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Kim Y, Ku J, Jung Y, Lim Y, Ji M, Park Y, Cho H, Choi K, Park J. Evaluation of haematological parameters in haemolytic anaemia caused by tick-borne pathogens in grazing cattle. Vet Med Sci 2024; 10:e1434. [PMID: 38567942 PMCID: PMC10989275 DOI: 10.1002/vms3.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/07/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND No tick-borne pathogens (TBPs) causing haemolytic anaemia in cattle have been reported, except Theileria orientalis and complete blood count (CBC) profile is the only haematological parameter to determine the severity of regenerative haemolytic anaemia. OBJECTIVES To identify the causative agents of TBP-induced haemolytic anaemia and determine haematological parameters that indicate haemolytic anaemia in grazing cattle. METHODS Eighty-two Korean indigenous cattle (Hanwoo) were divided into two groups: grazing (n = 67) and indoor (n = 15) groups. CBC and serum biochemistry were performed. PCR was conducted using whole blood-extracted DNA to investigate the prevalence of TBPs. RESULTS TBP-induced haemolytic anaemia was observed in the grazing group. In grazing cattle, co-infection (43.3%, 29/67) was most frequently detected, followed by T. orientalis (37.6%, 25/67) and Anaplasma phagocytophilum infections (1.5%, 1/67). In indoor cattle, only co-infection (20%, 3/15) was identified. Grazing cattle exhibited regenerative haemolytic anaemia with marked monocytosis, mild neutropenia, and thrombocytopenia. According to grazing frequency, the 1st-time grazing group had more severe anaemia than the 2nd-time grazing group. Elevations in indirect bilirubin and L-lactate due to haemolytic anaemia were identified, and correlations with the respective markers were determined in co-infected grazing cattle. CONCLUSIONS Quantitative evaluation of haematocrit, mean corpuscular volume, and reticulocytes (markers of regenerative haemolytic anaemia in cattle) was performed for the first time. Our results show that, in addition to T. orientalis, A. phagocytophilum is strongly associated with anaemia. The correlation between haemolytic anaemia severity and haematological parameters (indirect bilirubin, reticulocytes, and L-lactate) was confirmed.
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Affiliation(s)
- Youngjun Kim
- Department of Veterinary Internal MedicineCollege of Veterinary MedicineJeonbuk UniversityIksanRepublic of Korea
- Department of Animal Hospital, Hanwoo (Korean Indigenous Cattle) Genetic Improvement CenterNational Agricultural Cooperative FederationSeosanRepublic of Korea
| | - Ji‐Young Ku
- Department of Veterinary Internal MedicineCollege of Veterinary MedicineJeonbuk UniversityIksanRepublic of Korea
| | - Youngwoo Jung
- Department of Veterinary Internal MedicineCollege of Veterinary MedicineJeonbuk UniversityIksanRepublic of Korea
| | - Young‐Hwan Lim
- Department of Animal Hospital, Hanwoo (Korean Indigenous Cattle) Genetic Improvement CenterNational Agricultural Cooperative FederationSeosanRepublic of Korea
| | - Min‐Jeong Ji
- Department of Animal Science and Biotechnology, College of Ecology and Environmental ScienceKyungpook National UniversitySangjuRepublic of Korea
| | - Yu‐Jin Park
- Department of Animal Science and Biotechnology, College of Ecology and Environmental ScienceKyungpook National UniversitySangjuRepublic of Korea
| | - Hyung‐Chul Cho
- Department of Animal Science and Biotechnology, College of Ecology and Environmental ScienceKyungpook National UniversitySangjuRepublic of Korea
| | - Kyoung‐Seong Choi
- Department of Animal Science and Biotechnology, College of Ecology and Environmental ScienceKyungpook National UniversitySangjuRepublic of Korea
| | - Jinho Park
- Department of Animal Hospital, Hanwoo (Korean Indigenous Cattle) Genetic Improvement CenterNational Agricultural Cooperative FederationSeosanRepublic of Korea
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Nishida Y, Yamamoto R, Ono S, Sasaki J. Association between preoperative lactate level and early complications after surgery for isolated extremity fracture. BMC Musculoskelet Disord 2024; 25:314. [PMID: 38654188 PMCID: PMC11036590 DOI: 10.1186/s12891-024-07409-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The role of lactate level in selecting the timing of definitive surgery for isolated extremity fracture remains unclear. Therefore, we aimed to elucidate the use of preoperative lactate level for predicting early postoperative complications. METHODS This was a single-center retrospective observational study of patients with isolated extremity fracture who underwent orthopedic surgery. Patients who underwent lactate level assessment within 24 h prior to surgery were included. The incidence of early postoperative complications was compared between patients with a preoperative lactate level of ≥ 2 and < 2 mmol/L. Moreover, subgroup analyses were performed based on the time from hospital arrival to surgery and fracture type. RESULTS In total, 187 patients were included in the study. The incidence of postoperative complications was significantly higher in patients with a preoperative lactate level of ≥ 2 mmol/L than those with a preoperative lactate level of < 2 mmol/L. This result did not change after adjusting for age and severity. Further, a high preoperative lactate level was associated with a greater incidence of postoperative complications in patients who underwent definitive surgery within 6 h after arrival. CONCLUSION A preoperative lactate level of ≥ 2 mmol/L was associated with a greater incidence of early postoperative complications in isolated extremity fractures. Nevertheless, this correlation was only observed among patients who underwent definitive fixation within 6 h after hospital arrival.
