Quantitative response of volumetric variables measured by a new ultrasound dilution method in a juvenile model of hemorrhagic shock and resuscitation

• Published in: Resuscitation 2012-08, Vol.83 (8), p.1031-1037
• Main Authors: Vigani, Alessio, Shih, Andre, Queiroz, Patricia, Pariaut, Romain, Gabrielli, Andrea, Thuramalla, Naveen, Bandt, Carsten
• Format: Article
• Language: English
• Subjects: Animals; Arterial Pressure; Blood Volume - drug effects; Blood Volume - physiology; Disease Models, Animal; Emergency; Fluid responsiveness; Fluid Therapy - methods; Hemodynamics; Hemorrhagic shock; Horses; Norepinephrine - pharmacology; Preload; Resuscitation - methods; Shock, Hemorrhagic - physiopathology; Shock, Hemorrhagic - therapy; Ultrasonography; Ultrasound dilution
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2012.01.014

Abstract Objective New volumetric variables of preload, such as total end-diastolic volume index (TEDVI) and active circulation volume index (ACVI) and central blood volume index (CBVI), may represent good indicators of preload and predictors of fluid responsiveness. During acute changes of intravascular volume these variables would allow a more accurate intervention. Aim The aim of the present study was to investigate the changes in TEDVI, ACVI, CBVI in a juvenile model of hemorrhagic shock and resuscitation. Methods Twelve anaesthetized ponies (3–8 months of age) were studied at normovolaemia (BASE), after blood withdrawal to mean arterial pressure (MAP) of 40 mmHg (HEMO), after infusion of norepinephrine to reach a MAP of ±10% of baseline (HE-NE), and after retransfusion of shed blood (RESU). TEDVI, ACVI, CBVI were measured by Ultrasound Dilution (UD) technology with CoStatus device. Data were analyzed using 1-way (ANOVA) followed by Bonferroni's multiple pairwise comparisons. Evaluation of dependence between CoStatus volumetric variables and stroke volume index (SVI) were performed using the linear regression analysis and calculating the r2 coefficient of determination. Results TEDVI and ACVI changed significantly during HEMO and RESU status. NE administration induced MAP and CVP significant changes, whereas TEDVI and ACVI remained unchanged. CBVI showed high variability and seemed to be inconsistent on the identification of the volume status. In the correlation analysis, only TEDVI consistently correlated with SVI and volume induced SVI changes. Conclusions In this animal model, TEDVI and ACVI were superior to CBVI in consistently reflecting hemorrhage. TEDVI but not ACVI and CBVI correlated with volume-induced changes in SVI. NE administration did not affect this correlation.