The Edwards Acumen IQ system using peripheral arterial catheter-based waveforms to estimate cardiac output is not accurate as compared to thermodilution in dogs

OBJECTIVE

To assess the agreement between cardiac output (CO) estimated via evaluation of the arterial pressure waveform by a novel monitoring system (Edwards Acumen IQ sensor and HemoSphere Advanced Monitor Platform [HS-IQ]; Edwards LifeSciences) and measured by thermodilution (TD) in anesthetized, normovolemic, and hypovolemic dogs. To assess the agreement between the HS-IQ CO measurements in the radial artery and dorsal metatarsal artery.

ANIMALS

8 purpose-bred Beagles.

METHODS

Dogs were placed under general anesthesia. CO was measured via TD and via the HS-IQ at radial and dorsal metatarsal arterial catheters. CO measurements were obtained at 4 time points including normovolemic and multiple hypovolemic states. Paired measurements of CO were evaluated via the method of Bland and Altman with acceptable limits of agreement (LOA) defined as < 30%.

RESULTS

A total of 24 (dorsal metatarsal) and 21 (radial) paired measurements were collected in 8 dogs. The overall bias (CI) for comparison of TD to radial arterial HS-IQ CO measurements was -0.09 L/min. LOA and proportional LOA were -2.66 to 2.49 L/min and -140.72% to 104.94%. The overall bias (CI) for comparison of TD to dorsal metatarsal arterial HS-IQ CO measurements was -0.26 L/min. LOA and proportional LOA were -2.76 to 2.24 L/min and -135.96% to 93.25%. The overall proportional error for radial arterial was -17.9% and for dorsal metatarsal was -21.4%.

CLINICAL RELEVANCE

CO measurements with the HS-IQ were easy to obtain but did not produce results within a clinically acceptable range for either measurement site, with a very wide LOA. The CO estimations from the HS-IQ are not appropriate for clinical use at this time.

The evolution of some blood parameters in hypovolemia conditions in rabbits

The shock is a general, non-specific pathological process, caused by the sudden action of very brutal pathogens, a situation for which the body has no reserves for qualitative and quantitative compensation-adaptation. The objective of our experiment was to make an evaluation of the changes in some hematological and biochemical parameters of the blood, during some hypovolemic evolutions, in the rabbits. Twenty New Zealand White rabbits we used. An IDEXX ProCyte Dx Hematology Analyzer was applied to perform hematological determinations. An IDEXX VetTest Chemistry Analyzer was used to perform blood biochemistry determinations. The data obtained were statistically analyzed, calculating the Media and Standard Deviation (SD), using the Microsoft Excel application. At the same time, the statistical significance of the differences between the batches was calculated based on the t test (Student) using the Microsoft Excel application. The study revealed a decrease in the number of red blood cells and leukocytes per unit volume of blood (p⟨0.05) in the case of group 2 and an increase in glucose, triglycerides (p⟨0.05). Experimental hypovolemia induced in the conditions of our experiment determined: an obvious posthemorrhagic anemia, a significant leukopenia mainly 6 hours after the production of hypovolemic shock and a significant hyperglycemia, manifested mainly 12 hours after the induction of hypovolemia.

Sudden death due to acute hemoabdomen and hypovolemia from a ruptured splenic hemangiosarcoma in a German shepherd dog

A 12-year-old neutered male German shepherd dog was evaluated after dying suddenly at home. A few hours prior to the unexpected death the dog displayed anorexia and lethargy. Post-mortem examination and histopathology led to a diagnosis of marked hemoabdomen and hypovolemia due to a single ruptured splenic hemangiosarcoma.