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Affiliation(s)
- Yusho Nishida
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Soichiro Ono
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Divers TJ, Radcliffe RM, Cook VL, Bookbinder LC, Hurcombe SDA. Calculating and selecting fluid therapy and blood product replacements for horses with acute hemorrhage. J Vet Emerg Crit Care (San Antonio) 2022; 32:97-107. [PMID: 35044062 DOI: 10.1111/vec.13127] [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: 02/23/2017] [Revised: 08/14/2017] [Accepted: 10/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blood products, crystalloids, and colloid fluids are used in the medical treatment of severe hemorrhage in horses with a goal of providing sufficient blood flow and oxygen delivery to vital organs. The fluid treatments for hemorrhage will vary depending upon severity and duration and whether hemorrhage is controlled or uncontrolled. DESCRIPTION With acute and severe controlled hemorrhage, treatment is focused on rapidly increasing perfusion pressure and blood flow to vital organs. This can most easily be accomplished in field cases by the administration of hypertonic saline. If isotonic crystalloids are used for resuscitation, the volume administered should be at least as great as the estimated blood loss. Following crystalloid resuscitation, clinical signs, HCT, and laboratory evidence of tissue hypoxia may help determine the need for a whole blood transfusion. In uncontrolled hemorrhage, crystalloid resuscitation is often more conservative and is referred to as "permissive hypotension." The goal of "permissive hypotension" would be to provide enough perfusion pressure to vital organs such that function is maintained while keeping blood pressure below the normal range in the hope that clot formation will not be disrupted. Whole blood and fresh frozen plasma in addition to aminocaproic acid are indicated in most horses with severe uncontrolled hemorrhage. SUMMARY Blood transfusion is a life-saving treatment for severe hemorrhage in horses. No precise HCT serves as a transfusion trigger; however, an HCT < 15%, lack of appropriate clinical response, or significant improvement in plasma lactate following crystalloid resuscitation and loss of 25% or more of blood volume is suggestive of the need for whole blood transfusion. Mathematical formulas may be used to estimate the amount of blood required for transfusion following severe but controlled hemorrhage, but these are not very accurate and, in practice, transfusion volume should be approximately 40% of estimated blood loss. KEY POINTS Modest hemorrhage, <15% of blood volume (<12 mL/kg), can be fully compensated by physiological mechanisms and generally does not require fluid or blood product therapy. More severe hemorrhage, >25% of blood volume (> 20 mL/kg), often requires crystalloid or blood product replacement, while acute loss of greater than 30% (>24 mL/kg) of blood volume may result in hemorrhagic shock requiring resuscitation treatments Uncontrolled hemorrhage is a common occurrence in equine practice, and is most commonly associated with abdominal bleeding (eg, uterine artery rupture in mares). If the hemorrhage can be controlled such as by ligation of a bleeding vessel, then initial efforts to resuscitate the horse should focus on increasing perfusion pressure and blood flow to organs as quickly as possible with crystalloids or colloids while assessing need for whole blood transfusion. While fluid therapy is being administered every effort to physically control hemorrhage should be made using ligatures, application of compression, surgical methods, and local hemostatic agents like collagen-, gelatin-, and cellulose-based products, fibrin, yunnan baiyao (YB), and synthetic glues Although some synthetic colloids have been shown to be associated with acute kidney injury in people receiving resuscitation therapy,20 this undesirable effect in horses has not been reported.
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Affiliation(s)
- Thomas J Divers
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Rolfe M Radcliffe
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Vanessa L Cook
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Lauren C Bookbinder
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Samuel D A Hurcombe
- Emergency Surgery and Medicine, Cornell Ruffian Equine Specialists, Elmont, New York, USA
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Hurcombe SDA, Radcliffe RM, Cook VL, Divers TJ. The pathophysiology of uncontrolled hemorrhage in horses. J Vet Emerg Crit Care (San Antonio) 2022; 32:63-71. [PMID: 35044067 DOI: 10.1111/vec.13122] [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: 02/23/2017] [Revised: 10/23/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemorrhagic shock in horses may be classified in several ways. Hemorrhage may be considered internal versus external, controlled or uncontrolled, or described based on the severity of hypovolemic shock the patient is experiencing. Regardless of the cause, as the severity of hemorrhage worsens, homeostatic responses are stimulated to ameliorate the systemic and local effects of an oxygen debt. In mild to moderate cases of hemorrhage (<15% blood volume loss), physiological adaptations in the patient may not be clinically apparent. As hemorrhage worsens, often in the uncontrolled situation such as a vascular breach internally, the pathophysiological consequences are numerous. The patient mobilizes fluid and reserve blood volume, notably splenic stored and peripherally circulating erythrocytes, to preferentially supply oxygen to sensitive organs such as the brain and heart. When the global and local delivery of oxygen is insufficient to meet the metabolic needs of the tissues, a cascade of cellular, tissue, and organ dysfunction occurs. If left untreated, the patient dies of hemorrhagic anemic shock. CLINICAL IMPORTANCE An understanding of the pathophysiological consequences of hemorrhagic shock in horses and their clinical manifestations may help the practitioner understand the severity of blood volume loss, the need for referral, the need for transfusion, and potential outcome. In cases of severe acute uncontrolled hemorrhage, it is essential to recognize the clinical manifestations quickly to best treat the patient, which may include humane euthanasia. KEY POINTS Uncontrolled hemorrhage may be defined as the development of a vascular breach and hemorrhage that cannot be controlled by interventional hemostasis methods such as external pressure, tourniquet, or ligation. Causes of uncontrolled hemorrhage in horses may be due to non-surgical trauma, surgical trauma, invasive diagnostic procedures including percutaneous organ biopsy, coagulopathy, hypertension, cardiovascular anomaly, vascular damage, neoplasia such as hemangiosarcoma, toxicity, or idiopathic in nature. When a critical volume of blood is lost, the respondent changes in heart rate, splenic blood mobilization, and microcirculatory control can no longer compensate for decreasing oxygen delivery to the tissues In spite of organ-specific microvascular responses (eg, myogenic responses, local mediator modulation of microvasculature, etc), all organs experience decreases in blood flow during severe hypovolemia Acute, fatal hemorrhagic shock is characterized by progressive metabolic acidosis, coagulopathy, and hypothermia, often termed the "triad of death," followed by circulatory collapse.
