Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation‐volvulus: 84 dogs (2003–2007)

Objective – To test whether an initial plasma lactate≥6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation‐volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival. Design – Retrospective study over a 5‐year period (2003–2007). Setting – Urban private referral small animal teaching hospital. Animals – Eighty‐four client‐owned dogs with a diagnosis of GDV and plasma lactate measurements. Interventions – None. Measurements and Main Results – There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate≥6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and <4.1 mmol/L for predicting survival to discharge. Forty dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by≥50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by≥50% from the initial blood lactate. Conclusion – The results of this study indicate that an initial presenting plasma lactate concentration≥6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations≥50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome.     

Effects of isovolemic resuscitation with hemoglobin-based oxygen carrier Hemoglobin glutamer-200 (bovine) on systemic and mesenteric perfusion and oxygenation in a canine model of hemorrhagic shock: a comparison with 6% hetastarch solution and shed blood

OBJECTIVE: To study Hemoglobin glutamer-200 bovine (Hb-200), 6% hetastarch (HES) and shed whole blood (WB) resuscitation in canine hemorrhagic shock. STUDY DESIGN: Prospective laboratory investigation. Animals Twelve adult dogs [29 +/- 1 kg (mean +/- SD)]. METHODS: Anesthetized dogs were instrumented for recording systemic and mesenteric hemodynamic parameters and withdrawal of arterial, mixed and mesenteric venous blood, in which hematological, oxygenation, blood gas and acid-bases variables were determined. Recordings were made before [baseline (BL)], after 1 hour of hypovolemia and immediately and 3 hours post-resuscitation with 30 mL kg(-1) of either Hb-200, HES, or WB. RESULTS: Blood withdrawal (average 34 +/- 2 mL kg(-1)) caused significant hemodynamic changes, metabolic acidosis and hyperlactatemia characteristic for hemorrhagic shock. Only WB transfusion restored all variables. Hemoglobin glutamer-200 bovine infusion returned most hemodynamic parameters including cardiac output and mesenteric arterial blood flow to BL but increased mean arterial pressure above BL (p < 0.05). However, Hb-200 failed to restore total Hb and arterial oxygen content (CaO2), leaving systemic (DO2I) and mesenteric O2 delivery (DO2Im) below BL (p < 0.05). Nevertheless, acid-base variables recovered completely after Hb-200 resuscitation, and met-hemoglobin (Met-Hb) levels increased (p < 0.05). Hetastarch resuscitation returned hemodynamic variables to or above BL but further decreased total Hb and CaO2, preventing recovery of sDO2I and mDO2I (p < 0.05). Thus, systemic and mesenteric O2 extraction stayed above BL (p < 0.05) while acid-base variables recovered to BL, although slower than in Hb-200 and WB groups (p < 0.05). CONCLUSIONS AND CLINICAL RELEVANCE: Resuscitation with Hb-200 seemed to resolve metabolic acidosis and lactatemia more rapidly than HES, but not WB; yet it is not superior to HES in improving DO2I and DO2Im. The hyperoncotic property of solutions like Hb-200 that results in rapid volume expansion with more homogenous microvascular perfusion and the ability to facilitate diffusive O2 transfer accelerating metabolic recovery may be the key mechanisms underlying their beneficial effects as resuscitants.     

Hemolysis of Canine Fresh and Stored Blood Associated With Peristaltic Pump Infusion

Hemolysis produced by peristaltic pump infusion of canine whole blood was studied in fresh (3-hours-old) and stored (21-day-old) blood units. Blood was pumped at infusion rates of 50, 100, and 200 ml/hr and compared to gravity flow blood at the same rates. IVAC 530 and 560 (peristaltic) and the Animed Flowset 100 (rotaty) pumps were evaluated.
In the fresh blood group, the IVAC 530 did not produce significant hemolysis at any rate compared togravity infusion. Blood pumped through the IVAC 560 and the Animed Flowset 100 was significantly hemolyzed when compared to blood administered by gravity flow.
Free plasma hemoglobin was higher in stored blood than in fresh blood for all groups. The Animed Flowset 100 demonstrated significant hemolysis at 50 and 100 ml/hr flow rates compared to free-dripped blood, the IVAC 530, and the IVAC 560. All pumps hemolyzed blood more at 100 and 200 ml/hr than at 50 ml/hr.
When fresh blood is transfused, it can be pumped through an IVAC 530 at 50, 100, or 200 ml/hr without significant hemolysis. The IVAC 560 produces an intermediate level of hemolysis. The Animed Flowset 100 is not recommended for pumping whole blood. Blood that has been stored for 21 days appears to have a much higher level of hemolysis than fresh blood at all infusion rates.     

