Keywords
How to Cite
Abstract
This randomized clinical trial aimed to evaluate different fluid therapy protocols associated with inhalational or total intravenous anesthesia in the cardiorespiratory stability of bitches with sepsis subjected to a surgical procedure to control the infectious focus. Thirty-two bitches diagnosed with pyometra and sepsis and treated at the University Veterinary Hospital between 2018 and 2019 were recruited. After admission, diagnosis, clinical, and laboratory evaluation, patients were randomly distributed into the following groups: propofol 5 (P[5]: preoperative restrictive fluid therapy–5mL/kg/h and intravenous general anesthesia); propofol 10 (P[10]: preoperative liberal fluid therapy–10mL/kg/h and intravenous general anesthesia); and isoflurane 5 (I[5]: preoperative restrictive fluid therapy–5mL/kg/h and inhalational general anesthesia). Lactate on admission (LAC1) and release (LAC2), heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), rectal temperature (RT), oxygen saturation (SpO2 ), and carbon dioxide extraction rate (EtCO2 ) were analyzed at PRE, T10, T20, T30, T40, T50, TEXT, and TDIS. Clearance of 20% of lactate occurred in 18 dogs, with the P[10] group displaying the best performance. There was no statistical difference in vasopressor requirements among the groups. Liberal fluid therapy showed greater cardiovascular stability than restrictive therapy in the perioperative period. Regarding general anesthesia, isoflurane showed greater cardiorespiratory stability than propofol during anesthetic maintenance. In conclusion, although the three proposed protocols are safe and there is no difference in their superiority, some observed changes may be relevant and considered when it is possible to individualize the therapy for the patient.
References
Andrade, M. B., Cole, E. F., Evêncio Neto, J., Silva, A. C. J., Aleixo, G. A. S., & Cunha, A. L. T. (2010). Escala de coma de Glasgow pediátrica modificada para cães. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, 62(1), 47-53. http://dx.doi.org/10.1590/S0102-09352010000100007.
Blutinger, A. L., Zollo, A. M., Weltman, J., & Prittie, J. (2021). Prospective evaluation of plasma lactate parameters for prognosticating dogs with shock. JVECC, 31(3), 351-359. http://dx.doi.org/10.1111/vec.13046. PMid:33709568.
Brown, E. N., Purdon, P. L., Akeju, O., & Solt, K. (2015). Monitoring brain state during general anesthesia and sedation. In M. A. Gropper & R. D. Miller (Eds.), Miller’s anesthesia. Philadelphia: Elsevier.
Conti‐Patara, A., Araújo Caldeira, J., Mattos-Junior, E., Carvalho, H. S., Reinoldes, A., Pedron, B. G., Patara, M., Francisco Talib, M. S., Faustino, M., Oliveira, C. M., & Cortopassi, S. R. (2012). Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal‐directed hemodynamic optimization at admission to ICU and the relation to outcome. JVECC, 22(4), 409-418. http://dx.doi.org/10.1111/j.1476- 4431.2012.00769.x. PMid:22731982.
Davis, H., Jensen, T., Johnson, A., Knowles, P., Meyer, R., Rucinsky, R., & Shafford, H. (2013). AAHA/AAFP fluid therapy guidelines for dogs and cats. Journal of the American Animal Hospital Association, 49(3), 149-159. http://dx.doi.org/10.5326/JAAHA-MS-5868. PMid:23645543.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., Belley-Cote, E., Burry, L., Cecconi, M., Centofanti, J., Coz Yataco, A., De Waele, J., Dellinger, R. P., Doi, K., Du, B., Estenssoro, E., Ferrer, R., Gomersall, C., Hodgson, C., Møller, M. H., Iwashyna, T., Jacob, S., Kleinpell, R., Klompas, M., Koh, Y., Kumar, A., Kwizera, A., Lobo, S., Masur, H., McGloughlin, S., Mehta, S., Mehta, Y., Mer, M., Nunnally, M., Oczkowski, S., Osborn, T., Papathanassoglou, E., Perner, A., Puskarich, M., Roberts, J., Schweickert, W., Seckel, M., Sevransky, J., Sprung, C. L., Welte, T., Zimmerman, J., & Levy, M. (2021). Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 47(11), 1181-1247. http://dx.doi.org/10.1007/s00134-021-06506-y. PMid:34599691.