Use of a modified passive leg-raising maneuver to predict fluid responsiveness during experimental induction and correction of hypovolemia in healthy isoflurane-anesthetized pigs

OBJECTIVE To evaluate the use of a modified passive leg-raising maneuver (PLRM) to predict fluid responsiveness during experimental induction and correction of hypovolemia in isoflurane-anesthetized pigs. ANIMALS 6 healthy male Landrace pigs. PROCEDURES Pigs were anesthetized with isoflurane, positioned in dorsal recumbency, and instrumented. Following induction of a neuromuscular blockade, pigs were mechanically ventilated throughout 5 sequential experimental stages during which the blood volume was manipulated so that subjects transitioned from normovolemia (baseline) to hypovolemia (blood volume depletion, 20% and 40%), back to normovolemia, and then to hypervolemia. During each stage, hemodynamic variables were measured before and 3 minutes after a PLRM and 1 minute after the pelvic limbs were returned to their original position. The PLRM consisted of raising the pelvic limbs and caudal portion of the abdomen to a 15° angle relative to the horizontal plane. RESULTS Hemodynamic variables did not vary in response to the PLRM when pigs were normovolemic or hypervolemic. When pigs were hypovolemic, the PLRM resulted in a significant increase in cardiac output and decrease in plethysomographic variability index and pulse pressure variation. When the pelvic limbs were returned to their original position, cardiac output and pulse pressure variation rapidly returned to their pre-PLRM values, but the plethysomographic variability index did not. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested a modified PLRM might be useful for identification of hemodynamically unstable animals that are likely to respond to fluid therapy. Further research is necessary to validate the described PLRM for prediction of fluid responsiveness in clinically ill animals.

Effects of controlled hypoxemia or hypovolemia on global and intestinal oxygenation and perfusion in isoflurane anesthetized horses receiving an alpha-2-agonist infusion

BACKGROUND

Aim of this prospective experimental study was to assess effects of systemic hypoxemia and hypovolemia on global and gastrointestinal oxygenation and perfusion in anesthetized horses. Therefore, we anesthetized twelve systemically healthy warmblood horses using either xylazine or dexmedetomidine for premedication and midazolam and ketamine for induction. Anesthesia was maintained using isoflurane in oxygen with either xylazine or dexmedetomidine and horses were ventilated to normocapnia. During part A arterial oxygen saturation (SaO2) was reduced by reducing inspiratory oxygen fraction in steps of 5%. In part B hypovolemia was induced by controlled arterial exsanguination via roller pump (rate: 38 ml/kg/h). Mean arterial blood pressure (MAP), heart rate, pulmonary artery pressure, arterial and central venous blood gases and cardiac output were measured, cardiac index (CI) was calculated. Intestinal microperfusion and oxygenation were measured using laser Doppler flowmetry and white-light spectrophotometry. Surface probes were placed via median laparotomy on the stomach, jejunum and colon.

RESULTS

Part A: Reduction in arterial oxygenation resulted in a sigmoid decrease in central venous oxygen partial pressure. At SaO2 < 80% no further decrease in central venous oxygen partial pressure occurred. Intestinal oxygenation remained unchanged until SaO2 of 80% and then decreased. Heart rate and pulmonary artery pressure increased significantly during hypoxemia. Part B: Progressive reduction in circulating blood volume resulted in a linear decrease in MAP and CI. Intestinal perfusion was preserved until blood loss resulted in MAP and CI lower 51 ± 5 mmHg and 40 ± 3 mL/kg/min, respectively, and then decreased rapidly.

CONCLUSIONS

Under isoflurane, intestinal tissue oxygenation remained at baseline when arterial oxygenation exceeded 80% and intestinal perfusion remained at baseline when MAP exceeded 51 mmHg and CI exceeded 40 mL/kg/min in this group of horses.

TRIAL REGISTRY NUMBER

33.14-42,502-04-14/1547.

Changes in pulse pressure variation and plethysmographic variability index caused by hypotension-inducing hemorrhage followed by volume replacement in isoflurane-anesthetized dogs

OBJECTIVE

To compare changes in pulse pressure variation (PPV) and plethysmographic variability index (PVI) induced by hemorrhage followed by volume replacement (VR) in isoflurane-anesthetized dogs.

ANIMALS

7 healthy adult dogs.

PROCEDURE

Each dog was anesthetized with isoflurane and mechanically ventilated. End-tidal isoflurane concentration was adjusted to maintain mean arterial pressure (MAP) at 60 to 70 mm Hg before hemorrhage. Controlled hemorrhage was initiated and continued until the MAP decreased to 40 to 50 mm Hg, then autologous blood removed during hemorrhage was retransfused during VR. Various physiologic variables including PPV and PVI were recorded immediately before (baseline) and after controlled hemorrhage and immediately after VR.

