Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000300007
Brazilian Journal of Anesthesiology
Scientific Article

Variação da pressão sistólica como indicadora precoce de hipovolemia e guia de reposição volêmica com solução hiperosmótica e hiperoncótica no cão

Systolic pressure variation as an earlier hypovolemia indicator and a guide for volume replacement with hypertonic and hyperoncotic solution in dogs

Odilar de Paiva Filho; José Reinaldo Cerqueira Braz; Fredson de Paula e Silva; Tiago Otávio Pedro; Paulo do Nascimento Júnior

http://dx.doi.org/10.1590/S0034-70942003000300007 Braz J Anesthesiol, vol.53, n3, p.361-376, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: Estudos introduziram novo método para avaliação da pré-carga, baseado na análise da variação da pressão sistólica (VPS) durante ventilação artificial. O objetivo desta pesquisa é avaliar se a VPS e sua derivada delta down (ddown) são indicadoras precoces de hipovolemia e guias de reposição volêmica com solução hiperosmótica e hiperoncótica. MÉTODO: Doze cães foram submetidos a sangramentos parciais de 5% da volemia até se atingir 20% da volemia (14 ml.kg-1). Antes (controle) e após cada sangramento foram realizadas análises hemodinâmicas, respiratórias e sangüíneas. Após, os cães foram submetidos à reposição com solução de NaCl a 7,5% em dextran 70 a 3,75% (SHD) (4 ml.kg-1) e novas análises dos atributos estudados foram realizadas aos 5 e 30 minutos após a reposição. RESULTADOS: A pressão arterial média diminuiu durante o sangramento e aumentou após a reposição, sem retornar aos valores do controle. As pressões da artéria pulmonar e do átrio direito (PAD) diminuíram antes e aumentaram após a reposição para valores semelhantes aos do controle. A pressão da artéria pulmonar ocluída (PAPO) diminuiu após o primeiro sangramento e manteve-se em valores abaixo aos do controle, mesmo após a reposição. O índice cardíaco não se alterou, mas aumentou após a reposição, para valores superiores aos do controle. O índice sistólico (IS) diminuiu antes e aumentou após a reposição, em níveis superiores aos do controle. Os índices de resistência vascular sistêmica (IRVS) e pulmonar (IRVP) não se alteraram antes, mas diminuíram após a reposição, com o IRVS em níveis inferiores aos do controle, e o IRVP em níveis semelhantes aos do controle. Os índices de trabalho sistólico dos ventrículos direito (ITSVD) e esquerdo (ITSVE) diminuíram durante o sangramento, mas aumentaram após a reposição, com o ITSVD em níveis superiores aos do controle e o ITSVE em níveis semelhantes aos do controle. A VPS e ddown aumentaram progressivamente durante o sangramento e diminuíram após a reposição, mas mantendo-se em valores superiores aos do controle. As maiores correlações de VPS e ddown foram com IS, PAPO, PAD e ITSVE. CONCLUSÕES: No cão, nas condições empregadas, a VPS e sua derivada ddown são indicadoras precoces de hipovolemia e guias sensíveis de reposição volêmica com SHD.

