Prediction of Fluid Responsiveness Based on the External Jugular Vein Distensibility Index After Changes in Volume Status in Healthy, Anesthetized, and Mechanically Ventilated Dogs.

Daeyun Seo, Seongsoo Lim, Beomkwan Namgoong, Heesung Uhm, Hyeajeong Hong, Nanju Lee, Isong Kim, Seunghun Heo, Ji Hwan Kang, Cheyoun Kim, Hayoung Shin, Jiwoong Her, Min-Su Kim
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Abstract

Objective: To investigate whether point-of-care ultrasound of the external jugular vein (EJV) can predict fluid responsiveness (FR) in healthy, anesthetized, mechanically ventilated dogs.

Design: Prospective, nonrandomized experimental study.

Setting: University-based small animal research facility.

Animals: Six healthy Beagle dogs.

Interventions: Dogs were investigated at six time points (TPs): baseline (TP1); 20 mL/kg of circulating blood was collected over 10 min (TP2); half of the collected blood was autotransfused for 10 min (TP3); remaining collected blood was autotransfused for 10 min (TP4); 0.9% normal saline (10 mL/kg for 10 min) was administered (TP5); and an additional dose of 0.9% normal saline (10 mL/kg for 10 min) was administered (TP6). Hemodynamic variables, Doppler images of the left ventricular outflow tract (LVOT), and M-mode images of the EJV were obtained at each TP. FR was evaluated during TP3-6. FR was defined as an increase of >15% in the LVOT velocity time integral following fluid challenge, while other results were defined as fluid nonresponsiveness (FNR). The external jugular vein distensibility index (EJVDI) was calculated as follows: [(maximal EJV diameter - minimal EJV diameter)/minimal EJV diameter] × 100%. The maximal EJV diameter was measured during inspiration, and the minimal EJV diameter was measured during expiration. In addition, gray zones indicating the range of diagnostic uncertainty were proposed in various indices for predicting FR.

Measurements and main results: Among the 24 fluid challenges performed between TP3 and TP6, 11 FR and 13 FNR were identified. The area under the receiver operating characteristic curve for the EJVDI in predicting FR was 0.92, with a cut-ff value of 22.7%, and the gray zone was identified as 22.6%-27.3%.

Conclusions: The EJVDI could be used to predict FR in healthy, anesthetized, mechanically ventilated dogs. Further studies are required before point-of-care ultrasound of the EJV can be applied in various clinical settings.

基于颈外静脉扩张指数预测健康、麻醉和机械通气犬容量状态变化后的液体反应
目的:探讨颈外静脉即时超声(EJV)能否预测健康、麻醉、机械通气犬的液体反应性(FR)。设计:前瞻性、非随机实验研究。环境:以大学为基础的小动物研究机构。动物:6只健康的比格犬。干预措施:在六个时间点(TPs)对狗进行调查:基线(TP1);10min内采集循环血20 mL/kg (TP2);一半采集的血液自输10min (TP3);剩余采血自输10min (TP4);给予0.9%生理盐水(10ml /kg,持续10min) (TP5);另外给予0.9%生理盐水(10 mL/kg,持续10分钟)(TP6)。在每个TP处获得血流动力学变量、左心室流出道(LVOT)的多普勒图像和EJV的m型图像。在TP3-6期间评估FR。FR被定义为液体冲击后LVOT速度时间积分增加bbbb15 %,而其他结果被定义为流体无响应性(FNR)。计算颈外静脉扩张指数(EJVDI)为[(最大EJV直径-最小EJV直径)/最小EJV直径]× 100%。吸气时测量最大EJV直径,呼气时测量最小EJV直径。此外,在预测FR的各种指标中,提出了指示诊断不确定性范围的灰色区域。测量和主要结果:在TP3和TP6之间进行的24次流体挑战中,确定了11次FR和13次FNR。EJVDI预测FR的受试者工作特征曲线下面积为0.92,截断值为22.7%,灰色区域为22.6% ~ 27.3%。结论:EJVDI可用于预测健康、麻醉、机械通气犬的FR。在急诊超声应用于各种临床环境之前,还需要进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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