Fleischmann, C., Scherag, A., Adhikari, N. K. J., Hartog, C. S., Tsaganos, T., Schlattmann, P., Angus, D. C., & Reinhart, K. (2016). Assessment of global incidence and mortality of hospital-treated sepsis: Current estimates and limitations. American Journal of Respiratory and Critical Care Medicine, 193(3), 259-272. http://dx.doi.org/10.1164/ rccm.201504-0781OC. PMid:26414292.
Fossum, T. W. (2014). Cirurgia de pequenos animais (4a ed.). Rio de Janeiro: Elsevier.
Grubb, T., Sager, J., Gaynor, J. S., Montgomery, E., Parker, J. A., Shafford, H., & Tearney, C. (2020). AAHA anesthesia and monitoring guidelines for dogs and cats. Journal of the American Animal Hospital Association, 56(2), 59-82. http://dx.doi.org/10.5326/JAAHA-MS-7055. PMid:32078360.
L’Her, E., Amerand, A., Vettier, A., & Sebert, P. (2006). Effects of mild induced hypothermia during experimental sepsis. Critical Care Medicine, 34(10), 2621-2623. http://dx.doi.org/10.1097/01.CCM.0000240231.76837.DC. PMid:16915110.
Lucas, S. S., Nasr, V. G., Ng, A. J., Joe, C., Bond, M., & DiNardo, J. A. (2016). Pediatric Cardiac Intensive Care Society 2014 consensus statement: Pharmacotherapies in cardiac critical care: sedation, analgesia and muscle relaxant. Pediatric Critical Care Medicine, 17(3, Supl. 1), S3-S15. http://dx.doi.org/10.1097/PCC.0000000000000619. PMid:26945327.
Montealegre, F., & Lyons, B. M. (2021). Fluid therapy in dogs and cats with sepsis. Frontiers in Veterinary Science, 8, 622127. http://dx.doi.org/10.3389/fvets.2021.622127. PMid:33718468.
Nguyen, H. B., Loomba, M., Yang, J. J., Jacobsen, G., Shah, K., Otero, R. M., Suarez, A., Parekh, H., Jaehne, A., & Rivers, E. P. (2010). Early lactate clearance is associated with biomarkers of inflammation, coagulation, apoptosis, organ dysfunction and mortality in severe sepsis and septic shock. Journal of Inflammation, 7(1), 6. http://dx.doi.org/10.1186/1476-9255-7-6. PMid:20181046.
Noel-Morgan, J., & Muir, W. W. (2018). Anesthesia-associated relative hypovolemia: Mechanisms, monitoring, and treatment considerations. Frontiers in Veterinary Science, 5, 53. http://dx.doi.org/10.3389/fvets.2018.00053. PMid:29616230.
Otto, C. M. (2007). Clinical trials in spontaneous disease in dogs: A new paradigm for investigations of sepsis. Journal of Veterinary Emergency and Critical Care, 17(4), 359-367. http://dx.doi.org/10.1111/j.1476-4431.2007.00249.x.
Permpikul, C., Tongyoo, S., Viarasilpa, T., Trainarongsakul, T., Chakorn, T., & Udompanturak, S. (2019). Early use of norepinephrine in septic shock resuscitation (CENSER): A randomized trial. American Journal of Respiratory and Critical Care Medicine, 199(9), 1097-1105. http://dx.doi.org/10.1164/rccm.201806-1034OC. PMid:30704260.
Rhodes, A., Phillips, G., Beale, R., Cecconi, M., Chiche, J. D., De Backer, D., Divatia, J., Du, B., Evans, L., Ferrer, R., Girardis, M., Koulenti, D., Machado, F., Simpson, S. Q., Tan, C. C., Wittebole, X., & Levy, M. (2015). The Surviving Sepsis Campaign bundles and outcome: Results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Medicine, 41(9), 1620-1628. http://dx.doi.org/10.1007/s00134-015- 3906-y. PMid:26109396.
Rumbus, Z., Matics, R., Hegyi, P., Zsiboras, C., Szabo, I., Illes, A., Petervari, E., Balasko, M., Marta, K., Miko, A., Parniczky, A., Tenk, J., Rostas, I., Solymar, M., & Garami, A. (2017). Fever is associated with reduced, hypothermia with increased mortality in septic patients: A meta-analysis of clinical trials. PLoS One, 12(1), e0170152. http://dx.doi.org/10.1371/journal.pone.0170152. PMid:28081244.
