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Use of less invasive/non invasive methods for evaluating and predicting fluid responsiveness in dogs


Study rationale / General objectives: Optimization of cardiac output (CO) / stroke volume (SV) based on the curvilinear relationship between preload and SV (Frank-Starling Curve), has been used as hemodynamic goal for fluid administration in severely-ill patients or individuals undergoing major surgical interventions (Michard 2005; Michard et al, 2007; Bednarczyk et al, 2017). According to the strategy, named fluid-responsiveness, fluid administration can be performed only in individuals where intravascular volume expansion will significantly increase CO/SV because the heart is operating on the ascending portion of the Frank-Starling curve. Following the current trend to minimize the degree if invasiveness of hemodynamic monitoring in anesthesia and critical care medicine, the present research proposal aims to evaluate less invasive methods for evaluating fluid responsiveness in dogs.Specific objectives / Proposed Methodology: During PHASE I, the ability of velocity X time integral of the aortic flow -VTI(aorta), obtained by trans-thoracic echocardiograph, to correctly identify individuals that are responders to volume expansion (defined as an increase in stroke volume greater or equal to 15% in response to a fluid challenge) will be evaluated. This objective will be assessed by comparing VTI(aorta) changes in response to volume expansion with changes in stroke volume obtained by a method of known accuracy and precision to evaluate fluid-responsiveness (transpulmonary thermodilution). During PHASE II, the ability of Pulse Pressure Variation (PPV) obtained from a peripheral artery (less invasive method) to predict fluid-responsiveness will be compared with the predictive ability of fluid-responsiveness of PPV values obtained from a central artery. (AU)

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