs ( 15 ).…”

Section: The Fluid Challenge Approach and The End-point Of Fluid Ressuscitationmentioning

confidence: 99%

“…The criteria used to define responders to volume expansion in veterinary studies has been an increase in CO or SV ≥10–15% ( Table 2 ). Transthoracic echocardiography ( 12 , 15 , 17 , 19 ), transesophageal echocardiography ( 13 , 18 ), esophageal Doppler ( 14 ), transpulmonary thermodilution ( 16 , 20 , 22 ), and uncalibrated pulse contour analysis ( 21 ) have been used to monitor fluid responsiveness status in anesthetized dogs. While it has been recognized that only 50% of critically ill human individuals positively respond to a fluid challenge with substantial increases in CO or SV ( 32 , 42 ), the percentage of responders to a single fluid challenge with crystalloids in canine studies has been reported to range from 38 to 100% ( Table 2 ).…”

Section: The Fluid Challenge Approach and The End-point Of Fluid Ressuscitationmentioning

confidence: 99%

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Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What Can We Learn From Human Studies?

Neto

Valverde

2021

Front. Vet. Sci.

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Resuscitative fluid therapy aims to increase stroke volume (SV) and cardiac output (CO) and restore/improve tissue oxygen delivery in patients with circulatory failure. In individualized goal-directed fluid therapy (GDFT), fluids are titrated based on the assessment of responsiveness status (i.e., the ability of an individual to increase SV and CO in response to volume expansion). Fluid administration may increase venous return, SV and CO, but these effects may not be predictable in the clinical setting. The fluid challenge (FC) approach, which consists on the intravenous administration of small aliquots of fluids, over a relatively short period of time, to test if a patient has a preload reserve (i.e., the relative position on the Frank-Starling curve), has been used to guide fluid administration in critically ill humans. In responders to volume expansion (defined as individuals where SV or CO increases ≥10–15% from pre FC values), FC administration is repeated until the individual no longer presents a preload reserve (i.e., until increases in SV or CO are <10–15% from values preceding each FC) or until other signs of shock are resolved (e.g., hypotension). Even with the most recent technological developments, reliable and practical measurement of the response variable (SV or CO changes induced by a FC) has posed a challenge in GDFT. Among the methods used to evaluate fluid responsiveness in the human medical field, measurement of aortic flow velocity time integral by point-of-care echocardiography has been implemented as a surrogate of SV changes induced by a FC and seems a promising non-invasive tool to guide FC administration in animals with signs of circulatory failure. This narrative review discusses the development of GDFT based on the FC approach and the response variables used to assess fluid responsiveness status in humans and animals, aiming to open new perspectives on the application of this concept to the veterinary field.

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Section: What Is Fluid Responsiveness and How Can It Be Assessed?mentioning

confidence: 99%

Section: The Fluid Challenge Approach and The End-point Of Fluid Ressuscitationmentioning

confidence: 99%

Section: Transpulmonary Thermodilutionmentioning

confidence: 99%

Section: The Fluid Challenge Approach and The End-point Of Fluid Ressuscitationmentioning

confidence: 99%

Section: The Fluid Challenge Approach and The End-point Of Fluid Ressuscitationmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What Can We Learn From Human Studies?

Neto

Valverde

2021

Front. Vet. Sci.

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Modified passive leg-raising maneuver to predict fluid responsiveness by transthoracic ultrasound guidance in healthy pigs under sevoflurane anesthesia.

Tarragona,

Donati,

Zaccagnini

et al. 2024

Preprint

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This study aimed to evaluate whether the velocity-time integral of aortic blood flow (VTIAo) assessed by transthoracic echocardiography is significantly increased after passive leg-raising maneuver (PLRM) in anesthetized and mechanically ventilated fluid responder pigs. Eight healthy Landrace pigs were anesthetized, mechanically ventilated, and subjected to PLRM. Ultrasound-guided VTIAo measurements were taken before and after PLRM and compared to assess changes. Fluid challenge was then performed, and changes in VTIAo were assessed to classify pigs as fluid responders or non-responders. Following PLRM, fluid responders exhibited a significant increase in VTIAo compared to baseline (p = 0.017). An optimal cutoff of 11.2% for ΔVTIAo was calculated for predicting fluid responsiveness after PLRM, with an AUROC of 1.00 (95% CI not estimated – 1.00), sensitivity of 100% (95% CI 59 – 100%), specificity of 100% (95% CI 2.5–100%), positive predictive value of 100% (95% CI 59–100%), and a negative predictive value of 100% (95% CI 2.5–100%). This study demonstrates the potential of using ultrasound-guided VTIAo measurements associated with PLRM to predict fluid responsiveness in anesthetized pigs. A ΔVTIAo value of ≥11.2% reliably identified fluid-responsive pigs under anesthesia and mechanical ventilation, offering a non-invasive alternative to fluid challenges. Further research addressing study limitations could enhance understanding of fluid responsiveness assessment in animal models.

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Esophageal Doppler-derived indices and arterial load variables provide useful hemodynamic information during assessment of fluid responsiveness in anesthetized dogs undergoing acute changes in blood volume

Paranjape

Henao-Guerrero

Menciotti

et al. 2023

ajvr

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OBJECTIVE To investigate the relationship between invasively measured stroke volume (SV) and (1) esophageal Doppler-derived indices such as stroke distance (StrokeD), flow time corrected (FTc), stroke distance variation (SDV), and peak velocity variation (PVV); and (2) arterial load (AL) variables during evaluation of fluid responsiveness (FR) in anesthetized dogs undergoing sudden hemodynamic shifts in blood volume. ANIMALS 6 healthy male dogs. PROCEDURES Dogs were anesthetized with isoflurane, ventilated mechanically, and instrumented to undergo sequential, nonrandomized experimental stages. The dogs transitioned from normovolemia (NORMO-BL) to hypovolemia (30% blood loss; HYPO-30), followed by autologous blood transfusion, and then to hypervolemia (colloid bolus). During each stage, SV was quantified using pulmonary artery thermodilution and its relationship with StrokeD, FTc, SDV, and PVV; and AL variables such as effective arterial elastance (Ea), dynamic arterial elastance (Eadyn), and total arterial compliance (Ca) were established. RESULTS As SV decreased significantly during HYPO-30 compared to NORMO-BL, there was a significant (P < .001) decrease in StrokeD, FTc, and Ca, with simultaneous increases in SDV, PVV, Ea, and Eadyn. Upon restoration of blood volume, these values stabilized closer to NORMO-BL. A significant (P < .001) correlation was observed between SV and StrokeD, FTc, Ea, Eadyn, and Ca. CLINICAL RELEVANCE Minimally invasive StrokeD, FTc, SDV, and PVV act as SV surrogates and help assess FR during different blood volume stages in healthy dogs. During hypovolemia-induced hypotension, Ea, Eadyn, and Ca may be able to guide therapeutic decisions favoring improvement in blood pressure and SV.

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Use of aortic flow indexes derived from transthoracic echocardiography to evaluate response to a fluid challenge in anesthetized dogs

Cited by 4 publications

References 28 publications

Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What Can We Learn From Human Studies?

Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What Can We Learn From Human Studies?

Modified passive leg-raising maneuver to predict fluid responsiveness by transthoracic ultrasound guidance in healthy pigs under sevoflurane anesthesia.

Esophageal Doppler-derived indices and arterial load variables provide useful hemodynamic information during assessment of fluid responsiveness in anesthetized dogs undergoing acute changes in blood volume

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