Relationship between tricuspid annular plane systolic excursion, fluid responsiveness and volume status in hospitalised dogs with circulatory abnormalities.

AIMS: To evaluate the echocardiographic variable tricuspid annular plane systolic excursion normalised to body weight (TAPSEnorm) as a predictor of fluid responsiveness in hospitalised dogs with haemodynamic and tissue perfusion alterations and to investigate the association of left ventricular internal diameter in diastole normalised to body weight (LVIDdN) and aortic velocity time integral (VTIAo) with TAPSEnorm. METHODS: A single-centre, prospective study was carried out in a cohort of spontaneously breathing dogs, hospitalised for any reason, with severe haemodynamic and tissue perfusion alterations. The echocardiographic variables TAPSEnorm, LVIDdN, and VTIAO were measured. A bolus of 30 mL/kg of lactated Ringer's solution was administered and then VTIAo was subsequently remeasured. Patients were classified as fluid responsive if VTIAo increased by ≥15% after fluid expansion, or non-responsive if VTIAo increased by <15% after fluid expansion. The area under the receiver operating characteristic (AUROC) curve was generated to evaluate the ability of TAPSE to predict fluid responsiveness. Simple regression models were used to assess the linear relationship between TAPSEnorm and LVIDdN or VTIAO. RESULTS: TAPSEnorm was lower in fluid responsive dogs (mean 0.57 (95% CI = 0.50-0.64) cm/kg) compared to non-responsive dogs (mean 0.76 (95% CI = 0.62-0.90) cm/kg). The AUROC for TAPSEnorm was 0.827 (95% CI = 0.65-1.00). The optimal cut-off point was 0.76 with sensitivity of 80 (95% CI = 28.4-99.5)% and specificity of 86.7 (95% CI = 69.3-99.2)%, positive predictive value of 50 (95% CI = 15.7-84.3)% and negative predictive value of 96.3 (95% CI = 81-99.9)%. A monotonic linear relationship was observed between TAPSEnorm and LVIDdN (p<0.001) and between TAPSEnorm and VTIAo (p=0.001). CONCLUSIONS AND CLINICAL RELEVANCE: TAPSEnorm could be useful in determining those dogs that are likely to respond to a fluid bolus from those that are likely to be non-responsive. Additionally, a positive linear association between the LVIDdN and the TAPSEnorm suggests that TAPSEnorm decreases at lower preload values. The present study results suggest that TAPSEnorm could be a valuable tool for evaluating blood volume status and fluid responsiveness in hospitalised dogs.Abbreviations: AUROC: Area under the receiver operating characteristic; CO: Cardiac output; ICC: Intraclass correlation coefficient; LVIDd: Left ventricular internal diameter in diastole; LVIDdN: Left ventricular internal diameter in diastole normalised to body weight; TAPSE: Tricuspid annular plane systolic excursion; TAPSEnorm: Tricuspid annular plane systolic excursion normalised to body weight; VTIAo: Aortic velocity time integral.

Clinicopathological factors associated with the presence of hypercapnia at admission in hospitalised cats with decompensated chronic kidney disease.

AIMS: To evaluate associations between clinicopathological variables and hypercapnia measured in cats with decompensated chronic kidney disease (CKD) on admission to a veterinary hospital. METHODS: This is a retrospective, cross-sectional study of cats (n = 39) that presented to a tertiary veterinary hospital in Argentina between June 2015 and December 2017 with blood creatinine concentrations >140 µmol/L, and abdominal ultrasound results consistent with CKD. Data recorded included venous partial pressure of CO2 (PvCO2), blood pH, haematocrit and concentrations of glucose, potassium, sodium, corrected sodium (Na+c), and ionised calcium in blood. A logistic regression model was used to assess associations between the presence of hypercapnia (PvCO2 ≥ 44.7 mmHg) and the other clinicopathologic variables. The duration of hospitalisation was compared in cats with and without hypercapnia using the Wilcoxon Rank Sum test. RESULTS: The final study population comprised 39 cats. Eleven cats (28.2%) had hypercapnia. In the logistic regression model, two independent variables were associated with the presence of hypercapnia at admission in cats with CKD: the concentration of creatinine in blood (OR = 1.06 (95% CI = 1.016-1.108); p = 0.007) and Na+c (OR = 1.33 (95% CI = 1.08-1.63); p = 0.005). There were no statistically significant differences in the length of hospital stay between the two groups. CONCLUSIONS AND CLINICAL RELEVANCE: There appears to be an association between elevated concentrations of creatinine and Na+c in blood, and hypercapnia in cats with CKD, suggesting careful assessment of blood gas and electrolyte parameters during hospitalisation is required. Further prospective studies are needed to evaluate the mechanisms behind this association and the association of hypercapnia with disease outcome including mortality.

Regional anesthetic techniques for the thoracic limb and thorax in small animals: A review of the literature and technique description.

Veterinary regional anesthesia (RA) has been rapidly increasing in popularity over the last 10 years, as evidenced by the increasing amount of literature available and the continuous development of new techniques in small animals. The introduction of new technologies such as nerve stimulation and ultrasound (which increased the objectivity and precision of the procedure) and the promising beneficial perioperative effects conferred by RA are encouraging clinicians to incorporate these techniques in their daily perioperative anesthetic and analgesic animal care. However, there is a lack of consensus regarding outcomes when RA is used, as well as outcome comparisons between regional anesthetic techniques. Further large-scale clinical studies are still necessary. This article is the first part of a two-part review of RA in small animals, and its aim is to discuss the most relevant studies in the veterinary literature, where objective methods of nerve location have been used, and to illustrate in pictures the currently used techniques for providing RA to the thoracic limb and the thorax in small animals.

Regional anesthetic techniques for the pelvic limb and abdominal wall in small animals: A review of the literature and technique description.

Increasing interest in using peripheral nerve blocks in small animals is evident, given the numerous studies published recently on this topic in important veterinary journals. Initially, research was focused on intraoperative analgesia to the pelvic limb, and several descriptions of lumbosacral plexus, femoral and sciatic nerve blocks have been described in studies. There is recent interest in developing techniques for somatosensory blockade of the abdominal wall. This article is the second part of a two-part review of regional anesthesia (RA) in small animals, and its aim is to discuss the most relevant studies in the veterinary literature, where objective methods of nerve location have been used, and to illustrate in pictures the currently used techniques for providing RA to the abdominal wall and the pelvic limb in small animals.