Evaluation of the shock index in dogs presenting as emergencies

Abstract

Objectives To 1) determine the normal range for Shock Index (SI) [defined as heart rate (HR)/systolic blood pressure (SBP)], in healthy dogs, and 2) compare SI in healthy dogs with dogs presenting to the emergency room (ER) deemed to be in or not in a state of shock. Design Prospective study. Animals 68 clinically normal dogs,,18 dogs that were presented to the ER deemed to be in shock and 19 dogs presenting to the ER not deemed to be in shock. Setting University teaching hospital. Interventions Peripheral or central venous blood sampling. Measurements and Main Results Heart rate and SBP were recorded on simulated presentation (healthy dogs), and emergency presentations for both dogs deemed to be in shock and dogs not deemed in shock. Dogs in shock had a median SI of 1.37 (0.87–3.13), which was significantly higher than both other groups; dogs not deemed in shock had median SI 0.73 (0.56–1.20), P<0.0001 and healthy dogs had median SI 0.78 (0.37–1.30) P<0.0001), respectively. Receiver operator characteristic curve analysis suggested a SI cut-off of 1.0, yielding an area under the receiver operator characteristic (AUROC) of 0.89 (Specificity (Sp) 89, Sensitivity (Sn) 90) when comparing dogs deemed in shock with healthy dogs, and 0.92 (Sp 95, Sn 89) when comparing dogs in shock with to dogs not deemed in shock. Conclusions The SI is an easy and non-invasive patient parameter that is higher in dogs that are deemed to be in shock than both healthy dogs and dogs presented as emergencies but not deemed to be in a state of shock. The measurement of SI may have some benefit in clinical assessment of emergency patients.

Bacterial translocation in critical illness

“…These conditions lead to shock, which occurs secondary to poor tissue perfusion causing a critical decrease in oxygen delivery so that it is insufficient for tissue demands (Porter et al . ). Oxygen tension at the intestinal villous tip is lower than that of the arterial blood.…”

“…2012 ). These conditions lead to shock, which occurs secondary to poor tissue perfusion causing a critical decrease in oxygen delivery so that it is insufficient for tissue demands (Porter et al . 2013 ).…”

Triage of the veterinary patient

“…This is a quick, simple measurement that may help to determine whether the patient is in shock; it has been found to be higher in dogs that are in shock (Porter and others 2013). …”

Evaluation of the use of shock index in identifying acute blood loss in healthy blood donor dogs

“…The calculation of a shock index (SI), the ratio of the HR to SBP, has been shown to be both specific and sensitive for detection of moderate to severe shock in both people and dogs when the value is >0.9 or 1 . The use of SI has also been shown to help identify people in the prehospital setting that are at a higher risk of needing a massive transfusion, and has also been found to accurately identify children who are most severely injured when adjusted for different age groups .…”

“…The use of SI has also been shown to help identify people in the prehospital setting that are at a higher risk of needing a massive transfusion, and has also been found to accurately identify children who are most severely injured when adjusted for different age groups . In veterinary studies, an SI > 1.0 accurately identified dogs presenting to an emergency room in shock compared to both healthy dogs and those presenting to an emergency room not in shock . It has also been shown to correlate with volume status in hemorrhagic shock models in splenectomized anesthetized dogs while other parameters (ie, central venous pressure, HR, mean blood pressure, and pulmonary capillary pressures) did not…”