Palavras-chave

ANIMAL, REPOSIÇÃO VOLÊMICA

Abstract

BACKGROUND AND OBJECTIVES: Studies have introduced a new method for preload evaluation based on systolic pressure variation analysis (SPV) during mechanical ventilation. This research aimed at evaluating whether SPV and its delta down derived (ddown) are earlier hypovolemia indicators and guides for volume replacement with hypertonic and hyperoncotic solutions. METHODS: Twelve dogs were submitted to graded hemorrhage of 5% of their volume until reaching 20% of volume (14 ml.kg-1). Before (control) and after every hemorrhage, hemodynamic, ventilatory and blood parameters were evaluated. Then, dogs were submitted to volume replacement with 7.5% NaCl in 3.75% dextran 70 (SHD) (4 ml.kg-1), and the parameters were again evaluated 5 and 30 minutes after volume replacement. RESULTS: Mean blood pressure decreased during hemorrhage and increased after SHD infusion, however without returning to baseline values. Right atrium (RAP) and pulmonary artery pressure (PAP) decreased before and increased after volume replacement reaching values similar to baseline. Pulmonary capillary wedge pressure (PCWP) decreased after the first hemorrhage and remained below baseline values even after volume replacement. Cardiac index has not changed, but increased after SHD infusion reaching values above baseline. Stroke volume index (SVI) decreased before, and increased after volume replacement reaching values above baseline. Systemic vascular and pulmonary resistance did not change during hemorrhage, but decreased after volume replacement, with SVRI remaining below baseline values and SVPRI in levels similar to baseline. Left ventricular stroke work index (LVSWI) and right ventricular stroke work index (RVSWI) decreased before and increased after SHD infusion, with RVSWI remaining above baseline values and LVSWI in levels similar to baseline. SPV and ddown progressively increased during hemorrhage and decreased after volume replacement, however remaining above baseline values. Major SPV and ddown correlations were found with SVI, PWCP, RAP, PAP and LVSWI. CONCLUSIONS: In dogs under our experimental conditions, SPV and its derived ddown are early hypovolemia indicators and sensitive guides for volume replacement with hypertonic and hyperoncotic solutions.

Keywords

ANIMAL, VOLUME REPLACEMENT

Referencias

Perel A, Pizov R, Cotev S. The systolic pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology. 1987;67:492-502.

Pizov R, Ya’Ari Y, Perel A. Systolic pressure variation is greater during hemorrhage than during sodium nitroprusside induced hypotension in ventilated dogs. Anesth Analg. 1988;67:170-174.

Pizov R, Ya’Ari Y, Perel A. The arterial pressure waveform during acute ventricular failure and synchronized external chest compression. Anesth Analg. 1989;65:150-156.

Pizov R, Segal E, Kaplan L. The use of systolic pressure variation in hemodynamic monitoring during deliberate hypotension in spine surgery. J Clin Anesth. 1990;2:96-100.

Coriat P, Vrillon M, Perel A. A comparison of systolic blood pressure variations and echocardiographic estimates on end diastolic left ventricular size in patients after aortic surgery. Anesth Analg. 1994;78:46-53.

Rooke GA, Schwid HA, Shapira Y. The effect of graded hemorrhage and intravascular volume replacement on systolic pressure variation in humans during mechanical and spontaneous ventilation. Anesth Analg. 1995;80:925-932.

Ornstein E, Eidelman LA, Drenger B. Systolic pressure variation predicts the response to acute blood loss. J Clin Anesth. 1998;10:137-140.

Weiss YG, Oppeinheim-Edden A, Sprung CL. Systolic pressure variation in hemodynamic monitoring after severe blast injury. J Clin Anesth. 1999;11:132-135.

Velasco IT, Pontieri V, Rocha e Silva M. Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol. 1980;239:H664-H673.

Crystal GJ, Gurevicius J, Kim SS. Effects of hypertonic saline solutions in the coronary circulation. Circ Shock. 1994;42:27-38.

Auler Jr JOC, Pereira MHC, Gomide do Amaral RV. Hemodynamic effects of hypertonic sodium chloride during surgical treatment of aortic aneurysms. Surgery. 1987;101:594-601.

Cross JS, Gruber DP, Burchard KW. Hypertonic saline fluid therapy following surgery: a prospective study. J Trauma. 1989;29:817-825.

Boldt J, Kling D, Weidler B. Acute preoperative hemodilution in cardiac surgery: volume replacement with a hypertonic saline - hydroxyethyl starch solution. J Cardiothor Vasc Anesth. 1991;15:23-28.

Järvelä K, Koskinen M, Koukinem S. Effects of hypertonic saline (7.5%) on extracelular fluid volume compared with normal saline (0.9%) and 6% hydroxyethyl starch after aortocoronary bypass graft surgery. J Cardiothor Vasc Anesth. 2001;15:210-215.