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Affiliation(s)
- Samuel D A Hurcombe
- Emergency Surgery and Medicine, Cornell Ruffian Equine Specialists, Elmont, New York, USA
| | - Rolfe M Radcliffe
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Vanessa L Cook
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Thomas J Divers
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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Munsterman AS, Gillen AM, Coleridge MOD, Hanson RR. Evaluation of the effects of intraabdominal hypertension on equine central venous pressure. J Vet Emerg Crit Care (San Antonio) 2020; 30:653-659. [PMID: 32929882 DOI: 10.1111/vec.13001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 12/17/2018] [Accepted: 02/18/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effect of changes in intraabdominal pressure (IAP) on central venous pressure (CVP) in normal horses. DESIGN Experimental, in vivo study. SETTING University Teaching Hospital. ANIMALS Convenience sample of 7 mixed breed horses-5 geldings and 2 mares. INTERVENTIONS Pneumoperitoneum was induced in horses under standing sedation with carbon dioxide gas using a laparoscopic insufflator for a total of 60 minutes to simulate clinical elevation in IAP. Pressure was increased stepwise to 20 mm Hg over 30 minutes, and maintained at that pressure for 30 minutes to evaluate the effect of sustained intraabdominal hypertension. CVP was obtained from the cranial vena cava, concurrent with pressure obtained from the peritoneal cavity. MEASUREMENTS AND MAIN RESULTS CVP increased as IAP increased up to 12 mm Hg, and declined as IAP increased further. The changes in CVP over time were significantly different (P < 0.03). Repeated measures correlation was positive, and highest, for mean CVP as IAP increased from 0 to 12 mm Hg (r = .70; 95% CI, .43-.85; P < 0.0001). Correlation of mean CVP with insufflation pressure became negative as IAP increased further from 15 to 20 mm Hg (r = -.47; 95% CI, -.66 to -.21; P = 0.0006). CONCLUSIONS This report provides preliminary data demonstrating a biphasic trend in equine CVP caused by changes in IAP, similar to that observed in other species. Further investigations are needed to evaluate this trend and to confirm these results in clinical patients.
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Affiliation(s)
- Amelia S Munsterman
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Alexandra M Gillen
- The Philip Leverhulme Equine Hospital, University of Liverpool, Chester High Road, Neston, Cheshire, UK
| | | | - R Reid Hanson
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
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Khan A, Hallowell GD, Underwood C, van Eps AW. Continuous fluid infusion per rectum compared with intravenous and nasogastric fluid administration in horses. Equine Vet J 2019; 51:767-773. [PMID: 30900297 DOI: 10.1111/evj.13113] [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: 06/05/2018] [Accepted: 03/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Rectal fluid administration may offer a simple, safe and inexpensive alternative to intravenous or nasogastric fluid therapy in equine clinical cases. OBJECTIVES To evaluate the tolerance and effects of rectally administered fluid and compare the measurements of haemodilution and intravascular volume with those during nasogastric and intravenous fluid administration. STUDY DESIGN Randomised controlled experimental trial. METHODS Six clinically normal Standardbred geldings were used in a 4-way crossover study: each received three different fluid treatments (intravenous, nasogastric and rectal) at 5 mL/kg/h for 6 h and underwent a control (no treatment) with water and feed withheld. Bodyweight was measured at baseline and 6 h. Packed cell volume (PCV), total solids (TS), albumin, electrolytes, lactate, urine specific gravity, vital parameters, gastrointestinal borborygmi and central venous pressure were measured every 2 h. RESULTS Rectal fluid administration with plain water was well tolerated and caused clinical chemistry changes consistent with haemodilution, indicating absorption. Mean (95% confidence interval) PCV decreased from 40% [40-42] at 0 h to 35% [34-36] at 6 h during rectal fluid treatment (P<0.001), similar to decreases in PCV occurring also with i.v. and nasogastric (NGT) treatment (P<0.001). The TS also decreased with i.v. and rectal fluid (P<0.001). There was a decrease in bodyweight in the control (P<0.001) but not with any of the fluid treatments. MAIN LIMITATIONS A small sample size of healthy, euhydrated horses and a relatively short duration of fluid administration was used. CONCLUSIONS Rectal fluid administration requires clinical evaluation, but may offer an inexpensive, safe alternative or adjunct to i.v. fluid administration, particularly when administration via NGT is not possible or contraindicated. The Summary is available in Portuguese - see Supporting Information.
