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Kim D, Park SG, Kim M. Interventional Heartworm Extraction in Two Dogs: The Clinical Application of Impedance Cardiography. Animals (Basel) 2023; 13:3127. [PMID: 37835733 PMCID: PMC10571723 DOI: 10.3390/ani13193127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
Heartworm (HW) disease, caused by Dirofilaria immitis, is a life-threatening ailment in dogs. HW disrupts blood flow and decreases cardiac output (CO). The accurate monitoring of CO during HW extraction is pivotal for patient survival and overall health. OBJECTIVE This study aimed to assess the efficacy of using impedance cardiography (ICG) as a non-invasive approach for monitoring CO during interventional HW extraction. METHODS Two cases of HW infections were treated via surgical extraction. The CO and mean arterial pressure (MAP) were monitored using the ICG technique during the anesthesia stabilization, extraction process, and post-extraction phases. RESULTS In Case 1, the CO increased by 115% post-procedure, and in Case 2, the CO increased by 116%. In contrast, the MAP varied between the two cases. The ICG method provided real-time CO data without major disruptions during the extraction surgery. CONCLUSION The ICG technique for CO monitoring during interventional HW extractions is effective.
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Affiliation(s)
- Daesik Kim
- Veterinary Emergency Medicine, Department of Veterinary Clinical Science, Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National University, Seoul 08826, Republic of Korea
| | - Seol-Gi Park
- Incheon Sky Animal Hospital, Incheon 21555, Republic of Korea
| | - Minsu Kim
- Veterinary Emergency Medicine, Department of Veterinary Clinical Science, Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National University, Seoul 08826, Republic of Korea
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Whitehouse WH, Thomason JD, Thompson-Butler DA, Kelley MD, Cernicchiaro N, Tanner MC. A clinically utilized intravenous continuous rate infusion of diltiazem does not significantly decrease systolic function in healthy dogs. Am J Vet Res 2023; 84:ajvr.22.09.0158. [PMID: 36607773 DOI: 10.2460/ajvr.22.09.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine if left ventricular systolic function on echocardiography, systemic blood pressure, and electrocardiography change with a clinically accepted intravenous (IV) diltiazem constant rate infusion (CRI) compared to a control. ANIMALS 10 healthy client-owned adult dogs. PROCEDURES Prospective, masked, crossover study from May 27, 2021, to August 22, 2021. Dogs were randomized to receive diltiazem (loading dose of 240 μg/kg, IV followed by a CRI of 6 μg/kg/min for 300 minutes) or the same volume of 5% dextrose in water (D5W) administered IV followed by the opposite intervention after a 7-day washout. Blood pressure was monitored during each CRI, and echocardiographic and electrocardiographic studies were performed immediately before the CRI and during the last hour of the CRI. RESULTS Postdiltiazem systolic time interval (STI) (median, 0.30; range, 0.16 to 0.34) was significantly lower than post-D5W STI (median, 0.32; range, 0.22 to 0.40; P = .046). All other echocardiographic parameters did not differ significantly between each of the groups after receiving diltiazem or D5W. Systemic blood pressure did not change significantly with either diltiazem (P = .450) or D5W (P = .940), and none of the dogs became hypotensive at any point in the study. Expectedly, negative dromotropy was observed with diltiazem. CLINICAL RELEVANCE A significant decrease in left ventricular systolic function was not appreciated in healthy dogs receiving diltiazem at a clinically accepted intravenous infusion rate at this dosing regimen. Further studies are needed in dogs with cardiac disease.