Smith GJ, Kramer GC, Perron P. A comparison of several hypertonic solutions for resuscitation of bled sheep. J Surg Res. 1985;35:517-528.

Rocha e Silva M. Hypertonic saline resuscitation: a new concept. Baillière’s Clin Anaesthesiol. 1997;11:127-142.

Velasco IT, Rocha e Silva M, Oliveira MA. Hypertonic and hyperoncotic resuscitation from severe hemorrhagic shock in dogs: a comparative study. Crit Care Med. 1989;17:261-264.

Kramer GC, Walsh JC, Perron PR. Comparison of hypertonic saline dextran versus hypertonic saline hetastarch for resuscitation of hipovolemia. Braz J Med Biol Res. 1989;22:279-282.

Christ AT, Niklas M, Kreimeir V. Hyperosmotic- hyperoncotic solutions during abdominal aortic aneurysm (AAA) resection. Acta Anaesthesiol Scand. 1997;41:62-70.

Kreimeir V, Brückner UB, Wiemczy KS. Hyperosmotic saline dextran for resuscitation from traumatic-hemorrhagic hypotension: effect on regional blood flow. Circ Shock. 1990;32:83-99.

Nolte D, Bayer M, Lehr HA. Attenuation of postischemic microvascular disturbances in striate muscle by hyperosmolar saline dextran. Am J Physiol. 1992;263:H1411-1416.

Haskins SC. Monitoring the Anesthetized Patient. Lumb & Jones Veterinary Anesthesia. 1996:409-424.

The advanced trauma life support: courses for physicians. 1993:75-94.

Rocha e Silva M, Poli de Figueiredo LF. Fisiopatologia do Choque Hipovolêmico. Fisiopatologia Cardiovascular. 2000:155-172.

Hansen RW, Viquerat CE, Mattay MA. Poor correlation between pulmonary arterial wedge pressure and left ventricular and diastolic volume after coronary artery bypass surgery. Anesthesiology. 1986;67:764-770.

Rapper R, Sibbald WJ. Misled by the wedge: The Swan-Ganz catheter and LV preload. Chest. 1986;88:427-434.

Marik PE. The systolic blood pressure variation as an indicator of pulmonary capillary wedge pressure in ventilated patients. Anaesth Intensive Care. 1993;21:405-408.

Coriat P. Detecção de Hipovolemia no Intra-Operatório. O Sistema Cardiovascular e a Anestesia. 1997:119-124.

Tavernier B, Makhotine O, Lebuffer G. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology. 1998;89:1313-1321.

Wolf MB, Watson PD. Measurement of osmotic reflexion for small molecular in cats hindlimbs. Am J Physiol. 1989;256:H282-H290.

Smith GJ, Kramer GC, Perron P. A comparison of several hypertonic solutions for resuscitation of bled sheep. J Surg Res. 1985;35:517-528.

Walsh JC, Kramer GC. Resuscitation of hypovolemic sheep with hypertonic saline/dextran: the role of dextran. Circ Shock. 1991;34:336-343.

Vassar MJ, Perry CA, Holcroft JW. Prehospital resuscitation of trauma patients with 7.5 NaCl versus 7.5 NaCl added dextran: a controlled trial. J Trauma. 1993;34:622-632.

Oliveira SA, Bueno RM, Souza JM. Effects of hypertonic solution saline dextran on the postoperative evolution of Jehovah’s Witness patients submitted to cardiac surgery with cardiopulmonary bypass. Shock. 1995;3:391-394.

Kramer GC, Vane LA, Kilicturgay N. Resuscitation with hypertonic saline dextran mobilizes interstitial protein more effectively than normal saline. Anesthesiology. 1999;91(^s3):A696.

Perel A. Assessing fluid responsiveness by the systolic pressure variation in mechanically ventilated patient. Anesthesiology. 1998;89:1309-1310.

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