RESULTS

Mean ± SD PPV and PVI were significantly increased from baseline after hemorrhage (PPV, 20 ± 6%; PVI, 18 ± 4%). After VR, the mean PPV (7 ± 3%) returned to a value similar to baseline, whereas the mean PVI (10 ± 3%) was significantly lower than that at baseline. Cardiac index (CI) and stroke index (SI) were significantly decreased from baseline after hemorrhage (CI, 2.07 ± 0.26 L/min/m(2); SI, 20 ± 3 mL/beat/m(2)) and returned to values similar to baseline after VR (CI, 4.25 ± 0.63 L/min/m(2); SI, 36 ± 6 mL/beat/m(2)). There was a significant positive correlation (r(2) = 0.77) between PPV and PVI after hemorrhage.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that both PPV and PVI may be useful for identification of dogs that respond to VR with increases in SI and CI (ie, dogs in the preload-dependent limb of the Frank-Starling curve).

Hypovolemia induced systolic anterior motion of the mitral valve in two dogs

Systolic anterior (septal) motion of the mitral valve (SAM) is a common secondary phenomenon in hypertrophic cardiomyopathy (HCM) in people and cats. In humans, it is increasingly recognized that SAM may be found in other cardiac and non-cardiac disease states. In small animal cardiology, SAM unassociated with HCM has been described in dogs with mitral valve dysplasia and right ventricular pressure overload. In this report, we describe two cases of dogs where transient SAM was caused by hypovolemia. When SAM was present both dogs showed pseudohypertrophy and tachycardia. Important factors in the genesis of SAM in this scenario are probably hypovolemia induced changes in left ventricular geometry affecting the orientation of the mitral valve apparatus combined with elevated catecholamine levels. SAM associated with increased wall thickness is not pathognomonic of HCM; this observation is of particular clinical importance when extrapolated to species where HCM is highly prevalent, e.g., cats. An echocardiographic diagnosis should always be evaluated together with full clinical assessment of history and physical examination.

Interpreting lactate measurement in critically ill horses: diagnosis, treatment, and prognosis

In hospitalized horses, hypovolemia and the resulting decrease in tissue perfusion is the most common cause of hyperlactatemia. Therefore, measurement of blood lactate concentration can be a useful tool for guiding fluid therapy. Similarly, measuring blood lactate concentration can be used to assess the need for and adequacy of transfusions in horses receiving whole blood. Inflammatory leukocytes within closed body cavities consume glucose and produce lactate. Simultaneous measurement of blood lactate concentration and lactate concentration of peritoneal, pleural, or synovial fluid has been used to help differentiate septic from nonseptic effusions. A fluid lactate concentration higher than the blood lactate concentration provides evidence for a bacterial cause of the effusion. In horses evaluated for colic, a peritoneal lactate concentration higher than the simultaneously measured blood lactate concentration is indicative of intestinal strangulation and ischemia. Veterinary studies have suggested that serial blood lactate measurements might be a more useful prognostic indicator than a single lactate measurement. In hospitalized adult horses and foals, blood lactate concentration is higher at all time points in nonsurvivors compared with survivors, although the differences tend to be subtle. Measuring the rate at which lactate concentrations return to normal might also prove useful in equine medicine, but this requires further investigation.

Canine tactical field care. Part two--Massive hemorrhage control and physiologic stabilization of the volume depleted, shock-affected, or heatstroke-affected canine

Military and law enforcement agencies have seen a dramatic increase in the utilization of military working dogs (MWDs) and working canine officers, respectively both at home and in foreign deployments. Due to the fact that professional veterinary care is often distant from internal disaster or foreign deployment sites, the military medic, police tactical medic, or other first-response medical care providers may be charged with providing emergency or even basic, non-emergency veterinary care to working canines. The medical principles involved in treating canines are essentially the same as those for treating humans; however, the human healthcare provider needs basic information on canine anatomy and physiology, and common emergency conditions, in order to provide good basic veterinary care until a higher level of veterinary care can be obtained. This article represents the second in a series designed to provide condensed, basic veterinary information on the medical care of working canines, including police canines, federal agency employed working canines, and search-and-rescue dogs, in addition to the MWD, to those who are normally charged with tactical or first responder medical care of human patients. This article focuses on diagnosing and treating some of the more common high-mortality conditions affecting canines in the field including massive hemorrhage, volume-depletion, shock, and heatstroke.

