A pilot study evaluating adaptive closed-loop fluid resuscitation during states of absolute and relative hypovolemia in dogs
A pilot study evaluating adaptive closed-loop fluid resuscitation during states of absolute and relative hypovolemia in dogs
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DOI：
10.1111/vec.12753
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发表时间：
2018-09-01
影响因子：
1.3
通讯作者：
Muir, William W.
中科院分区：
文献类型：
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作者：
Gholami, Behnood;Haddad, Wassim M.;Muir, William W.
目的评价和确定部分自动化和全自动闭环式液体复苏系统在绝对和相对低血容量状态下的性能。设计前瞻性实验。设置研究实验室。动物5只成年Beagle犬。方法异氟醚麻醉机械通气犬造成绝对低血症(对照：2个试验；非对照：3个试验)、相对低血容量(2个试验)、相对和绝对控制低血症(2个试验)。控制性和非控制性低血容量是通过从颈动脉或股动脉抽血产生的。通过增加异氟醚浓度(1例)或静脉滴注硝普钠(1例)造成相对低血容量。增加异氟醚浓度(1例)和静脉滴注硝普钠(1例)造成相对低血容量合并控制性绝对低血症(1例)。连续监测和记录所有犬的血流动力学参数，包括每搏输出量变化(SVV)。一种基于液体分配和隔室动力系统的专有闭环液体给药系统，通过持续输注乳酸林格液，以恢复和维持SVV到预定的目标值。测量和主要结果在5只狗身上进行了9次实验。控制性或非控制性低血容量、相对低血容量、相对低血容量合并控制性低血症时，血流动力学指标恶化，SVV升高。每搏量变化在闭合循环输液时恢复到基线水平。结论在机械通气异氟醚麻醉犬绝对或相对低血容量时，基于IV液体分布和隔室动力系统的闭合输液系统可用于提供目标定向液体治疗。
ObjectiveTo evaluate and determine the performance of a partially automated as well as a fully automated closed-loop fluid resuscitation system during states of absolute and relative hypovolemia.DesignProspective experimental trial.SettingResearch laboratory.AnimalsFive adult Beagle dogs.MethodsIsoflurane anesthetized mechanically ventilated dogs were subjected to absolute hypovolemia (controlled: 2 trials; uncontrolled: 3 trials), relative hypovolemia (2 trials), and the combination of relative and absolute controlled hypovolemia (2 trials). Controlled and uncontrolled hypovolemia were produced by withdrawing blood from the carotid or femoral artery. Relative hypovolemia was produced by increasing the isoflurane concentration (1 trial) or by infusion of intravenous sodium nitroprusside (1 trial). Relative hypovolemia combined with controlled absolute hypovolemia was produced by increasing the isoflurane concentration (1 trial) and infusion of IV sodium nitroprusside (1 trial). Hemodynamic parameters including stroke volume variation (SVV) were continuously monitored and recorded in all dogs. A proprietary closed-loop fluid administration system based on fluid distribution and compartmental dynamical systems administered a continuous infusion of lactated Ringers solution in order to restore and maintain SVV to a predetermined target value.Measurements and Main ResultsA total of 9 experiments were performed on 5 dogs. Hemodynamic parameters deteriorated and SVV increased during controlled or uncontrolled hypovolemia, relative hypovolemia, and during relative hypovolemia combined with controlled hypovolemia. Stroke volume variation was restored to baseline values during closed-loop fluid infusion.ConclusionsClosed-loop fluid administration based on IV fluid distribution and compartmental dynamical systems can be used to provide goal directed fluid therapy during absolute or relative hypovolemia in mechanically ventilated isoflurane anesthetized dogs.