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Affiliation(s)
- William H Whitehouse
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Justin D Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Dorothy A Thompson-Butler
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Megan D Kelley
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Natalia Cernicchiaro
- Center for Outcomes Research and Epidemiology and Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Matthew C Tanner
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
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Sández I, Verdier N, Redondo JI, Tarragona L, Donati PA, Serrano S, Otero PE. Agreement between transthoracic echocardiography and esophageal Doppler on aortic flow variables in anesthetized mechanically ventilated dogs. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2022; 63:722-726. [PMID: 35784775 PMCID: PMC9207967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The use of transthoracic echocardiography (TTE) and esophageal Doppler (ED) for the measurement of hemodynamic variables in anesthetized dogs was studied. Fourteen mixed-breed dogs, without cardiac disease, undergoing general anesthesia for diagnostic or therapeutic procedures were included in this prospective preliminary study. Dogs were premedicated with dexmedetomidine (3 μg/kg) and methadone (0.3 mg/kg), intramuscularly. General anesthesia was induced with propofol intravenously titrated to effect and maintained with isoflurane in oxygen. Animals were positioned in dorsal recumbency. Transthoracic echocardiography was performed using a 5-2 MHz cardiac ultrasound probe placed in the subcostal window, whereas esophageal Doppler was performed using a CardioQ probe (MP50; Deltex Medical, Chichester, UK). Once an appropriate view of the aortic flow was obtained, the variables peak velocity (PV) and velocity-time integral (VTI) were measured. Agreement between methods was evaluated using the Bland-Altman method with single observation per individual. The bias and the limits of agreement (LOA) between the two methods were determined. Mean (± SD) PV was 99.46 cm/s (± 42.73 cm/s) and 110.29 cm/s (± 35.86 cm/s), and VTI was 13.24 cm (± 4.33 cm) and 13.05 cm (± 4.47 cm), for TTE and ED, respectively. Mean differences and LOA were 10.83 cm/s (range: -20.50 to 42.16 cm/s) and -0.19 cm (range: -3.32 to 2.95 cm) for PV and VTI, respectively. No statistically significant differences were determined in the variables measured between TTE and ED in anesthetized dogs without cardiac disease, positioned in dorsal recumbency. This could be of clinical relevance when an evaluation of the intraoperative hemodynamic status of anesthetized dogs is desired.
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Affiliation(s)
- Ignacio Sández
- Hospital Veterinario Vetsia, Leganés, Madrid, Spain (Sández, Serrano); Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina (Verdier, Tarragona, Donati, Otero); Department of Anesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Vienna, Austria (Verdier); Universidad Cardenal Herrera-CEU, CEU Universities, Medicina y Cirugía Animal, Alfara del Patriarca, Valencia, Spain (Redondo)
| | - Natalí Verdier
- Hospital Veterinario Vetsia, Leganés, Madrid, Spain (Sández, Serrano); Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina (Verdier, Tarragona, Donati, Otero); Department of Anesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Vienna, Austria (Verdier); Universidad Cardenal Herrera-CEU, CEU Universities, Medicina y Cirugía Animal, Alfara del Patriarca, Valencia, Spain (Redondo)
| | - J Ignacio Redondo
- Hospital Veterinario Vetsia, Leganés, Madrid, Spain (Sández, Serrano); Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina (Verdier, Tarragona, Donati, Otero); Department of Anesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Vienna, Austria (Verdier); Universidad Cardenal Herrera-CEU, CEU Universities, Medicina y Cirugía Animal, Alfara del Patriarca, Valencia, Spain (Redondo)
| | - Lisa Tarragona
- Hospital Veterinario Vetsia, Leganés, Madrid, Spain (Sández, Serrano); Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina (Verdier, Tarragona, Donati, Otero); Department of Anesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Vienna, Austria (Verdier); Universidad Cardenal Herrera-CEU, CEU Universities, Medicina y Cirugía Animal, Alfara del Patriarca, Valencia, Spain (Redondo)
| | - Pablo A Donati
- Hospital Veterinario Vetsia, Leganés, Madrid, Spain (Sández, Serrano); Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina (Verdier, Tarragona, Donati, Otero); Department of Anesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Vienna, Austria (Verdier); Universidad Cardenal Herrera-CEU, CEU Universities, Medicina y Cirugía Animal, Alfara del Patriarca, Valencia, Spain (Redondo)
| | - Susana Serrano
