Investigation of biomarkers for impending fluid overload in a feline acute haemorrhage-resuscitation model

Effects of haemorrhage and lactated Ringer's solution or tetrastarch 130/0.4 resuscitation on colloidal osmotic pressure and osmolality in cats

ObjectivesTo determine the effects of haemorrhage and fluid over-resuscitation on colloidal osmotic pressure of albumin (COP albumin), plasma (Posm) and effective (Eosm) osmolality in anaesthetised cats.MethodsA total of six cats were given three treatments once, at 2-month intervals, in a randomised, crossover haemorrhage-resuscitation study. The treatments were divided into two phases, a controlled haemorrhage phase and a fluid resuscitation phase, as follows: (1) NoHR = no controlled haemorrhage and no resuscitation; (2) LRS = controlled haemorrhage followed by lactated Ringer's solution infusion (60 ml/kg/h); and (3) TS = controlled haemorrhage followed by 6% tetrastarch 130/0.4 suspended in 0.9% saline infusion (20 ml/kg/h). The resuscitation fluids were administered for 120 mins. Data were collected before haemorrhage, before resuscitation and at 30 min intervals until 120 mins. Variables were calculated at each time point as follows: COP albumin = albumin concentration (g/l) × 0.57; Posm = (2 × sodium) + glucose + blood urea nitrogen; and Eosm = (2 × sodium) + glucose. All Posm and Eosm concentrations were measured as mmol/l. Data were compared using a general linear mixed model (significance: P <0.05).ResultsMean ± SD total haemorrhage volumes for NoHR, LRS and TS were 10.2 ± 2.3, 29.3 ± 9.0 and 29.1 ± 6.3 ml/kg, respectively. The COP albumin decreased over time in all treatments regardless of volumes of blood lost and fluid administered. The decrease in COP albumin was profound and clinically relevant in LRS and TS (both P <0.001). There were no statistical differences in Posm and Eosm over time except in LRS at 90 (P = 0.004) and 120 ml/kg (P <0.001).Conclusions and relevanceThe COP albumin decreased in all treatments but to low and clinically relevant concentrations in LRS and TS, putting the cats at risk of fluid overload. There were no clinically relevant derangements in Posm and Eosm.

Relationships between arterial and central venous blood acid-base variables in anaesthetised cats during euvolaemic and hypovolaemic states

ObjectivesThe aim of the study was to determine differences, agreements and correlations of acid-base variables between arterial and venous blood gas in anaesthetised cats in a euvolaemic or hypovolaemic state.MethodsA group of six cats was used in a prospective randomised crossover haemorrhage-resuscitation study. Anaesthetised cats underwent three treatments at intervals of 2 months. Each treatment had a controlled haemorrhage phase and a resuscitation phase. The haemorrhage phase is the focus of this study. Arterial (carotid artery) and central venous blood were drawn simultaneously from preplaced catheters before haemorrhage (euvolaemic state; mean ± SD blood loss 1.3 ± 0.3 ml/kg for pre-haemorrhage data collection) and soon after controlled haemorrhage (hypovolaemic state; mean ± SD blood loss 15.8 ± 9.9 ml/kg). Acid-base variables from arterial and venous blood were compared under euvolaemic and hypovolaemic states as follows: (1) a paired t-test to determine the differences between the two samples; (2) a Bland-Altman plot to evaluate agreement and establish maximum clinically acceptable differences (defined a priori); and (3) Pearson's correlation with least squares linear regression to determine the strength of correlation between the variables.ResultsThe differences in pH and partial pressure of carbon dioxide were statistically significant under euvolaemic and hypovolaemic states but would not alter clinical decision-making. Agreements were clinically acceptable for all acid-base variables, except for the bias observed in the partial pressure of carbon dioxide under a hypovolaemic state. Correlations for all variables were strong under a euvolaemic state but weakened under a hypovolaemic state.Conclusions and relevanceUsing central venous blood sampling for acid-base analysis was clinically acceptable compared with arterial blood in our haemorrhage-resuscitation cat model during early compensated hypovolaemia. However, the partial pressure of carbon dioxide should be interpreted with caution, especially during hypovolaemia. Further investigation is necessary to determine whether these findings can be translated to critically ill cats.