Self, W. H., Semler, M. W., Bellomo, R., Brown, S. M., deBoisblanc, B. P., Exline, M. C., Ginde, A. A., Grissom, C. K., Janz, D. R., Jones, A. E., Liu, K. D., Macdonald, S. P. J., Miller, C. D., Park, P. K., Reineck, L. A., Rice, T. W., Steingrub, J. S., Talmor, D., Yealy, D. M., Douglas, I. S., & Shapiro, N. I. (2018). Liberal versus restrictive intravenous fluid therapy for early septic shock: Rationale for a randomized trial. Annals of Emergency Medicine, 72(4), 457-466. http://dx.doi.org/10.1016/j.annemergmed.2018.03.039. PMid:29753517.
Silversides, J. A., Perner, A., & Malbrain, M. L. N. G. (2019). Liberal versus restrictive fluid therapy in critically ill patients. Intensive Care Medicine, 45(10), 1440-1442. http://dx.doi.org/10.1007/s00134-019-05713-y. PMid:31399779.
Silverstein, D. C., Aldrich, J., Haskins, S. C., Drobatz, K. J., & Cowgill, L. D. (2005). Assessment of changes in blood volume in response to resuscitative fluid administration in dogs. Journal of the Veterinary Emergency and Critical Care, 15(3), 185-192. http://dx.doi.org/10.1111/j.1476-4431.2005.00138.x.
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., van der Poll, T., Vincent, J. L., & Angus, D. C. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Journal of the American Medical Association, 315(8), 801- 810. http://dx.doi.org/10.1001/jama.2016.0287. PMid:26903338.
Skouropoulou, D., Lacitignola, L., Di Bella, C., Stabile, M., Acquafredda, C., Brienza, N., Grasso, S., Crovace, A., Iarussi, F., & Staffieri, F. (2021). Intraoperative assessment of fluid responsiveness in normotensive dogs under isoflurane anaesthesia. Veterinary Sciences, 8(2), 26. http://dx.doi.org/10.3390/vetsci8020026. PMid:33670144.
Smorenberg, A., Ince, C., & Groeneveld, A. B. J. (2013). Dose and type of crystalloid fluid therapy in adult hospitalized patients. Perioperative Medicine, 2(1), 17. http://dx.doi.org/10.1186/2047-0525-2-17. PMid:24472418.
van Haren, F. M. P. (2013). The use of hypertonic solutions in sepsis. Trends in Anaesthesia and Critical Care, 3(1), 37-41. http://dx.doi.org/10.1016/j.tacc.2012.10.001.
Vincent, J. L., Moreno, R., Takala, J., Willatts, S., Mendonça, A., Bruining, H., Reinhart, C. K., Suter, P. M., & Thijs, L. G. (1996). The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Medicine, 22(7), 707-710. http://dx.doi.org/10.1007/BF01709751. PMid:8844239.
Yamazaki, M., Stekiel, T. A., Bosnjak, Z. J., Kampine, J. P., & Stekiel, W. J. (1998). Effects of volatile anesthetic agents on in situ vascular smooth muscle transmembrane potential in resistance- and capacitance-regulating blood vessels. Anesthesiology, 88(4), 1085-1095. http://dx.doi.org/10.1097/00000542-199804000-00030. PMid:9579519.
Zollo, A. M., Ayoob, A. L., Prittie, J. E., Jepson, R. D., Lamb, K. E., & Fox, P. R. (2019). Utility of admission lactate concentration, lactate variables, and shock index in outcome assessment in dogs diagnosed with shock. JVECC, 29(5), 505-513. http://dx.doi.org/10.1111/vec.12868. PMid:31290240.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2022 Vírgínia Conceição Tavares Lima, Ana Julia Rodrigues Peixoto, Maria Eduarda dos Santos Lopes Fernandes, Lucinéia Costa Oliveira, Ana Carolina de Souza Campos, Ágatha Ferreira Xavier de Oliveira, Naiara Vidal Stocco, Cristiane Divan Baldani, Felipe Farias Pereira da Câmara Barros, Cássia Maria Molinaro Coelho