Biomarkers of coagulation and inflammation in dogs after randomized administration of 6% Hydroxyethyl Starch 130/0.4 or Hartmann’s Solution

Synthetic colloid fluids containing hydroxyethyl starch (HES) have been associated with impairment of coagulation in dogs. It is unknown if HES causes coagulation impairment in dogs with naturally occurring critical illness. This study used banked plasma samples from a blinded, randomized clinical trial comparing HES and balanced isotonic crystalloid for bolus fluid therapy in 39 critically ill dogs. Blood was collected prior to fluid administration and 6, 12, and 24 h thereafter. Coagulation biomarkers measured at each time point included prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen concentration, and the activities of coagulation factors V, VII, VIII, IX, and X, von Willebrand factor antigen, antithrombin, and protein C. Given the links between coagulation and inflammation, cytokine concentrations were also measured, including interleukins 6, 8, 10, and 18, keratinocyte-derived chemokine, and monocyte chemoattractant protein-1. Data were analyzed with linear mixed effects models. No significant treatment-by-time interactions were found for any biomarker, indicating that the pattern of change over time was not modified by treatment. Examining the main effect of time showed significant changes in several coagulation biomarkers and keratinocyte-derived chemokines. This study could not detect evidence of coagulation impairment with HES

Assessment of agreement between invasive blood pressure measured centrally and peripherally and the influence of different haemodynamic states in anaesthetised horses

Objective To determine the agreement of invasive blood pressure measured in the facial artery, the metatarsal artery and the carotid. Additionally, to evaluate the effects of two haemodynamic conditions on agreement. Study design Prospective, randomized study. Animals Eight horses aged 7 (4 -23) years with a body weight of 493 ± 33 kg. Methods Horses were anaesthetized and positioned in dorsal recumbency. Invasive blood pressure was measured simultaneously via catheters placed in the facial, metatarsal and carotid artery. Cardiovascular function and agreement between arteries was assessed before and during administration of phenylephrine and sodium nitroprusside. These were administered until carotid mean pressure (MAPc) increased or decreased from baseline (65 ± 5 mmHg) to > 90 mmHg or < 50 mmHg, respectively. Data recorded at each sample time included systolic (SAP), mean (MAP) and diastolic (DAP) for carotid (c), facial (f) and metatarsal (m) artery as well as cardiac output (Q̇t) and systemic vascular resistance (SVR). Bland-Altman analysis was used to assess agreement between peripheral and central sites and regression analysis was used to determine influence of Q̇t and SVR. Results The largest difference was observed in SAPc and SAPm with a bias and limits of agreement (LOA) of 2 (-15 to 19) mmHg. The bias (LOA) for MAPc and MAPf was 2 (-4 to 9) mmHg and for MAPc and MAPm was 5 (-4 to 14) mmHg. The best agreement for DAP was seen between DAPc and DAPf with bias (LOA) of 1 (-3 to 5) mmHg. Regression analysis indicated marginal influence on agreement by Q̇t on MAPc and MAPf. Conclusion and clinical relevance The MAP and DAP of the carotid was generally higher compared to the peripheral arteries, which may lead to overzealous treatment of hypotension, albeit maintaining central pressures. Cardiac output and systemic vascular resistance did not largely influence the difference between sites

Electrical impedance tomography to measure lung ventilation distribution in healthy horses and horses with left‐sided cardiac volume overload