- Hospital Veterinario Vetsia, Leganés, Madrid, Spain (Sández, Serrano); Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina (Verdier, Tarragona, Donati, Otero); Department of Anesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Vienna, Austria (Verdier); Universidad Cardenal Herrera-CEU, CEU Universities, Medicina y Cirugía Animal, Alfara del Patriarca, Valencia, Spain (Redondo)
| | - Pablo E Otero
- Hospital Veterinario Vetsia, Leganés, Madrid, Spain (Sández, Serrano); Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina (Verdier, Tarragona, Donati, Otero); Department of Anesthesiology and Perioperative Intensive Care, University of Veterinary Medicine, Vienna, Austria (Verdier); Universidad Cardenal Herrera-CEU, CEU Universities, Medicina y Cirugía Animal, Alfara del Patriarca, Valencia, Spain (Redondo)
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Rodrigues RR, Ambrósio AM, Engbruch AM, Gonçalves LA, Villela PA, Sanchez AF, Fantoni DT. Intraoperative Protective Mechanical Ventilation in Dogs: A Randomized Clinical Trial. Front Vet Sci 2022; 9:842613. [PMID: 35372547 PMCID: PMC8964628 DOI: 10.3389/fvets.2022.842613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/17/2022] [Indexed: 12/16/2022] Open
Abstract
Objective To evaluate gas exchange, respiratory mechanics, and hemodynamic impact of mechanical ventilation with low tidal volume (VT) in dogs with the use of positive end-expiratory pressure (PEEP) or preceded by alveolar recruitment maneuver (ARM). Study Design Prospective randomized clinical trial. Animals Twenty-one healthy client-owned mesocephalic healthy dogs, 1-7 years old, weighing 10-20 kg, and body condition scores 4-6/9 admitted for periodontal treatment. Methods Isoflurane-anesthetized dogs in dorsal recumbency were ventilated until 1 h with a volume-controlled ventilation mode using 8 mL kg-1 of VT. The dogs were distributed in 2 groups: in the ARM group, PEEP starts in 0 cmH2O, increasing gradually 5 cmH2O every 3 min, until reach 15 cmH2O and decreasing in the same steps until 5 cmH2O, maintaining this value until the end; and PEEP group, in which the pressure 5 cmH2O was instituted from the beginning of anesthesia and maintained the same level up to the end of the anesthesia. Cardiopulmonary, metabolic, oxygenation parameters, and respiratory mechanics were recorded after the anesthesia induction (baseline-BL), 15, 45, and 75 min after BL and during the recovery. Results The ARM increased the static compliance (Cst) (15 min after baseline) when compared with baseline moment (24.9 ± 5.8 mL cmH20-1 vs. 20.7 ± 5.4 mL cmH20-1-p = 0.0364), oxygenation index (PaO2/FIO2) (505.6 ± 59.2 mmHg vs. 461.2 ± 41.0 mmHg-p = 0.0453) and reduced the shunt fraction (3.4 ± 2.4% vs. 5.5 ± 1.6%-p = 0.062). In the PEEP group, no statistical differences were observed concerning the variables evaluated. At the beginning of the evaluation, the driving pressure (DP) before ARM was significantly greater than all other evaluation time points (6.9 ± 1.8 cmH20). Conclusions and Clinical Relevance The use of 8 mL kg-1 of VT and 5 cmH20 PEEP without ARM maintain adequate oxygenation and mechanical ventilation in dental surgeries for up to 1 h. The use of ARM slightly improved compliance and oxygenation during the maneuver.
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Xie Y, Song R, Yang D, Yu H, Sun C, Xie Q, Xu RX. Motion robust ICG measurements using a two-step spectrum denoising method. Physiol Meas 2021; 42. [PMID: 34433135 DOI: 10.1088/1361-6579/ac2131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022]
Abstract
Objective. Impedance cardiography (ICG) is a noninvasive and continuous method for evaluating stroke volume and cardiac output. However, the ICG measurement is easily interfered due to respiration and body movements. Taking into consideration about the spectral correlations between the simultaneously collected ICG, electrocardiogram (ECG), and acceleration signals, this paper introduces a two-step spectrum denoising method to remove motion artifacts of ICG measurements in both resting and exercising scenarios.Approach. First, the major motion artifacts of ECG and ICG are separately suppressed by the spectral subtraction with respect to acceleration signals. The obtained ECG and ICG are further decomposed into two sets of intrinsic mode functions (IMFs) through the ensemble empirical mode decomposition. We then extract the shared spectral information between the two sets of IMFs using the canonical correlation analysis in a spectral domain. Finally, the ICG signal is reconstructed using those canonical variates with largest spectral correlations with ECG IMFs.Main results. The denoising method was evaluated for 30 subjects under both resting and cycling scenarios. Experimental results show that the beat contribution factor of ICG signals increases from its original 80.1%-97.4% after removing the motion artifacts.Significance. The proposed denoising scheme effectively improves the reliability of diagnosis and analysis on cardiovascular diseases relying on ICG signals.