Validity of indicators of dehydration in working horses: a longitudinal study of changes in skin tent duration, mucous membrane dryness and drinking behaviour

REASONS FOR PERFORMING STUDY

Dehydration is a serious welfare concern in horses working in developing countries. Identification of a valid and practical indicator of dehydration would enable more rapid treatment and prevention.

OBJECTIVES

To examine changes in bodyweight, clinical and blood parameters during rehydration of working horses, identify a 'gold standard' criterion for dehydration and use this to validate a standardised skin tent test, drinking behaviour and mucous membrane dryness as potential field indicators.

METHODS

Fifty horses with a positive skin tent test, working in environmental temperatures of 30-44 degrees C in Pakistan, were rested and offered water to drink ad libitum. Bodyweight, clinical and blood parameters, mucous membrane dryness, drinking behaviour and skin tent duration at 6 anatomical locations were measured at 0, 30, 60, 120, 180, 240 and 300 min.

RESULTS

Skin tent duration was affected by side of animal (P = 0.008), anatomical location and coat moisture (both P < 0.001). Younger animals had shorter skin tents at all time points (P = 0.007). There was no significant association between plasma osmolality (P(osm)) or water intake and skin tent duration. Horses with a higher P(osm) drank significantly more water (P < 0.001), and had longer (P < 0.001) and more frequent (P = 0.001) drinking bouts. Neither P(osm) nor water intake affected qualitative and semi-quantitative measurements of mucous membrane dryness significantly.

CONCLUSIONS AND POTENTIAL RELEVANCE

The standardised skin tent test and measures of mucous membrane dryness investigated in this study were not valid or repeatable indicators of dehydration when compared with P(osm) as a 'gold standard' criterion. The volume of water consumed and the number and duration of drinking bouts were the most reliable guide to hydration status currently available for mature working horses. Offering palatable water to drink ad libitum provides both the diagnosis and the remedy for dehydration in working horses.

Comparison of peripheral and core temperatures in anaesthetized hypovolaemic sheep

OBJECTIVE

To compare rectal (C(R) degrees ), coronary band (P(CB) degrees ) and ear base (P(E) degrees ) temperatures with pulmonary arterial temperature (C(PA) degrees ), and to investigate the relationship between core-peripheral temperature difference ([C - P]t degrees ) and cardiac output (Qt) in an acute ovine trauma model (PIL 60/9064).

STUDY DESIGN

Observational study.

ANIMALS

Thirteen mixed-breed male sheep, body mass (mean +/- SD) 45.50 +/- 4.21 kg, aged approximately 1 year.

MATERIALS AND METHODS

Anaesthesia was induced with intravenous etomidate 0.5 mg kg(-1) and midazolam 0.5 mg kg(-1) and following endotracheal intubation maintained with halothane in a 2:1 N(2)O:O(2) mixture. The lungs were mechanically ventilated to maintain normocapnia. Core temperature was measured using a pulmonary arterial thermistor. Rectal temperature and peripheral temperatures at the thoracic limb coronary band and ear base were recorded using thermistor probes with a multi-channel recorder. Cardiac output was measured by continuous thermodilution. Recordings were taken hourly over a 24-hour period. After baseline data collection, hypovolaemia was induced by haemorrhage from bilateral femoral fractures. The development of hypovolaemic shock was confirmed by falling Qt, central venous pressure, mean arterial pressure and urine output. Resuscitation was attempted using intravenous fluids, inotropes and vasoconstrictors. Nine sheep received lumbosacral extradural bupivacaine.

RESULTS

The rectal temperature correlated closely with pulmonary arterial temperature in all sheep (r(c) = 0.924). There was no consistent statistically significant relationship between Qt and [C - P]t degrees .

