Comparison of the diagnostic accuracy of dynamic and static preload indexes to predict fluid responsiveness in mechanically ventilated, isoflurane anesthetized dogs

Autor(es)

Celeita-Rodriguez, Nathalia ^[1] ; Teixeira-Neto, Francisco J. ^{[1, 2]} ; Garofalo, Natache A. ^[2] ; Dalmagro, Tabata L. ^[1] ; Girotto, Carolina H. ^[1] ; Oliveira, Guillermo C. V. ^[1] ; Santos, Ivan F. C. ^[2]

Afiliação do(s) autor(es)

^[1] Univ Estadual Paulista UNESP, Fac Med, Botucatu, SP - Brazil

^[2] Univ Estadual Paulista UNESP, Fac Med Vet & Zootecnia, Dist Rubiao Jr S-N, BR-18618681 Botucatu, SP - Brazil

• Tipo de documento: Artigo Científico
• Fonte: VETERINARY ANAESTHESIA AND ANALGESIA; v. 46, n. 3, p. 276-288, MAY 2019.
• Citações Web of Science: 0

Resumo

Objective To compare the diagnostic accuracy of pulse pressure variation (PPV), stroke volume variation from pulse contour analysis (SVVPCA), plethysmographic variability index (PVI), central venous pressure (CVP) and global end-diastolic volume index measured by transpulmonary thermodilution (GEDVI(TPTD)) to predict fluid responsiveness (FR) in dogs. Study design Prospective study. Animals A group of 40 bitches (13.8-26.8 kg) undergoing ovariohysterectomy. Methods Anesthesia was maintained with isoflurane under volume-controlled ventilation (tidal volume 12 mL kg(-1); inspiratory pause during 40% of inspiratory time; inspiration: expiration ratio 1:1.5). Transpulmonary thermodilution cardiac output was recorded through a femoral artery catheter. FR was evaluated by a fluid challenge (lactated Ringer's, 20 mL kg(-1) over 15 minutes) administered once (n = 21) or twice (n = 18) before surgery. Individuals were responders if stroke volume index measured by transpulmonary thermodilution increased >15% after the last fluid challenge. Results Of the 39 animals studied, 21 were responders and 18 were nonresponders. Area under the receiver operating characteristics curve (AUROC) was 0.976, 0.906, 0.868 and 0.821 for PPV, PVI, CVP and SVVPCA, respectively (p < 0.0001 from AUROC = 0.5). GEDVI(TPTD) failed to predict FR (AUROC: 0.660, p = 0.078). Best cut-off thresholds discriminating responders and nonresponders, with respective zones of diagnostic uncertainty (gray zones) were: PPV > 16% (15-16%), PVI >11% (10-13%), SVVPCA > 10% (9-18%) and CVP <= 1 mmHg (0-3 mmHg). Percentage of animals within gray zone limits was 13% (PPV), 28% (PVI), 51% (SVVPCA) and 67% (CVP). Conclusions and clinical relevance PPV has better diagnostic accuracy to predict FR (conclusive results in nearly 90% of population) than other preload indexes in healthy dogs. When invasive blood pressure is unavailable, PVI will predict FR with reasonable accuracy (conclusive results in approximately 70% of the population). PPV and PVI values above gray zone limits (> 16% and > 13%, respectively) can reliably predict responders to volume expansion. (AU)

• Processo FAPESP: 14/25115-8 - Uma abordagem dos paradigmas da fluidoterapia no período perioperatório em pequenos animais
• Beneficiário: Francisco José Teixeira Neto
• Modalidade de apoio: Auxílio à Pesquisa - Regular