Objective: To evaluate the ability of transthoracic echocardiographic aortic flow measurements to discriminate response to a fluid challenge (FC) in healthy anesthetized dogs.
Study Design: Prospective experimental study.
Animals: A total of 48 isoflurane-anesthetized dogs (14.2-35.0 kg) undergoing elective surgery.
Methods: Fluid responsiveness was evaluated before surgery by FC (lactated Ringer's 10 mL kg intravenously over 5 minutes). Percentage increases in transpulmonary thermodilution stroke volume (ΔSV) >15% from values recorded before FC defined responders to volume expansion. A group of 24 animals were assigned as nonresponders (ΔSV ≤15%). When ΔSV was >15% after the first FC, additional FC were administered until ΔSV was ≤15%. Final fluid responsiveness status was based on the response to the last FC. Percentage increases after FC in aortic flow indexes [velocity time integral (ΔVTI) and maximum acceleration (ΔVmax)] and in mean arterial pressure (ΔMAP) were compared with ΔSV.
Results: After one FC, 24 animals were responders. For nonresponders, ΔSV was ≤15% after one, two and three FCs in eight/24, 15/24 and one/24 animals, respectively. The FC that defined responsiveness increased ΔSV by 29 (18-53)% in responders and by 8 (-3 to 15)% in nonresponders [mean (range)]. The area under the receiver operating characteristics curve (AUROC) of ΔVTI (0.901) was larger than the AUROCs of ΔVmax (0.774, p = 0.041) and ΔMAP (0.519, p < 0.0001). ΔMAP did not predict responsiveness (p = 0.826). Best cut-off thresholds for discriminating responders, with respective zones of diagnostic uncertainty (gray zones) were >14.7 (10.8-17.6)% for ΔVTI and >8.6 (-0.3 to 14.7)% for ΔVmax. Animals within the gray zone were 17% (ΔVTI) and 50% (ΔVmax).
Conclusions And Clinical Relevance: Changes in VTI induced by FC can determine responsiveness with reasonable accuracy in dogs and could play an important role in goal-directed fluid therapy.
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