CONCLUSIONS AND CLINICAL RELEVANCE

Rectal temperature accurately reflected core temperature in anaesthetized sheep but [C - P]t degrees was unrelated to Qt, under the conditions described in this study.

Changes in central venous pressure and blood lactate concentration in response to acute blood loss in horses

OBJECTIVE

To evaluate selected hemodynamic, blood gas, and biochemical responses to mild to moderate acute blood loss in standing, awake horses.

DESIGN

Prospective study.

ANIMALS

7 healthy mares.

PROCEDURES

Each horse was restrained in standing stocks, and its head was maintained in a neutral position; sedatives and tranquilizers were not administered. During a 1-hour period, blood was collected into collection bags by use of a suction pump. The rate of blood collection was approximately 16 mL/kg/h (7.3 mL/lb/h). Thirty minutes after blood collection, the blood was readministered at the same rate. Central venous pressure (CVP), central venous blood gas, blood lactate concentration, and heart rate were measured at baseline (after placement of catheters), after removal of blood, and after readministration of blood.

RESULTS

In response to blood loss, CVP decreased and blood lactate concentration increased significantly, compared with baseline values; heart rate and results of central venous blood gas analysis did not change significantly. After readministration of blood, CVP returned to baseline value and blood lactate concentration approached baseline value.

CONCLUSIONS AND CLINICAL RELEVANCE

Changes in CVP and blood lactate concentration appear to be early indicators of hypovolemia in horses, which may represent acute blood loss in trauma patients; these variables should be monitored to assess the potential need for blood transfusions. These variables can be used to monitor responses of horses to blood transfusions when whole blood is administered as the replacement fluid.

Validity of a behavioural measure of heat stress and a skin tent test for dehydration in working horses and donkeys

REASONS FOR PERFORMING STUDY

Dehydration and heat stress are serious welfare issues for equids working in developing countries. There is a lack of any standardised method or validated interpretation of the skin tent test in horses and donkeys. Owners of dehydrated and heat-stressed animals often depend on veterinary examination for identification of these conditions, leading to delays in treatment and unnecessary reliance on external sources to effect welfare improvement.

OBJECTIVES

To validate a standardised skin tent test for dehydration and a behavioural measure of heat stress in working equids; and to examine the effect of heat stress and dehydration on tripping and staggering behaviour.

METHODS

The study was carried out on 130 working horses and donkeys in Pakistan. Associations between skin tent and blood parameters (packed cell volume [PCV], serum total protein [TP], serum osmolality), clinical parameters, resting and drinking behaviour were examined. Heat stress behaviour (increased respiratory rate and depth, head nodding, flared nostrils, apathy) was observed in conjunction with rectal temperature. Tripping and staggering were assessed using a simple obstacle course.

RESULTS

In both species, heat stress behaviour was significantly associated with increased rectal temperature (P<0.001). A positive skin tent test was not significantly associated with PCV or TP, although in donkeys it was significantly associated with lower serum osmolality (P<0.001). More animals age >15 years had a positive skin tent than those in younger age groups (P = 0.037). Very thin horses were more likely to have a positive skin tent than those in thin or moderate condition (P = 0.028). There was no significant correlation between skin tent and tripping or staggering in either species.

CONCLUSIONS AND POTENTIAL RELEVANCE

Heat stress behaviour is related to increased body temperature in working horses and donkeys. Owners may use this to make judgements regarding rest and cooling, precluding the need to seek veterinary attention. The skin tent test for dehydration used in this study did not show a significant relationship with PCV or TP. However, the use of blood parameters to validate the skin tent test may be confounded by anaemia, hypoproteinaemia or electrolyte depletion. Alternative methods are needed to confirm or refute the validity of the skin tent test in working equids.

Impact of dopamine or dobutamine infusions on cardiovascular variables after rapid blood loss and volume replacement during isoflurane-induced anesthesia in dogs

OBJECTIVE

To determine the cardiovascular effects of dopamine and dobutamine infusions during nor-movolemia, hypovolemia (HV) through blood loss of 10 mL/kg (HV(10)), further loss to 25 mL/kg (HV(25)), and volume replacement (VR) in isoflurane-anesthetized dogs.