Feline caudal vena cava to aorta ratio reference interval

OBJECTIVES

The primary objective of this investigation was to ultrasonographically evaluate the caudal vena cava to aorta (CVC:Ao) ratio in healthy, conscious cats and to generate reference intervals. A secondary objective was to identify the site of examination with the least intra- and inter-observer variability. This investigation was undertaken to assess whether the CVC:Ao ratio holds promise as a technique to assess intravascular volume responsiveness in cats.

METHODS

In total, 42 healthy cats were included for reference interval generation. Ultrasound examinations were performed by two operators with each examination performed twice by each operator on the same occasion. Examinations were performed on conscious cats in left lateral recumbency. Ultrasound sites investigated were the subxiphoid, hepatic intercostal, hepatorenal and iliac bifurcation. Operators also assessed each site for 'ease of visualisation' on a scale of 0-3.

RESULTS

Reference intervals were generated for the CVC:Ao ratio at all four ultrasonographic sites. While each site demonstrated low variability around its mean ratio, all sites exhibited significant intra- and inter-observer variability. The hepatorenal and iliac bifurcation sites were found to be the easiest to visualise (score 3; well-defined visualisation of both vessels) and had reference intervals of 0.8-1.41 and 0.75-1.2, respectively.

CONCLUSIONS AND RELEVANCE

The ultrasonographic assessment of the CVC:Ao ratio was possible at four anatomical locations in the cat. The hepatorenal and iliac bifurcation may offer more readily assessable CVC:Ao ratios. Further studies are necessary to assess the utility of the CVC:Ao ratio in disease states, including in hypovolaemia and hypervolaemia.

Prothrombin and activated partial thromboplastin times, thromboelastography, hematocrit, and platelet count in a feline hemorrhage/over-resuscitation model using lactated Ringer's solution or 6% tetrastarch 130/0.4

OBJECTIVE

To describe and compare prothrombin time (PT), activated partial thromboplastin time (aPTT), thromboelastography (TEG), HCT, and platelet count measurements in a hemorrhage/over-resuscitation model.

DESIGN

Randomized crossover study.

SETTING

University teaching hospital.

ANIMALS

Six cats.

INTERVENTIONS

Anesthetized cats underwent 3 treatments at 2-month intervals. The treatments were as follows: NHR-no controlled hemorrhage and sham resuscitation; LRS-controlled hemorrhage and lactated Ringer's solution (LRS) for resuscitation; and Voluven-controlled hemorrhage and 6% tetrastarch 130/0.4 for resuscitation. The LRS and Voluven were administered at 60 and 20 mL/kg/h, respectively, for 120 minutes. Blood samples were drawn for PT, aPTT, TEG, HCT, and platelet count measurements at a healthy check (T - 7d), after controlled hemorrhage (T0), at 60 and 120 minutes of resuscitation (T60 and T120), and at 24 hours after completion of resuscitation (T24h). Data were analyzed using a general linear mixed model approach (significance was P < 0.05).

MEASUREMENTS AND MAIN RESULTS

Total median blood loss (controlled hemorrhage and blood sampling from T0 to T120) at T120 was 11.4, 31.0, and 30.8 mL/kg for NHR, LRS, and Voluven, respectively. PT and aPTT during LRS and Voluven were prolonged at T60 and T120 compared to NHR (P < 0.001). On TEG, the reaction time, kinetic time, and alpha-angle were within reference intervals for cats at all time points in all treatments, while maximum amplitude was less than the reference interval (40 mm) at T0, T60, and T120 during Voluven and at T60 and T120 during LRS compared to NHR (both P < 0.001). The HCT and platelet count were significantly lower at T60 and T120 during LRS and Voluven compared to NHR (P < 0.001).

CONCLUSIONS

Hypocoagulopathy was observed during hemorrhage and liberal fluid resuscitation. Prolongation of PT and aPPT and decreased clot strength may have been caused by hemodilution and platelet loss.