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A comparative evaluation of treatments with dopamine or norepinephrine for hypotension in dogs with sepsis using orthogonal polarization spectal image

Abstract

Sepsis is a clinical syndrome defined by the invasion of microorganisms or their toxins into the blood causing hemodynamic changes like a hypoperfusion, organ dysfunction and hypotension, responsive or not, to fluid resuscitation. The fluids are used as initial treatment in septic patients in order to restore blood pressure and consequently tissue perfusion. Unresponsive patients to fluid resuscitation are usually treated with vasopressor agents. Those agents such as norepinephrine and dopamine are fundamental to restore blood pressure but the use of vasopressor may compromise the microcirculation. The parameters that evaluate the microcirculation are often able to predict more accurately the development of organ dysfunction and death than traditional hemodynamic parameters, considering that these last ones do not evaluate regional reductions on blood flow or even the tissue hypoxia. Recently, the Orthogonal Polarization Spectral imaging (OPS), was developed as a noninvasive technique to investigate the microvasculature. The objective of this study is to compare the dopamine and norepinephrine in the treatment of sepsis in dogs by the OPS and others hemodynamic variables. This study will include 30 dogs with severe sepsis presenting at least two variables of systemic inflammatory response and at least one variable organ dysfunction. Fluid resuscitation will be made with 15ml/kg of Ringer's lactate in 15 minutes. If the mean blood pressure doesn't reach values higher than 65 mmHg and central venous pressure values over 8 mm Hg, the animals are divided into two groups. The first group will receive dopamine 5 mcg / kg / min and would be increment with 2 mg / kg / min at an initial dose every 5 minutes in order to achieve the prescribed pressure level. The second group will initially receive 0.05 mcg / kg / min of norepinephrine and would have increased 0.02 mcg / kg / min of the initial dose for the same purpose. Will face the parameters of density and flow with the OPS found in both groups, as well as ventilation and hemodynamic data, seeking the best treatment. The parameters of density and flow with the OPS found in both groups will be confronted, as well as ventilation and hemodynamic data, seeking the best treatment. (AU)

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