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

Author(s)

Fantoni, Denise T. ^{[1, 2]} ; Ida, Keila K. ^[2] ; Gimenes, Andre M. ^[3] ; Mantovani, Matheus M. ^[3] ; Castro, Jacqueline R. ^[3] ; Patricio, Geni C. F. ^[1] ; Ambrosio, Aline M. ^[1] ; Otsuki, Denise A. ^[2]

Affiliation

^[1] Univ Sao Paulo, Fac Vet Med & Anim Sci, Dept Surg, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Lab Med Invest 8, Anesthesiol, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Vet Med & Anim Sci, Dept Internal Med, Sao Paulo - Brazil

• Document type: Journal article
• Source: VETERINARY ANAESTHESIA AND ANALGESIA; v. 44, n. 4, p. 710-718, JUL 2017.
• Web of Science Citations: 4

Abstract

Objective To investigate whether pulse pressure variation (PPV) can predict fluid responsiveness in healthy dogs during clinical surgery. Study design Prospective clinical study. Animals Thirty-three isoflurane-anesthetized dogs with arterial hypotension during orthopedic surgery. Methods Fluid challenge with lactated Ringer's solution (15 mL kg(-1) in 15 minutes) was administered in mechanically ventilated dogs (tidal volume 10 mL kg(-1)) with hypotension {[}mean arterial pressure (MAP) < 65 mmHg]. The volume expansion was considered effective if cardiac output (CO; transesophageal Doppler) increased by >= 15%. Cardiopulmonary data were analyzed using two-way ANOVA, receiver operating characteristics (ROC) curves and Spearman coefficient; p < 0.05 was considered significant. Results Effective volume expansion, mean +/- standard deviation 42 +/- 4% increase in CO (p < 0.0001) was observed in 76% of the dogs, resulting in a decrease in PPV (p < 0.0001) and increase in MAP (p < 0.0001), central venous pressure (CVP; p = 0.02) and ejection fraction (p < 0.0001) compared with before the fluid challenge. None of these changes occurred when volume expansion resulted in a nonsignificant CO increase of 4 +/- 5%. No significant differences were observed in blood gas analysis between responsive and nonresponsive dogs. The increase in CO was correlated with the decrease in PPV (r = -0.65; p < 0.0001) but absolute values of CO and PPV were not correlated. The PPV performance (ROC curve area: 0.89 +/- 0.06, p = 0.0011) was better than that of CVP (ROC curve area: 0.54 +/- 0.12) and MAP (ROC curve area: 0.59 +/- 0.13) to predict fluid responsiveness. The best cut-off for PPV to distinguish responders and nonresponders was 15% (50% sensitivity and 96% specificity). Conclusions and clinical relevance In mechanically ventilated, healthy, isoflurane-anesthetized dogs, PPV predicted fluid responsiveness to volume expansion, and MAP and CVP did not show such applicability. (AU)

• FAPESP's process: 12/18024-0 - Determination of pulse pressure variation in mechanical ventilated isoflurane anesthetized horses undergoing fluid replacement
• Grantee: Denise Tabacchi Fantoni
• Support Opportunities: Regular Research Grants