The effect of Hetastarch (670/0.75) in vivo on platelet closure time in the dog

Objective – To evaluate the effect of 6% hydroxyethyl starch (HES) solution in vivo, with an average molecular weight of 670 kDa and degree of substitution of 0.75, on canine platelet function.
Design – Prospective, controlled-experimental study.
Setting – University of California, Davis, Veterinary Medical Teaching Hospital.
Animals – Seven healthy employee-owned dogs.
Interventions – Seven dogs were included in the treatment group. Four of these dogs also served as the control group. Platelet closure time (CT) was measured using a platelet function analyzer and collagen/ADP cartridges. Dogs were given 20 mL/kg of either sodium chloride 0.9% (control group, n =4) or HES (treatment group, n =7) IV over 1 hour. CT was measured before the infusion, and at 1, 3, 5, and 24 hours after the start of the infusion.
Measurements and Main Results – There was a significant change over time from 0 to 24 hours ( P <0.001), a significant difference between groups across time ( P <0.001), and a significant group-by-time interaction ( P =0.007). At 3 hours, mean CT for the treatment group was 122.3±18.1 seconds, which was significantly different ( P <0.001) from the control group (71.0±3.5 s). At 5 hours, mean CT for the treatment group was 142.7±33.9 seconds, which was significantly different ( P =0.001) from the control group (75.0±8.6 s). Mean CT at 24 hours was within the reference interval for both the control and treatment group (66.0±2.9 and 81.8±11.9 s, respectively); however, CT in 3 individual dogs in the treatment group at this time point remained prolonged.
Conclusions – A clinically relevant dose of HES 670/0.75 prolongs CT in dogs for up to 24 hours. This may be due to platelet dysfunction in addition to the effects of hemodilution, and therefore, may increase the risk of bleeding.     

Comparison of fluid types for resuscitation after acute blood loss in mallard ducks (Anas platyrhynchos)

Objective – The purpose of this study was to determine the LD₅₀ for acute blood loss in mallard ducks ( Anas platyrhynchos ), compare the mortality rate among 3 fluid resuscitation groups, and determine the time required for a regenerative RBC response.
Design – Prospective study.
Setting – Medical College of Wisconsin Research facility.
Animals – Eighteen mallard ducks were included for the LD₅₀ study and 28 for the fluid resuscitation study.
Interventions – Phlebotomy was performed during both the LD₅₀ and fluid resuscitation studies. Ducks in the fluid resuscitation study received a 5 mL/kg intravenous bolus of crystalloids, hetastarch (HES), or a hemoglobin-based oxygen-carrying solution (HBOCS).
Measurements and Main Results – The LD₅₀ for acute blood loss was 60% of total blood volume. This blood volume was removed in the fluid resuscitation study to create a model of acute blood loss. Following fluid administration, 6 birds in the crystalloid group (66%), 4 birds in the HES group (40%), and 2 birds in the HBOCS group (20%) died. No statistical difference in mortality rate was seen among the 3 fluid resuscitation groups. Relative polychromasia evaluated post-phlebotomy demonstrated regeneration starting at 24 hours and continuing through 48 hours.
Conclusions – The LD₅₀ for acute blood loss in mallard ducks was 60% of their total blood volume. Although no statistical difference in mortality rate was appreciated among the 3 fluid resuscitation groups, a trend of decreased mortality rate was observed in the HBOCS group. An early regenerative response was apparent following acute blood loss.     

Evaluation of Pulse Oximetry as a Continuous Monitoring Technique in Critically Ill Dogs in the Small Animal Intensive Care Unit

To assess the clinical applicability of pulse oximetry in the intensive care setting, a comparison was made of arterial hemoglobin saturation values determined by in vitro oximetry (SaO₂) and pulse oximetry (SpO₂) in 21 critically ill dogs. Single SaO₂ measurements were compared to simultaneously obtained SpO₂ readings. The correlation between these two methods was statistically significant (r = 0.8944, p = 0.0001). In addition, heart rates read by the pulse oximeter were compared to simultaneously obtained electrocardiograms (ECG). The correlation between these two methods was statistically significant (r = 0.9966, p = 0.0001). The pulse oximeter was easy to use, and recorded trends in oxygenation virtually instantaneously. Pulse oximetry appears to be an accurate and practical technique for the continuous non-invasive monitoring of oxygenation in critically ill dogs in the intensive care unit.