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Affiliation(s)
- A Khan
- School of Veterinary Science, the University of Queensland, Gatton, Queensland, Australia
| | - G D Hallowell
- School of Veterinary Medicine and Science, the University of Nottingham, Leicestershire, UK
| | - C Underwood
- School of Veterinary Science, the University of Queensland, Gatton, Queensland, Australia
| | - A W van Eps
- School of Veterinary Science, the University of Queensland, Gatton, Queensland, Australia
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O'Neill HD, Ricardi G. Concurrent repair of a displaced rib fracture and splenic capsular tearing using laparoscopic technique in a standing horse with acute haemoperitoneum. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H. D. O'Neill
- Donnington Grove Veterinary Surgery Newbury Berkshire UK
| | - G. Ricardi
- Donnington Grove Veterinary Surgery Newbury Berkshire UK
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8
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Freeman DE. Fifty years of colic surgery. Equine Vet J 2018; 50:423-435. [DOI: 10.1111/evj.12817] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/05/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Affiliation(s)
- D. E. Freeman
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville Florida USA
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Johnson A, Ahrens T. Stroke volume optimization: the new hemodynamic algorithm. Crit Care Nurse 2016; 35:11-27. [PMID: 25639574 DOI: 10.4037/ccn2015427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Critical care practices have evolved to rely more on physical assessments for monitoring cardiac output and evaluating fluid volume status because these assessments are less invasive and more convenient to use than is a pulmonary artery catheter. Despite this trend, level of consciousness, central venous pressure, urine output, heart rate, and blood pressure remain assessments that are slow to be changed, potentially misleading, and often manifested as late indications of decreased cardiac output. The hemodynamic optimization strategy called stroke volume optimization might provide a proactive guide for clinicians to optimize a patient's status before late indications of a worsening condition occur. The evidence supporting use of the stroke volume optimization algorithm to treat hypovolemia is increasing. Many of the cardiac output monitor technologies today measure stroke volume, as well as the parameters that comprise stroke volume: preload, afterload, and contractility.
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Affiliation(s)
- Alexander Johnson
- Alexander Johnson is a clinical nurse specialist, Central DuPage Hospital, Cadence Health System-Northwestern Medicine, Winfield, Illinois.Thomas Ahrens is a research scientist, Barnes-Jewish Hospital, St Louis, Missouri.
| | - Thomas Ahrens
- Alexander Johnson is a clinical nurse specialist, Central DuPage Hospital, Cadence Health System-Northwestern Medicine, Winfield, Illinois.Thomas Ahrens is a research scientist, Barnes-Jewish Hospital, St Louis, Missouri
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Hutchinson KM, Shaw SP. A Review of Central Venous Pressure and Its Reliability as a Hemodynamic Monitoring Tool in Veterinary Medicine. Top Companion Anim Med 2016; 31:109-121. [PMID: 27968811 DOI: 10.1053/j.tcam.2016.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/04/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To review the current literature regarding central venous pressure (CVP) in veterinary patients pertaining to placement (of central line), measurement, interpretation, use in veterinary medicine, limitations, and controversies in human medicine. ETIOLOGY CVP use in human medicine is a widely debated topic, as numerous sources have shown poor correlation of CVP measurements to the volume status of a patient. Owing to the ease of placement and monitoring in veterinary medicine, CVP remains a widely used modality for evaluating the hemodynamic status of a patient. A thorough evaluation of the veterinary and human literature should be performed to evaluate the role of CVP measurements in assessing volume status in veterinary patients. DIAGNOSIS Veterinary patients that benefit from accurate CVP readings include those suffering from hypovolemic or septic shock, heart disease, or renal disease or all of these. Other patients that may benefit from CVP monitoring include high-risk anesthetic patients undergoing major surgery, trending of fluid volume status in critically ill patients, patients with continued shock, and patients that require rapid or large amounts of fluids. THERAPY The goal of CVP use is to better understand a patient's intravascular volume status, which would allow early goal-directed therapy. PROGNOSIS CVP would most likely continue to play an important role in the hemodynamic monitoring of the critically ill veterinary patient; however, when available, cardiac output methods should be considered the first choice for hemodynamic monitoring.
