Vicenti Caterina, Romagnoli Noemi, Stabile Marzia, Lambertini Carlotta, Piemontese Claudia, Spaccini Francesca, Foglia Armando, Lacitignola Luca, Crovace Antonio, Staffieri Francesco
Section of Veterinary Clinics and Animal Production, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, 70010 Valenzano, Italy.
Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Via Tolara di Sopra 50, Ozzano Emilia, 40064 Bologna, Italy.
Vet Sci. 2024 Aug 27;11(9):396. doi: 10.3390/vetsci11090396.
The aim of this prospective, randomized clinical trial was to evaluate the use of the pleth variability index (PVi) to guide the rate of intraoperative fluid therapy compared to a traditional fixed-fluid-rate approach in ASA 1-2 dogs undergoing surgery. Twenty-seven dogs met the inclusion criteria and were randomly assigned to the conventional fluid management group (CFM, = 12) or the PVi-guided group (PVi, = 15). The CFM group received a fixed rate of 5 mL kg h of crystalloid solution, while in the PVi group the rate was continuously adjusted based on the PVi: PVi < 14% = 3 mL kg h; 14% ≤ PVi ≥ 20% = 10 mL kg h; and PVi > 20% = 15 mL kg h. Hypotension (MAP < 65 mmHg) in the CFM was treated with a maximum of two fluid boluses (5 mL kg in 10 min) and in the case of no response, dobutamine (1-3 mcg kg min) was administered. In the PVi group, the treatment of hypotension was similar, except when the PVi > 14%, when dobutamine was started directly. Total fluid volume was significantly lower in the PVI group (0.056 ± 0.027 mL kg min) compared to the CFM group (0.132 ± 0.115 mL kg min), and the incidence of hypotension was lower ( = 0.023) in the PVi group (0%) compared to the CFM group (41%). The mean arterial pressure (MAP) was significantly higher in the PVi group during surgery. Dobutamine was never administered in either group. Preliminary data suggest that the PVi may be considered as a potential target to guide fluid therapy in dogs; larger studies are needed, especially in cases of cardiovascular instability.
这项前瞻性随机临床试验的目的是，在接受手术的美国麻醉医师协会（ASA）1-2级犬中，评估使用脉搏波变异指数（PVi）指导术中液体治疗的速率，并与传统的固定液体速率方法进行比较。27只犬符合纳入标准，被随机分配到传统液体管理组（CFM，n = 12）或PVi指导组（PVi，n = 15）。CFM组接受5 mL·kg-1·h-1的晶体溶液固定速率，而PVi组的速率根据PVi进行持续调整：PVi < 14% = 3 mL·kg-1·h-1；14%≤PVi≥20% = 10 mL·kg-1·h-1；PVi > 20% = 15 mL·kg-1·h-1。CFM组的低血压（平均动脉压< 65 mmHg）最多用两次液体冲击治疗（10分钟内5 mL·kg），如果无反应，则给予多巴酚丁胺（1-3 mcg·kg-1·min-1）。在PVi组中，低血压的治疗类似，除非PVi > 14%，此时直接开始使用多巴酚丁胺。与CFM组（0.132±0.115 mL·kg-1·min-1）相比，PVi组的总液体量显著更低（0.056±0.027 mL·kg-1·min-1），且PVi组（0%）的低血压发生率低于CFM组（41%）（P = 0.023）。手术期间PVi组的平均动脉压（MAP）显著更高。两组均未使用过多巴酚丁胺。初步数据表明，PVi可被视为指导犬液体治疗的潜在指标；需要开展更大规模的研究，尤其是在心血管不稳定的情况下。