ANIMALS

7 healthy young dogs.

PROCEDURES

Dogs were anesthetized with isoflurane 2 times (3 weeks apart). Cardiovascular measurements were obtained for each volume state. The cardiac index (CI) determined by the lithium dilution technique was compared with CI assessed by the arterial pulse contour technique. At each volume state, random treatment with dobutamine or dopamine was assessed (CI by the arterial pulse contour technique). Ten-minute treatments with 3 and 6 microg of dobutamine/kg/min or 7 and 14 microg of dopamine/kg/min (low and high doses, respectively) were administered sequentially. Differences from baseline were determined for volume, drug, and dose effects.

RESULTS

Significant proportional changes in blood pressure (BP), stroke index (SI), and CI were evident with changes in volume state. Systemic vascular resistance (SVR) decreased after VR. Dobutamine induced little change in BP; increased heart rate (HR), SI, and CI; and decreased SVR (high dose). Dopamine increased BP and SI, did not change CI, and increased SVR (high dose). The arterial pulse contour technique underestimated changes in CI associated with volume changes.

CONCLUSIONS AND CLINICAL RELEVANCE

Isoflurane eliminates clinically obvious compensatory increases in HR during HV. Dopamine is suitable for temporary management of blood loss in isoflurane-anesthetized dogs. Dobutamine increased CI without an associated improvement in BP. The arterial pulse contour monitor should be recalibrated when volume status changes.

[Behavior of intraocular pressure according to cardiorespiratory and hemodynamic effects induced by desflurane in dogs subjected to experimental hypovolemia]

PURPOSE

To observe the behavior of intraocular pressure according to the cardiopulmonary and hemodynamic effects induced by desflurane in dogs subjected to experimental hypovolemia.

METHODS

Eighteen healthy male and female mongrel dogs, weighing between 10 and 15 kg were used. Hypovolemia was induced by withdrawal of 40 ml blood/kg body weight. Then anesthesia was induced with desflurane by mask until tracheal intubation was permitted. Intraocular pressure was measured with applanation tonometry. Heart rate, cardiac output, mean arterial pressure, central venous pressure, end-tidal concentration of CO2 and respiratory rate were recorded. Parameters were registered after animal instrumentation and before any procedure in the awake dogs (T0), fifteen minutes after experimental hemorrhage induction (T45), and after thirty minutes of desflurane anesthesia (T75).

RESULTS

Intraocular pressure presented direct correlation only with pressure and end-tidal concentration of CO2.

CONCLUSIONS

It was not possible to establish a correlation between alterations of mean arterial pressure and central venous pressure and intraocular pressure and there was a direct relationship between values of intraocular pressure and values of exhaled CO2.

Evaluation of induction by use of a combination of oxymorphone and diazepam or hydromorphone and diazepam and maintenance of anesthesia by use of isoflurane in dogs with experimentally induced hypovolemia

OBJECTIVE

To compare induction with hydromorphone and diazepam (HydroD) or oxymorphone and diazepam (OxyD) followed by maintenance with isoflurane in dogs with induced hypovolemia.

ANIMALS

6 healthy mixed-breed dogs.

PROCEDURE

The study used a crossover design. Measurements were obtained in normovolemic dogs during isoflurane. Hypovolemia was induced (blood loss of 30 mL/kg) and measurements repeated following recovery from anesthesia, after HydroD (hydromorphone, 0.1 mg/kg; diazepam, 0.2 mg/kg; i.v.) or OxyD (oxymorphone, 0.05 mg/kg; diazepam, 0.2 mg/kg; i.v.), after another dose of the same opioid, during administration of isoflurane (end-tidal concentration, 0.9%), and after glycopyrrolate (0.01 mg/kg, i.v.). Significant changes were identified.