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Affiliation(s)
| | - Scott P Shaw
- VCA, Specialty Regional Medical Director; Northeast Los Angeles, CA, USA
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12
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Guedes A, Aleman M, Davis E, Tearney C. Cardiovascular, respiratory and metabolic responses to apnea induced by atlanto-occipital intrathecal lidocaine injection in anesthetized horses. Vet Anaesth Analg 2016; 43:590-598. [PMID: 26849108 DOI: 10.1111/vaa.12344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/28/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine physiologic responses to apnea-induced severe hypoxemia in anesthetized horses. STUDY DESIGN Prospective experimental study. ANIMALS Six university-owned horses with a median (range) body weight of 500 (220-510) kg and aged 13.5 (0.8-24.0) years scheduled for euthanasia. METHODS Xylazine-midazolam-ketamine-anesthetized horses breathing room air spontaneously were instrumented with a facial artery catheter for pressure measurement and blood sampling, and were made apneic with atlanto-occipital intrathecal lidocaine (4 mg kg-1 ). Cardiopulmonary, biochemical and hematologic variables were recorded before (baseline) and every minute for 10 minutes after lidocaine injection. RESULTS PaO2 values were: baseline, 55 mmHg (7.3 kPa); 1 minute, 28 mmHg (3.8 kPa); 2 minutes, 18 mmHg (2.4 kPa); 3 minutes, 15 mmHg (2.0 kPa), and 4-10 minutes, (8-11 mmHg (1.1-1.5 kPa). PaCO2 values were: baseline, 50 mmHg (6.7 kPa); 1 minute, 61 mmHg (8.1 kPa), and 2-10 minutes, 64-66 mmHg (8.5-8.8 kPa). Base excess values at baseline, 1 minute and 2-10 minutes were 5.3 mmol L-1 , 6.5 mmol L-1 and 7.0-8.1 mmol L-1 , respectively. Pulse rates at baseline, 1 minute and 2-7 minutes were 36, 53 and 54-85 beats minute-1 , respectively. Asystole occurred at 8 minutes. Pulse pressures were 50 mmHg at baseline and 1 minute, and 39 mmHg, 31 mmHg, 22 mmHg, 17 mmHg and 1-9 mmHg at 2, 3, 4, 5 and 6-10 minutes, respectively. Lactate was 0.9 mmol L-1 at baseline, progressively increasing to 1.7-2.4 mmol L-1 at 7-10 minutes. Packed cell volume increased after 7 minutes of apnea. There were no other major changes. CONCLUSIONS AND CLINICAL RELEVANCE Apnea immediately exacerbated hypoxemia and hypercapnia and rapidly caused hemodynamic instability. Apnea in hypoxemic anesthetized horses is associated with a serious risk for progress to cardiovascular collapse.
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Affiliation(s)
- Alonso Guedes
- Department of Surgical and Radiological Sciences, University of California, Davis, CA, USA. .,Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, USA.
| | - Monica Aleman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Eric Davis
- International Animal Welfare Training Institute, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Caitlin Tearney
- William R Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA, USA
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Navas de Solis C, Dallap Schaer BL, Boston R, Slack J. Myocardial insult and arrhythmias after acute hemorrhage in horses. J Vet Emerg Crit Care (San Antonio) 2015; 25:248-55. [PMID: 25752472 DOI: 10.1111/vec.12295] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/08/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objectives of this investigation were to: (1) Determine if acute hemorrhage is associated with increased plasma cardiac troponin I (cTnI) concentration or cardiac arrhythmias, (2) to describe the types of arrhythmias and their clinical course in horses following acute hemorrhage, (3) to determine the ability of clinical or clinicopathological variables to predict an increase in cTnI concentration and the presence of arrhythmias, and (4) to determine the associations of cTnI and cardiac arrhythmias with outcome. DESIGN Prospective observational study. SETTING Large animal veterinary teaching hospital. ANIMALS Eleven client-owned adult horses admitted for treatment of acute hemorrhage (HG) and 4 adult horses undergoing controlled blood collection (BDG). METHODS Serial cTnI concentrations were measured and continuous ECGs were obtained from the HG and BDG groups. Statistical tests were used to determine associations among acute hemorrhage and plasma cTnI concentrations, the presence of cardiac arrhythmias, clinicopathologic data (heart rate [HR], packed cell volume [PCV], total plasma protein [TPP], plasma lactate, and plasma creatinine concentrations), and outcome. RESULTS Plasma cTnI concentration and ECG were within reference intervals at all time points in the BDG. All horses in the HG had increased cTnI (ranging from 0.1-29.9 ng/mL). Arrhythmias were detected in 8 of these horses. There was an association between acute hemorrhage and increased cTnI (P = 0.004, ρ = 0.77), and the presence of arrhythmias (P = 0.026, ρ = 0.64). There were associations among plasma cTnI concentration and the presence of arrhythmias (P = 0.005), arrhythmias requiring treatment (P = 0.036), and poor outcome (P = 0.024). CONCLUSIONS Acute hemorrhage results in myocardial injury that can be detected by measuring cTnI concentration. Arrhythmias were frequent in hospitalized horses following acute hemorrhage.
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Affiliation(s)
- Cristobal Navas de Solis
- Sections of Sports Medicine and Imaging, Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, 19348; Universidad Autonoma de Barcelona, Bellaterra, Barcelona, Spain
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14
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Radcliffe RM, Buchanan BR, Cook VL, Divers TJ. The clinical value of whole blood point-of-care biomarkers in large animal emergency and critical care medicine. J Vet Emerg Crit Care (San Antonio) 2015; 25:138-51. [PMID: 25590562 DOI: 10.1111/vec.12276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/15/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To summarize the current medical literature and provide a clinical perspective of whole blood point-of-care (POC) biomarkers in large animal emergency and critical care practice. DATA SOURCES Original studies, reviews, and textbook chapters in the human and veterinary medical fields. SUMMARY POC biomarkers are tests used to monitor normal or disease processes at or near the patient. In both human and veterinary medicine these tools are playing an increasingly important role in the management of critical diseases. The most important whole blood POC biomarkers available for veterinary practitioners include l-lactate, cardiac troponin I, serum amyloid A, triglyceride, creatinine, and glucose, although many other tests are available or on the horizon. CONCLUSION Whole blood POC biomarkers enable clinicians to provide improved management of critical diseases in large animals. These tools are especially useful for establishing a diagnosis, guiding therapy, and estimating disease risk and prognosis.