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Affiliation(s)
- Yao Xie
- School of Engineering Science, University of Science and Technology of China, Hefei, 230027, People's Republic of China.,Anhui Tongling Bionic Technology Co. Ltd, No. 5089, Wangjiang West Road, Hefei, People's Republic of China
| | - Rencheng Song
- Department of Biomedical Engineering, Hefei University of Technology, Hefei, 230009, People's Republic of China
| | - Dong Yang
- Anhui Tongling Bionic Technology Co. Ltd, No. 5089, Wangjiang West Road, Hefei, People's Republic of China
| | - Honglong Yu
- Department of Biomedical Engineering, Hefei University of Technology, Hefei, 230009, People's Republic of China
| | - Cuimin Sun
- School of Engineering Science, University of Science and Technology of China, Hefei, 230027, People's Republic of China
| | - Qilian Xie
- Anhui Tongling Bionic Technology Co. Ltd, No. 5089, Wangjiang West Road, Hefei, People's Republic of China.,Anhui Medical University, Hefei, 230032, People's Republic of China
| | - Ronald X Xu
- School of Engineering Science, University of Science and Technology of China, Hefei, 230027, People's Republic of China
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Teixeira-Neto FJ, Valverde A. Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What Can We Learn From Human Studies? Front Vet Sci 2021; 8:701377. [PMID: 34414228 PMCID: PMC8368984 DOI: 10.3389/fvets.2021.701377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Resuscitative fluid therapy aims to increase stroke volume (SV) and cardiac output (CO) and restore/improve tissue oxygen delivery in patients with circulatory failure. In individualized goal-directed fluid therapy (GDFT), fluids are titrated based on the assessment of responsiveness status (i.e., the ability of an individual to increase SV and CO in response to volume expansion). Fluid administration may increase venous return, SV and CO, but these effects may not be predictable in the clinical setting. The fluid challenge (FC) approach, which consists on the intravenous administration of small aliquots of fluids, over a relatively short period of time, to test if a patient has a preload reserve (i.e., the relative position on the Frank-Starling curve), has been used to guide fluid administration in critically ill humans. In responders to volume expansion (defined as individuals where SV or CO increases ≥10–15% from pre FC values), FC administration is repeated until the individual no longer presents a preload reserve (i.e., until increases in SV or CO are <10–15% from values preceding each FC) or until other signs of shock are resolved (e.g., hypotension). Even with the most recent technological developments, reliable and practical measurement of the response variable (SV or CO changes induced by a FC) has posed a challenge in GDFT. Among the methods used to evaluate fluid responsiveness in the human medical field, measurement of aortic flow velocity time integral by point-of-care echocardiography has been implemented as a surrogate of SV changes induced by a FC and seems a promising non-invasive tool to guide FC administration in animals with signs of circulatory failure. This narrative review discusses the development of GDFT based on the FC approach and the response variables used to assess fluid responsiveness status in humans and animals, aiming to open new perspectives on the application of this concept to the veterinary field.
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Affiliation(s)
- Francisco José Teixeira-Neto
- Departmento de Cirurgia Veterinária e Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista, Botucatu, Brazil
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Gonçalves LA, Otsuki DA, Pereira MA, Nagashima JK, Ambrosio AM, Fantoni DT. Comparison of pulse pressure variation versus echocardiography-derived stroke volume variation for prediction of fluid responsiveness in mechanically ventilated anesthetized dogs. Vet Anaesth Analg 2019; 47:28-37. [PMID: 31822378 DOI: 10.1016/j.vaa.2019.08.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the ability and accuracy of aortic flow velocity-time integral variation (ΔVTI) and peak aortic velocity variation (ΔVpeak) compared with pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated dogs. STUDY DESIGN Prospective clinical study. ANIMALS A group of 50 mechanically ventilated dogs with spontaneous hypotension during orthopedic or oncologic surgery. METHODS Investigations were performed in the surgery room. When mean arterial pressure (MAP) decreased to <65 mmHg, measurements were performed before and after a fluid challenge (lactated Ringer's solution 5 mL kg-1 over 15 minutes). Responders were defined as a change in stroke volume (SV; transesophageal Doppler) ≥15%. Data were analyzed using paired/unpaired t test or Mann-Whitney/Wilcoxon test when appropriate and receiver operating characteristics (ROC) curves; a p value <0.05 was considered statistically significant. RESULTS After the fluid challenge, 35 (70%) of 50 dogs were responders with significant increases in SV and decreases in PPV; 15 dogs were nonresponders. ΔVTI and ΔVpeak correlated with a 15% increase in SV. The optimum cut-off value for PPV was 15.6% (sensitivity, 88%; specificity, 100%), for ΔVTI was 10.65% (sensitivity, 65%; specificity, 100%) and for ΔVpeak was 10.15% (sensitivity, 80%; specificity, 100%). The area under the ROC curve for PPV was (0.93 ± 0.08) and for ΔVpeak was (0.89 ± 0.09), before fluid challenge. The gray zone area spread from 6.15% to 15.6% for PPV (18 dogs), 2.45% to 10.65% for ΔVTI (22 dogs) and 0.6% to 10.15% for ΔVpeak (25 dogs). CONCLUSIONS When using mechanical ventilation, ΔVTI and ΔVpeak predicted fluid responsiveness with the same ability as PPV, based on the area under the ROC curve analysis. However, PPV showed great accuracy demonstrated by a narrower gray zone that included fewer individuals. CLINICAL RELEVANCE ΔVTI and ΔVpeak can be used as indices of fluid responsiveness in anesthetized dogs.