RESULTS

Induction effect was evident within 1 minute. All dogs were intubated after the second dose of opioid. No significant differences were found between inductions. The HydroD decreased heart rate (mean +/- SEM, -41 +/- 9.8 beats/min), whereas both inductions increased stroke index (0.4 +/- 0.09 mL/kg/beat) and caused moderate respiratory depression. Cardiac index was decreased (-30.2 +/- 6.04 mL/kg/min) and there was minor metabolic acidosis during isoflurane following HydroD, compared with values for anesthetized normovolemic dogs. Glycopyrrolate increased heart rate (50 +/- 8.6 beats/min) and decreased systolic blood pressure (-23.2 +/- 4.87 mm Hg) in dogs induced with HydroD and decreased stroke index (-0.3 +/- 0.08 mL/kg/beat) for both inductions.

CONCLUSIONS AND CLINICAL RELEVANCE

Similar effects were detected after administration of HydroD or OxyD in hypovolemic dogs. Either combination should be safe for use in hypovolemic dogs. Administration of glycopyrrolate was not beneficial.

Comparison of a small volume of hypertonic saline solution and dextran 40 on hemodynamic alternations in conscious calves

The hemodynamic effects of rapid intravenous (IV) administration of 10% dextran 40 in saline solution (D40) and 7.2% hypertonic saline solution (HSS) in calves were compared. Calves received isotonic saline solution (ISS), HSS or D40 (3 calves/group) and were monitored of blood pressure, and cardiac output (CO) for 180 min. HSS and D40 infusions induced a significant increase in relative plasma volume reaching 134.9+/-2.8 and 125.0+/-1.9%, respectively at the end of fluid infusion. In the HSS group, CO, cardiac index (CI) and stroke volume (SV) remained constant at low levels after 90 minutes despite the maximal values of CO, CI and SV at the end of infusion, reaching 21.0+/-6.3 l/min (p<0.05), 177.8+/-14.2 ml/min/kg (p<0.001) and 0.20+/-0.03 l/beat (at t=10 min, p<0.001), respectively. In contrast, CI and SV in the D40 group showed significant increases to 14.7+/-2.9 l/min and 153.5+/-17.2 ml/min/kg, respectively, at the end of fluid infusion. And those values remained constant at higher levels than those of the before infusions values throughout the experimental periods. Positive effects for hemodynamic alternations of D40 in calf practice were milder and longer than those of HSS. Therefore, the D40 infusion should be explored as a possible treatment for dehydrated calves, since rapid infusion of D40 may be safe and more beneficial for rehydrating more than HSS treatment.

Inadequacy of low-volume resuscitation with hemoglobin-based oxygen carrier hemoglobin glutamer-200 (bovine) in canine hypovolemia

Stroma-free hemoglobin-based oxygen carriers (HBOC) have been developed to overcome problems associated with transfusion of allogeneic blood. We have studied the efficacy of the first licensed veterinary blood substitute, hemoglobin glutamer-200 bovine (Oxyglobin; Biopure, Cambridge, MA, USA, Hb-200), in a canine model of acute hypovolemia and examined whether clinically commonly used criteria are adequate to guide fluid resuscitation with this product. Twelve anesthetized dogs were instrumented for measurements of physiological variables including hemodynamic, oxygenation, and blood gas and acid-base parameters. Dogs were bled to a mean arterial pressure (MAP) of 50 mmHg for 1 h followed by resuscitation with either shed blood (controls) or Hb-200 until heart rate (HR), MAP and central venous pressure (CVP) returned to baseline. Recordings were repeated immediately and 3 h after termination of fluid resuscitation. Hemorrhage (average 32 mL/kg) caused significant decreases in total hemoglobin (Hb), mean pulmonary arterial pressure (PAP), cardiac output (CO) and oxygen delivery (DO2I), increases in HR and systemic vascular resistance (SVRI), and lactic acidosis. In controls, only re-transfusion of all shed blood returned HR, MAP and CVP to prehemorrhage values, whereas in other dogs this endpoint was reached with infusion of 10 mL/kg Hb-200. Unlike blood transfusion, Hb-200 infusion failed to return CI and DO2I to baseline and to increase arterial oxygen content (CaO2) and total Hb; SVRI further increased. Thus, commonly used criteria (HR, MAP, CVP) to guide transfusion therapy in patients posthemorrhage prove insufficient when HBOCs with pronounced vasoconstrictive action are used and lead to inadequate volume repletion.