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Affiliation(s)
- Rolfe M Radcliffe
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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Gray SN, Dechant JE, LeJeune SS, Nieto JE. Identification, Management and Outcome of Postoperative Hemoperitoneum in 23 Horses After Emergency Exploratory Celiotomy for Gastrointestinal Disease. Vet Surg 2014; 44:379-85. [DOI: 10.1111/j.1532-950x.2014.12236.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 02/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah N. Gray
- William R Pritchard Veterinary Medical Teaching Hospital; University of California; Davis California
| | - Julie E. Dechant
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California; Davis California
| | - Sarah S. LeJeune
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California; Davis California
| | - Jorge E. Nieto
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California; Davis California
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16
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Tennent-Brown B. Blood lactate measurement and interpretation in critically ill equine adults and neonates. Vet Clin North Am Equine Pract 2014; 30:399-413, viii. [PMID: 25016498 DOI: 10.1016/j.cveq.2014.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Admission blood lactate concentration is widely used as a prognostic indicator in equine medicine and can be a useful indicator of disease severity but typically fails to completely discriminate survivors from nonsurvivors. Increased admission lactate concentrations in adult horses typically return to normal within 12 to 24 hours. Lactate concentrations in neonatal foals are higher than adult concentrations for the first 24 to 72 hours of life. Serial measures reflecting both the magnitude and duration of hyperlactatemia might enable more accurate prognostication and provide insight into disease pathogenesis and could be a valuable therapeutic guide.
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Affiliation(s)
- Brett Tennent-Brown
- Faculty of Veterinary Science, Equine Centre, The University of Melbourne, 250 Princess Highway, Werribee, Victoria 3030, Australia.
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17
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Hubbell JAE, Muir WW. Oxygenation, oxygen delivery and anaesthesia in the horse. Equine Vet J 2014; 47:25-35. [DOI: 10.1111/evj.12258] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/26/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. A. E. Hubbell
- The Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus USA
| | - W. W. Muir
- Veterinary Clinical Pharmacology Consulting Services; Columbus Ohio USA
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18
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De Pedro P, Wilkins PA, McMichael MA, Dirikolu L, Lascola KM, Clark-Price SC, Boston RC. Exogenous L-lactate clearance in adult horses. J Vet Emerg Crit Care (San Antonio) 2013; 22:564-72. [PMID: 23110569 DOI: 10.1111/j.1476-4431.2012.00800.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine endogenous production of L-lactate and the clearance of exogenous sodium L-lactate (ExLC) in healthy adult horses. DESIGN A sodium L-lactate solution (1 mmol/kg body weight qs to 500 mL final volume in 0.9% NaCl) was adminstered IV over 15 minutes. Blood samples for L-lactate concentration [LAC] measurement were collected immediately prior to infusion, at 5, 10, and 15 minutes during infusion and at 1 minute intervals for 15 minutes, at 30, 45, 60, 120, and 180 minutes postinfusion. Disposition modeling and pharmacokinetic analysis was performed using proprietary software. SETTING University Teaching Hospital. ANIMALS Six clinically healthy adult horses. MEASUREMENTS AND MAIN RESULTS Median (range) baseline [LAC] was 0.43 (0.20-0.72) mmol/L for samples obtained every 3 hours over the 24 hours prior to ExLC and demonstrated variability primarily associated with horse. Median [LAC] immediately prior to ExLC was 0.43 (0.35-0.52) mmol/L. A 2-compartment model was used to specify the pharmacokinetic parameters. Median (range) ExLC was 1.05 (0.073-1.75) L·h(-1) ·kg(-1) and t(1/2) β was 29.54 (20.8-38.6) min. Median lactate production based on basal [LAC] immediately prior to ExLC was was 0.49 (0.31-0.93) mmol·h(-1) ·kg(-1) . CONCLUSIONS ExLC in healthy adult horses is greater than that of hyperlactemic human patients but similar to normolactemic-sick human patients examined using the same model, supporting development of species, and disease specific ExLC parameters.
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Affiliation(s)
- Pedro De Pedro
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, 1008W. Hazelwood Drive, Urbana, IL 61802, USA
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19
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Henderson ISF. Diagnostic and prognostic use of L-lactate measurement in equine practice. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Compostella F, Roberts VLH, Tremaine WH. Haemoabdomen and colitis following a colon displacement in a 9-year-old Thoroughbred mare. EQUINE VET EDUC 2011. [DOI: 10.1111/j.2042-3292.2011.00339.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Tam K, Rezende M, Boscan P. Correlation between jugular and central venous pressures in laterally recumbent horses. Vet Anaesth Analg 2011; 38:580-3. [DOI: 10.1111/j.1467-2995.2011.00667.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Norton J, Nolen-Walston R, Underwood C, Boston R, Slack J, Dallap B. Repeatability, Reproducibility, and Effect of Head Position on Central Venous Pressure Measurement in Standing Adult Horses. J Vet Intern Med 2011; 25:575-8. [DOI: 10.1111/j.1939-1676.2011.0701.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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23
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Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care 2011; 1:1. [PMID: 21906322 PMCID: PMC3159904 DOI: 10.1186/2110-5820-1-1] [Citation(s) in RCA: 368] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/21/2011] [Indexed: 02/08/2023] Open
Abstract
The clinical determination of the intravascular volume can be extremely difficult in critically ill and injured patients as well as those undergoing major surgery. This is problematic because fluid loading is considered the first step in the resuscitation of hemodynamically unstable patients. Yet, multiple studies have demonstrated that only approximately 50% of hemodynamically unstable patients in the intensive care unit and operating room respond to a fluid challenge. Whereas under-resuscitation results in inadequate organ perfusion, accumulating data suggest that over-resuscitation increases the morbidity and mortality of critically ill patients. Cardiac filling pressures, including the central venous pressure and pulmonary artery occlusion pressure, have been traditionally used to guide fluid management. However, studies performed during the past 30 years have demonstrated that cardiac filling pressures are unable to predict fluid responsiveness. During the past decade, a number of dynamic tests of volume responsiveness have been reported. These tests dynamically monitor the change in stroke volume after a maneuver that increases or decreases venous return (preload) and challenges the patients' Frank-Starling curve. These dynamic tests use the change in stroke volume during mechanical ventilation or after a passive leg raising maneuver to assess fluid responsiveness. The stroke volume is measured continuously and in real-time by minimally invasive or noninvasive technologies, including Doppler methods, pulse contour analysis, and bioreactance.