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Affiliation(s)
- Lucas A Gonçalves
- Department of Surgery, School of Veterinary Medicine and Zootechnics (FMVZ), University of São Paulo, São Paulo, SP, Brazil.
| | - Denise A Otsuki
- Laboratório de Investigação Médica 08 - Anestesiologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, University of São Paulo, São Paulo, SP, Brazil
| | - Marco Aa Pereira
- Department of Surgery, School of Veterinary Medicine and Zootechnics (FMVZ), University of São Paulo, São Paulo, SP, Brazil
| | - Julio K Nagashima
- Department of Surgery, School of Veterinary Medicine and Zootechnics (FMVZ), University of São Paulo, São Paulo, SP, Brazil
| | - Aline M Ambrosio
- Department of Surgery, School of Veterinary Medicine and Zootechnics (FMVZ), University of São Paulo, São Paulo, SP, Brazil
| | - Denise T Fantoni
- Department of Surgery, School of Veterinary Medicine and Zootechnics (FMVZ), University of São Paulo, São Paulo, SP, Brazil
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Xu LY, Tu GW, Cang J, Hou JY, Yu Y, Luo Z, Guo KF. End-expiratory occlusion test predicts fluid responsiveness in cardiac surgical patients in the operating theatre. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:315. [PMID: 31475185 PMCID: PMC6694235 DOI: 10.21037/atm.2019.06.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether a 20-second end-expiratory occlusion (EEO) test can predict fluid responsiveness in cardiac surgery patients in the operating theatre. METHODS This prospective study enrolled 75 mechanically ventilated patients undergoing elective coronary artery bypass grafting surgery. Hemodynamic data coupled with transesophageal echocardiography monitoring of the velocity time integral (VTI) and the peak velocity (Vmax) at the left ventricular outflow tract were collected at each step (baseline 1, EEO, baseline 2 and fluid challenge). Patients were divided into fluid responders (increase in VTI ≥15%) and non-responders (increase in VTI <15%) after a fluid challenge (6 mL 0.9% saline per kg, given in 10 minutes). RESULTS Fluid challenge significantly increased the VTI by more than 15% in 36 (48%) patients (responders). An increase in VTI greater than 5% during the EEO test predicted fluid responsiveness with a sensitivity of 81% and a specificity of 93%. The area under the receiver-operating characteristic curve (AUROC) of ΔVTI-EEO was 0.90 [95% confidence interval (CI): 0.83-0.97]. ΔVmax-EEO was poorly predictive of fluid responsiveness, with an AUC of 0.75 (95% CI: 0.63-0.86). CONCLUSIONS Changes in VTI induced by a 20-second EEO can reliably predict fluid responsiveness in cardiac surgical patients in the operating theatre, whereas the changes in Vmax cannot.
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Affiliation(s)
- Li-Ying Xu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Guo-Wei Tu
- Department of Crit Care Med, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Cang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jun-Yi Hou
- Department of Crit Care Med, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ying Yu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhe Luo
- Department of Crit Care Med, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Crit Care Med, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Ke-Fang Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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