Evaluation of cardiac index as a criterion for termination of resuscitation with fluid therapy in dogs with hypovolemic shock

Subject Areas : Veterinary Clinical Pathology

reza  azargoun ¹ (Assistant Professor, Department of Internal Medicine and Clinical Pathology, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran.)
Reza  Avizeh ² (Professor, Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran.)
Alireza  Ghadiri ³ (Professor, Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran.)
Mohammad  Razi Jalali ⁴ (Professor, Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran.)
Mahdi  Pourmahdi borujeni ⁵ (Associated Professor, Department of Food Hygiene, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran.)
Hadi  Imani Rastabi ⁶ (Assistant Professor, Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran.)

Received: 2019-12-21 Accepted : 2020-10-27 Published : 2020-10-22

Keywords: Dog, Cardiac index, Hypovolemic shock,

Abstract :

The cardiac index which is obtained by dividing the cardiac output on the body surface is known as the standard parameter to evaluate tissue perfusion. The purpose of this study was to evaluate cardiac index changes as a novel criterion to estimate the time of fluid therapy termination in dogs with hypovolemic shock. For this purpose, 10 mixed breed dogs were selected and after determination of body surface area, cardiac output was measured by Doppler echocardiography in eight stages. After induction of anesthesia and recording of vital signs, cardiac index evaluation was performed in control stage. Hypovolemic shock was induced by blood withdrawal to a mean arterial pressure of 40 to 50 mmHg within 30 minutes and then maintained for 30 minutes under hypovolemic condition. The dogs were then randomly divided into two equal groups; each group was resuscitated with lactated Ringer's solution (20 ml/kg) or 6% hydroxyethyl starch (5 ml/kg) over four 15-min intervals. The dogs were monitored for up to one hour from the last stage of resuscitation and at the end of each stage evaluation of cardiac index was performed. Hypovolemic shock caused significant decrease in cardiac index (2.3±0.1) compared to control stage (4.8±0.6) (p <0.05). Following resuscitation, cardiac index increased and returned to pre-shock values in both groups. Based on the results of this study, echocardiographic evaluation of cardiac index is an ideal criterion for estimating the termination of resuscitation in dogs with hypovolemic shock.

References:

• Antonelli, M., Levy, M., Andrews, P.J., Chastre, J., Hudson, L.D., Manthous, C., et al. (2007). Hemodynamic monitoring in shock and implications for management. Intensive Care Medicine, 33(4): 575-590.


• Assadnassab, G.H., Mousavi, G.H. and Neshat Gharamaleky, M. (2008). Ultrasonographic measurement of canine aorta and aortic inlet before and after administration of Propofol. Veterinary Clinical Pathology, 2(3): 241-247. [In Persian]


• Aya, H.D., Rhodes, A., Chis Ster, I., Fletcher, N., Grounds, R.M. and Cecconi, M. (2017). Hemodynamic effect of different doses of fluids for a fluid challenge: A quasi-randomized controlled study. Critical Care Medicine, 45(2): e161–e168.


• Boothe, D.M. (2017). Drug selection and dosing regimens. In: Monitoring and Intervention for the Critically Ill Small Animal. Kirby, R. and Linklater, A. editors. 1st ed., Iowa: Wiley-Blackwell, pp: 177-206.


• Braz, J., Nascimento, P., Filho, O., Braz, L., Vane, L.A., Galva˜oVianna, P.T., et al. (2004). The Early Systemic and Gastrointestinal Oxygenation Effects of Hemorrhagic Shock Resuscitation with Hypertonic Saline and Hypertonic Saline 6% Dextran-70: A Comparative Study in Dogs. Anesthesia and Analgesia, 99(2): 536-546.


• Davis, H. (2016). Management of Patients in Shock. In: Small animal emergency and critical care for veterinary technicians. Battaglia, A.M. and Steele, A.M. editors. 3th ed., Missouri: Elsevier, pp: 223-233.


• Dinh, V.A., Ko, H.S., Rao, R., Bansal, R.C., Smith, D.D., Kim, T.E, et al. (2012). Measuring cardiac index with a focused cardiac ultrasound examination in the ED. American Journal of Emergency Medicine, 30(9): 1845-1851.


• Dipti, A., Soucy, Z., Surana, A. and Chandra, S. (2012). Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Emergency Medicine, 30(8): 1414-1419.