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Affiliation(s)
- Paul E Marik
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
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24
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Norton JL, Nolen-Walston RD, Underwood C, Slack J, Boston R, Dallap BL. Comparison of water manometry to 2 commercial electronic pressure monitors for central venous pressure measurement in horses. J Vet Intern Med 2011; 25:303-6. [PMID: 21281354 DOI: 10.1111/j.1939-1676.2010.0670.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Central venous pressure (CVP) customarily has been measured in veterinary patients with water manometry. However, many institutions are now using stallside electronic monitors in both anesthesia and intensive care units for many aspects of patient monitoring. HYPOTHESIS Electronic stall side monitoring devices will agree with water manometry for measurement of CVP in horses. ANIMALS Ten healthy adult horses from the university research herd. METHODS Central venous catheters were placed routinely, and measurements were obtained in triplicate with each of the 3 methods every 12 hours for 3 days. Data were analyzed by a Lin concordance correlation coefficient and modified Bland-Altman limits of agreement, with all devices compared pairwise. RESULTS Compared with water manometry, agreement (bias) of the Passport was -1.94 cmH₂O (95% limits of agreement, -8.54 to 4.66 cmH₂O) and of the Medtronic was -1.83 cmH₂O (95% limits of agreement, -8.60 to 4.94 cmH₂O). When compared with the Passport, agreement of the data obtained with the Medtronic was 0.27 cmH₂O (95% limits of agreement, -4.39 to 4.93 cmH₂O). CONCLUSIONS AND CLINICAL IMPORTANCE These data show that both electronic monitors systematically provide measurements that are approximately 2 cmH₂O lower than water manometry, but differences between the 2 electronic devices are small enough (< 0.5 cmH₂O) to be considered clinically unimportant. This discrepancy should be taken into account when interpreting data obtained with these monitoring devices.
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Affiliation(s)
- J L Norton
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA
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25
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Nolen-Walston RD, Norton JL, Navas de Solis C, Underwood C, Boston R, Slack J, Dallap BL. The effects of hypohydration on central venous pressure and splenic volume in adult horses. J Vet Intern Med 2010; 25:570-4. [PMID: 21092009 DOI: 10.1111/j.1939-1676.2010.0641.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Central venous pressure (CVP) is used in many species to monitor right-sided intravascular volume status, especially in critical care medicine. HYPOTHESIS That hypohydration in adult horses is associated with a proportional reduction in CVP. ANIMALS Ten healthy adult horses from the university teaching herd. METHODS In this experimental study, horses underwent central venous catheter placement and CVP readings were obtained by water manometry. The horses were then deprived of water and administered furosemide (1 mg/kg IV q6h) for up to 36 hours. Weight, CVP, vital signs, PCV, total protein (TP), and serum lactate were monitored at baseline and every 6 hours until a target of 5% decrease in body weight loss was achieved. The spleen volume was estimated sonographically at baseline and peak volume depletion. Linear regression analysis was used to assess the association of CVP and other clinical parameters with degree of body weight loss over time. RESULTS There was a significant association between CVP and decline in body weight (P < .001), with a decrease in CVP of 2.2 cmH(2)O for every percentage point decrease in body weight. Other significant associations between volume depletion and parameters measured included increased TP (P = .007), increased serum lactate concentration (P = .048), and decreased splenic volume (P = .046). There was no significant association between CVP and vital signs or PCV. CONCLUSIONS AND CLINICAL IMPORTANCE These findings suggest that CVP monitoring might be a useful addition to the clinical evaluation of hydration status in adult horses.
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Affiliation(s)
- R D Nolen-Walston
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA 19348, USA.