Background Left-sided cardiac volume overload (LCVO) can cause fluid accumulation in lung tissue changing the distribution of ventilation, which can be evaluated by electrical impedance tomography (EIT). Objectives To describe and compare EIT variables in horses with naturally occurring compensated and decompensated LCVO and compare them to a healthy cohort. Animals Fourteen adult horses, including university teaching horses and clinical cases (healthy: 8; LCVO: 4 compensated, 2 decompensated). Methods In this prospective cohort study, EIT was used in standing, unsedated horses and analyzed for conventional variables, ventilated right (VAR) and left (VAL) lung area, linear-plane distribution variables (avg-max VΔZLine, VΔZLine), global peak flows, inhomogeneity factor, and estimated tidal volume. Horses with decompensated LCVO were assessed before and after administration of furosemide. Variables for healthy and LCVO-affected horses were compared using a Mann-Whitney test or unpaired t-test and observations from compensated and decompensated horses are reported. Results Compared to the healthy horses, the LCVO cohort had significantly less VAL (mean difference 3.02; 95% confidence interval .77-5.2; P = .02), more VAR (−1.13; −2.18 to −.08; P = .04), smaller avg-max VΔZLLine (2.54; 1.07-4.00; P = .003) and VΔZLLine (median difference 5.40; 1.71-9.09; P = .01). Observation of EIT alterations were reflected by clinical signs in horses with decompensated LCVO and after administration of furosemide. Conclusions and Clinical Importance EIT measurements of ventilation distribution showed less ventilation in the left lung of horses with LCVO and might be useful as an objective assessment of the ventilation effects of cardiogenic pulmonary disease in horses

Thoracic Electrical Impedance Tomography—The 2022 Veterinary Consensus Statement

Electrical impedance tomography (EIT) is a non-invasive real-time non-ionising imaging modality that has many applications. Since the first recorded use in 1978, the technology has become more widely used especially in human adult and neonatal critical care monitoring. Recently, there has been an increase in research on thoracic EIT in veterinary medicine. Real-time imaging of the thorax allows evaluation of ventilation distribution in anesthetised and conscious animals. As the technology becomes recognised in the veterinary community there is a need to standardize approaches to data collection, analysis, interpretation and nomenclature, ensuring comparison and repeatability between researchers and studies. A group of nineteen veterinarians and two biomedical engineers experienced in veterinary EIT were consulted and contributed to the preparation of this statement. The aim of this consensus is to provide an introduction to this imaging modality, to highlight clinical relevance and to include recommendations on how to effectively use thoracic EIT in veterinary species. Based on this, the consensus statement aims to address the need for a streamlined approach to veterinary thoracic EIT and includes: an introduction to the use of EIT in veterinary species, the technical background to creation of the functional images, a consensus from all contributing authors on the practical application and use of the technology, descriptions and interpretation of current available variables including appropriate statistical analysis, nomenclature recommended for consistency and future developments in thoracic EIT. The information provided in this consensus statement may benefit researchers and clinicians working within the field of veterinary thoracic EIT. We endeavor to inform future users of the benefits of this imaging modality and provide opportunities to further explore applications of this technology with regards to perfusion imaging and pathology diagnosis

Skeletal muscle blood flow in anaesthetized horses. Part II: effects of anaesthetics and vasoactive agents

Objective: This review aims at evaluating studies investigating the effects of anaesthesia on skeletal muscle blood flow and associated cardiovascular function in anaesthetized horses and discusses how the results of these studies contribute to our understanding of the pathogenesis and prevention of post-anaesthetic myopathy. Database used: Pubmed & personal files. Conclusion: There is little published information on the effects of anaesthesia on skeletal muscle blood flow in horses. Available reports predominantly refer to halothane and isoflurane. The effects of vasoactive drugs have mainly been studied in halothane-anaesthetized horses. The results of these studies support the importance of cardiac output in the maintenance of adequate arterial blood pressure, perfusion pressure and muscle blood flow. Adequate perfusion pressure appears to be important for overcoming the detrimental effects of high intra-compartmental pressure in dependent muscles and hydrostatic pressure in nondependent muscles

Skeletal muscle blood flow in anaesthetized horses. Part I: measurement techniques

