Dynamic prediction of fluid responsiveness during positive pressure ventilation: a review of the physiology underlying heart–lung interactions and a critical interpretation |
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| Institution: | 1. Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA;2. Flosonics Medical, Sudbury, ON, Canada;3. Centre Hospitalier Universitaire Veterinaire, Faculte de Medecine Veterinaire, Universite de Montreal, Saint-Hyacinthe, QC, Canada;4. Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, AB, Canada;1. University of Bristol School of Veterinary Sciences, Langford, Bristol, UK;2. Langford Vets, Langford, Bristol, UK;1. Psychology Department, University of North Georgia, Dahlonega, GA, USA;2. Veterinary Referral Surgical Practice, Roswell, GA, USA;3. Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA;1. School of Veterinary Medicine, Louisiana State University, USA;2. Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland;1. The Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian, UK;2. Department of Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil;3. Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium;1. Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA;2. Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., “Aldo Moro” University of Bari, Bari, Italy;3. Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation D.E.O.T., “Aldo Moro” University of Bari, Bari, Italy |
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| Abstract: | ObjectiveCardiovascular responses to hypovolemia and hypotension are depressed during general anesthesia. A considerable number of anesthetized and critically ill animals may not benefit hemodynamically from a fluid bolus; therefore, it is important to have measures for accurate prediction of fluid responsiveness. Static measures of preload, such as central venous pressure, do not provide accurate prediction of fluid responsiveness, whereas dynamic measures of cardiovascular function, obtained during positive pressure ventilation, are highly predictive. This review describes key physiological concepts behind heart–lung interactions during positive pressure ventilation, factors that can modify this relationship and provides the basis for a rational interpretation of the information obtained from dynamic measurements, with a focus on pulse pressure variation (PPV).Database usedPubMed. Search items used were: heart–lung interaction, positive pressure ventilation, pulse pressure variation, dynamic index of fluid therapy, goal-directed hemodynamic therapy, dogs, cats, pigs, horses and rabbits.ConclusionsThe veterinary literature suggests that targeting specific PPV thresholds should guide fluid therapy in lieu of conventional assessments. Understanding the physiology of heart–lung interactions during intermittent positive pressure ventilation provides a rational basis for interpreting the literature on dynamic indices of fluid responsiveness, including PPV. Clinical trials are needed to evaluate whether goal-directed fluid therapy based on PPV results in improved outcomes in veterinary patient populations. |
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