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26
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Conwell RC, Hillyer MH, Mair TS, Pirie RS, Clegg PD. Haemoperitoneum in horses: a retrospective review of 54 cases. Vet Rec 2010; 167:514-8. [DOI: 10.1136/vr.c4569] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- R. C. Conwell
- EquiMed Referrals; 75 York Road Tadcaster North Yorkshire LS24 8AR
| | - M. H. Hillyer
- Newmarket Equine Hospital; Cambridge Road Newmarket Suffolk CB8 OFG
| | - T. S. Mair
- Bell Equine Veterinary Clinic; Butchers Lane, Mereworth Maidstone ME18 5GS
| | - R. S. Pirie
- Faculty of Veterinary Medicine; Royal (Dick) School of Veterinary Studies; Easter Bush Veterinary Centre, Easter Bush; Midlothian EH25 9RG
| | - P. D. Clegg
- Division of Equine Studies; University of Liverpool Veterinary Teaching Hospital, Leahurst; Neston Cheshire CH64 7TE
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27
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Wilsterman S, Hackett ES, Rao S, Hackett TB. A technique for central venous pressure measurement in normal horses. J Vet Emerg Crit Care (San Antonio) 2009; 19:241-6. [DOI: 10.1111/j.1476-4431.2009.00420.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 2008; 134:172-8. [PMID: 18628220 DOI: 10.1378/chest.07-2331] [Citation(s) in RCA: 879] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Central venous pressure (CVP) is used almost universally to guide fluid therapy in hospitalized patients. Both historical and recent data suggest that this approach may be flawed. OBJECTIVE A systematic review of the literature to determine the following: (1) the relationship between CVP and blood volume, (2) the ability of CVP to predict fluid responsiveness, and (3) the ability of the change in CVP (DeltaCVP) to predict fluid responsiveness. DATA SOURCES MEDLINE, Embase, Cochrane Register of Controlled Trials, and citation review of relevant primary and review articles. STUDY SELECTION Reported clinical trials that evaluated either the relationship between CVP and blood volume or reported the associated between CVP/DeltaCVP and the change in stroke volume/cardiac index following a fluid challenge. From 213 articles screened, 24 studies met our inclusion criteria and were included for data extraction. The studies included human adult subjects, healthy control subjects, and ICU and operating room patients. DATA EXTRACTION Data were abstracted on study design, study size, study setting, patient population, correlation coefficient between CVP and blood volume, correlation coefficient (or receive operator characteristic [ROC]) between CVP/DeltaCVP and change in stroke index/cardiac index, percentage of patients who responded to a fluid challenge, and baseline CVP of the fluid responders and nonresponders. Metaanalytic techniques were used to pool data. DATA SYNTHESIS The 24 studies included 803 patients; 5 studies compared CVP with measured circulating blood volume, while 19 studies determined the relationship between CVP/DeltaCVP and change in cardiac performance following a fluid challenge. The pooled correlation coefficient between CVP and measured blood volume was 0.16 (95% confidence interval [CI], 0.03 to 0.28). Overall, 56+/-16% of the patients included in this review responded to a fluid challenge. The pooled correlation coefficient between baseline CVP and change in stroke index/cardiac index was 0.18 (95% CI, 0.08 to 0.28). The pooled area under the ROC curve was 0.56 (95% CI, 0.51 to 0.61). The pooled correlation between DeltaCVP and change in stroke index/cardiac index was 0.11 (95% CI, 0.015 to 0.21). Baseline CVP was 8.7+/-2.32 mm Hg [mean+/-SD] in the responders as compared to 9.7+/-2.2 mm Hg in nonresponders (not significant). CONCLUSIONS This systematic review demonstrated a very poor relationship between CVP and blood volume as well as the inability of CVP/DeltaCVP to predict the hemodynamic response to a fluid challenge. CVP should not be used to make clinical decisions regarding fluid management.
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Affiliation(s)
- Paul E Marik
- Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, 834 Walnut St, Suite 650, Philadelphia, PA 19107, USA.
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29
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Hurcombe SD, Mudge MC, Hinchcliff KW. Clinical and clinicopathologic variables in adult horses receiving blood transfusions: 31 cases (1999–2005). J Am Vet Med Assoc 2007; 231:267-74. [PMID: 17630896 DOI: 10.2460/javma.231.2.267] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine clinical and clinicopathologic abnormalities in horses administered a blood transfusion and evaluate effects of blood transfusion on these variables. DESIGN Retrospective case series. ANIMALS 31 adult horses that received > or = 1 blood transfusion. Procedures-Medical records of horses receiving a blood transfusion were reviewed to obtain clinical findings, laboratory test results before and after transfusion, adjunctive treatments, transfusion type and volume, response to transfusion, results of donor-recipient compatibility testing, adverse reactions, and outcome. RESULTS 31 horses received 44 transfusions for hemorrhagic anemia (HG; n = 18 horses), hemolytic anemia (HL; 8), or anemia attributable to erythropoietic failure (EF; 5). Tachycardia and tachypnea were detected in 31 of 31 (100%) and 22 of 31 (71%) horses, respectively, before transfusion. The PCV and hemoglobin concentration were less than the reference range in 11 of 18 horses with HG, 8 of 8 horses with HL, and 5 of 5 horses with EF. Hyperlactatemia was detected in 16 of 17 recorded values before transfusion. Heart rate, respiratory rate, and PCV improved after transfusion, with differences among the types of anemia. Seventeen (54%) horses were discharged, 9 (29%) were euthanized, and 5 (16%) died of natural causes. Adverse reactions were evident during 7 of 44 (16%) transfusions, varying from urticarial reactions to anaphylactic shock. CONCLUSIONS AND CLINICAL RELEVANCE Abnormalities in clinical and clinicopathologic variables differed depending on the type of anemia. Colic, cold extremities, signs of depression, lethargy, tachycardia, tachypnea, low PCV, low hemoglobin concentration, and hyperlactatemia were commonly detected before transfusion and resolved after transfusion.
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Affiliation(s)
- Samuel D Hurcombe
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA
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