Comparison of Noninvasive Dynamic Indices of Fluid Responsiveness Among Different Ventilation Modes in Dogs Recovering from Experimental Cardiac Surgery

Abstract

BackgroundFluid resuscitation is a cornerstone of minimizing morbidity and mortality in critically ill patients, but the techniques for predicting fluid responsiveness is still a matter of debate. In this study, we aimed to evaluate the utility of noninvasive stroke volume variation (SVV), pulse pressure variation (PPV), and systolic pressure variation (SPV) as a dynamic predictor for assessing fluid responsiveness during different ventilation modes in anaesthetized, intubated dogs recovering from cardiac surgery.Material/MethodsThirty-six adult Beagle dogs undergoing experimental surgery for isolated right ventricular failure were monitored for SVV, PPV, and SPV simultaneously using electrical velocimetry device. The relationships between each indicator and SVI before and after volume loading were compared in 3 ventilatory modes: assist control (A/C), synchronized intermittent mandatory ventilation (SIMV), and continuous positive airway pressure (CPAP). Responders were defined as those whose stroke volume index increased by ≥10%.ResultsIn all of the indices, the baseline values were greater in responders than in nonresponders (P<0.01) under A/C and SIMV. Receiver operating curve analysis confirmed the best predictive value during A/C [area under the curve (AUC): SVV, 0.90; PPV, 0.88; SPV, 0.85; P<0.05] followed by SIMV (AUC: SVV, 0.86; PPV, 0.83; CPAP, 0.80; P<0.05), with their sensitivities and specificities of ≥7 5%. By contrast, no statistically significance detected in any parameter during CPAP (AUC: SVV, 0.71; PPV, 0.66; CPAP, 0.65; P>0.05).ConclusionsSVV, PPV, and SVV are all useful to predict cardiac response to fluid loading in dogs during A/C and SIMV, while their reliabilities during CPAP are poor.

Noninvasive assessment of fluid responsiveness for emergency abdominal surgery in dogs with pulmonary hypertension: Insights into high-risk companion animal anesthesia

“…Previous studies have shown that SVV threshold values of 13.5-15% for a 10% SVI response in dogs undergoing cardiac surgery (73-83% sensitivity and 60-84% specificity) [16,17] are in agreement with the present study of dogs with PH receiving the inotropic support. These findings support the feasibility of EV at least in part, for assessing intraoperative fluid responsiveness in anesthetized mechanically ventilated dogs such as continuous/synchronized intermittent mandatory ventilation [18,21].…”

“…Although only a few studies have directly compared SVV with other estimates of dynamic indices [ 50 , 51 ], our present and preliminary data demonstrated that both pulse pressure variation (PPV) and systolic pressure variation (SPV) showed comparable performance in predicting fluid responsiveness to raise the SVI and CI in dogs receiving high-risk veterinary anesthesia [ 21 ]. The optimal threshold value for SVV to discriminate between responders and nonresponders in dogs anesthetized in a variety of clinical scenarios is still limited because many factors (e.g., type and depth of anesthesia, ventilation modes, heart-lung interaction, and comorbid cardiac failure, etc.)…”

“…In addition to CO and stroke volume (SV) measurements, the EV also displays stroke volume variation (SVV) automatically in real-time [ 17 , 19 ]. Several lines of evidence suggest that SVV is better than the static methods for determining preload, such as central venous pressure and pulmonary artery occlusion pressure, for predicting fluid responsiveness and guiding fluid therapy in critically ill patients [ 9 , 20 ] and dogs undergoing experimental cardiac surgery [ 16 – 18 , 21 ]. Despite its potential for practical acceptance in terms of CO measurements and ease of use, limited clinical data are available regarding the role of noninvasive SVV assessment as a guide to intensive fluid management during high-risk surgical anesthesia in dogs.…”

Evaluation of the caudal vena cava diameter to abdominal aortic diameter ratio and the caudal vena cava respiratory collapsibility for predicting fluid responsiveness in a heterogeneous population of hospitalized conscious dogs

“…New indices based on heart and lung interactions, known as "dynamic indices" were introduced and their superiority was demonstrated over the previous "static indices", such as central venous pressure (CVP) [8,27]. Examples of these new "dynamic" respiratory indices are the systolic pressure variation (SPV) [6,41], pulse pressure variation (PPV) [15,40,41], stroke volume variation (SVV) [41], pleth variability index (PVI) [40] and the collapsibility of the vena cava (cIVC) [16], which are all based on cardiac response in terms of SV and cardiac output variations, to interactions between the heart and lungs during mechanical ventilation or spontaneous breathing.…”

Effect of different levels of stroke volume variation on the endothelial glycocalyx of patients undergoing colorectal surgery: A randomized clinical trial

“…These indicators were based on the Frank–Starling theorem and heart–lung interactions during mechanical ventilation (Díaz et al., 2015; Zlicar et al., 2018). Goal‐directed fluid therapy can shorten hospital stays, decrease postoperative complications and death of patients, and improve prognosis (Sasaki et al., 2018; Saxena et al., 2015; Zecavati et al., 2014). Currently, SVV and pulse pressure variation, based on dynamic haemodynamic parameters, are widely applied.…”