• Fakler, U., Pauli, Ch., Balling, G., Lorenz, H.P., Eicken, A., Hennig, M., et al. (2007). Cardiac index monitoring by pulse contour analysis and thermodilution after pediatric cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery, 133(1): 224-228.


• Fine, D.M., Durham, H.E., Rossi, N.F., Spier, A.W., Selting, K. and Rubin, L.J. (2010). Echocardiographic assessment of hemodynamic changes produced by two methods of inducing fluid deficit in dogs. Journal of Veterinary Internal Medicine, 24(2): 348-353.


• Fülöp, A., Turóczi, Z., Garbaisz, D., Harsányi, L. and Szijártó, A. (2013). Experimental Models of Hemorrhagic Shock: A Review. European Surgical Research, 50(2): 57-70.


• Gutierrez, G., Reines, H.D. and Wulf-Gutierrez, M.E. (2004). Clinical review: Hemorrhagic shock. Critical Care, 8(5): 373-381.


• Guyton, A.C. (1995). Determination of cardiac output by equating venous return curves with cardiac response curves. Physiological Reviews, 35(1): 123–129.


• Hasanpour, A., Amougli Tabrizi, B., Rezaie Saber, A.P. and Imandar, M. (2009). Evaluating the effect of administrating hypertonic and isotonic saline solutions on clinical improvement, serum electrolyte concentrations and renal function of calves affected by diarrhea. Veterinary Clinical Pathology, 3(3): 579-590. [In Persian]


• Haskins, S.C., Pascoe, P.J., Ilkiw, J.E., Fudge, M., Hopper, K. and Aldrich, J. (2005). The effect of moderate hypovolemia on cardiopulmonary function in dogs. Journal of Veterinary Emergency and Critical Care, 15(2): 100-109.


• Keefe, J. (2012). Shock and Initial Stabilization. In: Veterinary Technician's Manual for Small Animal Emergency and Critical Care. Norkus, C. editors. 1st ed., Iowa: Wiley-Blackwell, pp: 25-43.


• Ko, J.J., Alam, R. and Kim, N.S. (2012). Hemodynamic effects of fluid resuscitation with 6% hydroxyethyl starch and whole blood in experimental hypovolemic shock in Beagle dogs. Turkish Journal of Veterinary and Animal Sciences, 36(4): 416-423.


• Long, E., Babl, F.E., Oakley, E., Sheridan, B. and Duke, T. (2018). Cardiac Index Changes with Fluid Bolus Therapy in Children with Sepsis-An Observational Study. Pediatric Critical Care Medicine, 19(6): 513-518.


• Lopes, P.C., Sousa, M.G., Camacho, A.A., Carareto, R., Nishimori, C., Santos, P., et al. (2010). Comparison between two methods for cardiac output measurement in propofol-anesthetized dogs: thermodilution and Doppler. Veterinary Anaesthesia and Analgesia, 37(5): 401-408.


• Mazzaferro, E. and Powell, LL. (2013). Fluid therapy for the emergent small animal patient. Veterinary Clinics of North America: Small Animal Practice, 43(4): 721-734.


• McLean, A.S. (2016). Echocardiography in shock management. Critical Care, 20: 275.


• Mellema, M.S. and McIntyre, R.L. (2015). Cardiac output monitoring. In: Small animal critical care medicine. Silverstein, D.C. and Hopper, K. editors. 2nd ed., Missouri: Elsevier, pp: 962-966.


• Mousavi, G.H. (2015). Preventive effects of Naringenin (Citrus flavonone) on intestinal ischemia–reperfusion injury in the rat. Veterinary Clinical Pathology, 8(4): 675-689. [In Persian]


• Nascimento, P.Jr., De Paiva Filho, O., de Carvalho, L.R. and Braz, J.R. (2006). Early Hemodynamic and Renal Effects of Hemorrhagic Shock Resuscitation with Lactated Ringer’s Solution, Hydroxyethyl Starch, and Hypertonic Saline with or without 6% Dextran-70. The Journal of Surgical Research, 136(1): 98-105.


• Tao, J.P., Huang, Q.Q., Huang, H.Q., Yang, J.J., Shi, M., Zhou, Y., et al. (2015). Effects of goal-directed fluid therapy with different lactated Ringer's: hydroxyethyl starch ratios in hemorrhagic shock dogs. Genetics and Molecular Research, 14(2): 6649-6663.


• Weekes, A.J. and Quirke D.P. (2011). Emergency echocardiography. Emergency Medicine Clinics of North America, 29(4): 759-787.