Objective: The objective of this review was to describe the methodology and limitations of techniques that have been used to measure skeletal muscle blood flow in anaesthetized horses. Database used: Pubmed, personal files. Conclusion: Numerous techniques have been used in horses to study skeletal muscle blood flow during anaesthesia and after the administration of vasoactive agents. Of the available techniques, blood flow measurements are limited to either microvascular flow (radioactive xenon, laser Doppler flowmetry) or total blood flow (radioactive microspheres, electromagnetic flowmetry, Doppler ultrasonography). None of the techniques currently available are able to fully assess the distribution of flow throughout the skeletal muscle. Near-infrared spectroscopy has the potential to assess the adequacy of oxygenation within muscles; however, this technique is not without limitations, and more work is required to assess its suitability. Understanding the limitations of these techniques is an important prerequisite to the critical evaluation of the information currently available on the effects of anaesthesia and vasoactive drugs on skeletal muscle blood flow

Agreement of invasive and non-invasive blood pressure measurements in anaesthetised pigs using the Surgivet V9203

The automated oscillometric method is a common method for measuring blood pressure non-invasively and is broadly and confidently used in the veterinary setting. Twenty-one pigs undergoing anesthesia for exploratory laparotomy were enrolled in a study to evaluate the performance of the Surgivet V9203 non-invasive blood pressure (NIBP) monitor. The aim was to compare measurements of arterial blood pressure obtained simultaneously using the Surgivet V9203 oscillometric system and an intra-arterial catheter-transducer system, both at the level of the metatarsus. Invasive blood pressure (IBP) was consistently underestimated by the non-invasive method. Bland-Altman analysis showed poor agreement between the two modalities based on evaluation of mean bias and 95% limits of agreement. The Surgivet V9203 cannot therefore be recommended as a reliable alternative to invasive blood pressure monitoring in anaesthetised pigs. As pulse detection is one of the most important factors affecting NIBP accuracy it is likely that our findings may reflect an anatomical or physiological difference in the species that alters the detection of wall movement by the oscillometric technique and additionally, makes the algorithm used by the Surgivet to determine blood pressure parameters unsuitable for use in pigs

Comparison of invasive versus noninvasive blood pressure measurements before and after hemorrhage in anesthetized greyhounds using the Surgivet V9203

Objective To determine the agreement between blood pressure obtained with a noninvasive technique and direct technique using the Surgivet V9203 at varying blood pressure levels created using a canine hemorrhage model. Design Experimental study. Setting University Teaching Hospital. Animals Twenty-nine greyhounds with an average weight of 30 kg. Approval from the Murdoch University Animal Ethics Committee was obtained (R228609). Methods Arterial blood pressure (BP) was measured noninvasively (NIBP) via a cuff placed over the dorsal metatarsal artery and via a catheter in the contralateral dorsal metatarsal artery (IBP). Retrospectively the blood pressure measurements recorded were divided into various BP categories. A total of 84 paired readings were obtained. The data were further analyzed with respect to heart rate [120/min]. Comparison of the measurements was performed using the Bland–Altman method. Results For all categories, BP measurements were generally lower when recorded using the oscillometric technique [Systolic (Sys) bias 4.20 kPa (31.54 mm Hg), mean bias 0.52 kPa (3.93 mm Hg), and diastolic bias 1.04 kPa (7.83 mm Hg)]. Mean arterial BP had the least bias and greatest precision in the hypotensive group (bias 0.174 kPa (1.3063 mm Hg), precision 0.79 kPa (5.89 mm Hg)), low BP group (bias 0.62 kPa (4.67mm Hg) and precision 0.89 kPa (6.67mm Hg)) and normotensive group [bias 0.76 kPa (5.71 mm Hg) and precision 1.16 kPa (8.73 mmHg)]. Conclusions The results demonstrate that the agreement between NIBP measurements and IBP, are within the limits of agreement recommended by the American College of Veterinary Internal Medicine Hypertension Consensus Panel for all pressures except Sys BP. This suggests that mean and diastolic NIBP using the Surgivet V9203 are a clinically acceptable alternative of IBP in hypovolemic hypotensive dogs