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Pulse pressure variation in mechanical ventilated isoflurane anesthetized horses submitted to fluid challenge

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Author(s):
Eutálio Luiz Mariani Pimenta
Total Authors: 1
Document type: Doctoral Thesis
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Faculdade de Medicina Veterinária e Zootecnia (FMVZ/SBD)
Defense date:
Examining board members:
Denise Tabacchi Fantoni; Aline Magalhães Ambrósio; Adriano Bonfim Carregaro; Juan Carlos Duque Moreno; Francisco José Teixeira Neto
Advisor: Denise Tabacchi Fantoni
Abstract

Objective: To determine the relationship between ΔPP and fluid responsiveness in mechanically ventilated isoflurane anesthetizes horses. Method: In a prospective study, 8 adult healthy Arabian horses (366.5 ± 22.7kg) were anesthetized. All animals were randomly submitted in two groups: (I) 14h of water restriction; (II) 14 h of water restriction associated with 12mmHg of pneumoperitoneum. Anesthesia was induced with detomidine, diazepam and ketamine and maintained with 1.6% (I) or 1.3% (II) end-tidal concentration of isoflurane and all animals were placed dorsal recubency and mechanically ventilated (VTexp 14mL / kg). I - Baseline parameters was collected (TBasal) after 30 minutes of anesthetic induction and animals subjected to blood fluid challenge (VE) with lactate Ringer solution (15 mL / kg, 15 min) (T1). Responsive animals (DC> 15%) received up to two additional VE (T2 and T3, respectively). Dobutamine was given titrated to achieve PAM 65-75 mmHg for 15 minutes (T4) if animals were considered unresponsive. After was submitted to a new VE (T5). II - As described above, with difference after TBasal was established pneumoperitoneum (12 mmHg) for 15 minutes (PNP) and the challenges were realized in animals with pneumoperitoneum. After (T5) abdominal distension was discontinued and collected all values (T6). Results: Phase I: There was no significant increase in CI at T1 and T4. However an increase of 16.5% after new VE (T5). There was no significant increase in MAP at T1. But there was an increase at T4 with no further increase after new VE (T5). ΔPP and ΔPS values decreased compared to TBasal at T4, T5 and T1, T4 and T5, respectively. But there was no statistical difference when compared responsive with unresponsive animals. There was an 293% increase of PVC at T1, keeping above the baseline for all other times. The AUC obtained from ROC curve was 0.83, 0.83 and 0.40 for ΔPP, PVC and CVP respectively for T1 and T2; and 0.55, 0.69 and 0.65 including T5. Phase II: No significant change in CI and ΔPP in all observed times. Significant increase in MAP compared with Tbasal after DV under pneumoperitoneum (T1) was observed. With additional increase after new VE (T5). ΔPS values reduced only after discontinued pneumoperitoneum (T6). However there was no statistical difference when compared responsive with unresponsive animals. There was an 363% increase of PVC after pneumoperitoneum (PNP), with an additional increase of 189% after DV at T1, keeping above the baseline for all other times. Further increase was observed in T5, returning to values similar to PNP at T6. The AUC obtained from the ROC curve was 0.64, 0.50 and 0.29 for ΔPP, PVC and ΔPS respectively for T1 and T2; and 0.71, 0.64 and 0.61 including T5. Conclusion: With the methodology employed, the PP not shown to be a predictor of responsiveness volume in horses anesthetized with isoflurane and mechanically ventilated, occurring worsening when used pneumoperitoneum 12 mmHg. The use of dobutamine also reduced the sensitivity / specificity of this index. Therefore the use of this this tool appears limited in horses (AU)

FAPESP's process: 12/19905-0 - DETERMINATION OF PULSE PRESSURE VARIATION IN MECHANICAL VENTILATED ISOFLURANE ANESTHETIZED HORSES UNDERGOING FLUID REPLACEMENT
Grantee:Eutálio Luiz Mariani Pimenta
Support type: Scholarships in Brazil - Doctorate