Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome

Authors

  • Andreza Conti-Patara DVM, MSc, PhD,

    1. From the Department of Veterinary Surgery, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Juliana de Araújo Caldeira DVM,

    1. From the Department of Veterinary Surgery, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Ewaldo de Mattos-Junior DVM, MS,

    1. From the Department of Veterinary Surgery, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Haley da Silva de Carvalho DVM, MSc,

    1. From the Department of Veterinary Surgery, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Adriane Reinoldes DVM,

    1. From the Department of Veterinary Surgery, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Bruno Gregnanin Pedron DVM,

    1. From the Department of Veterinary Surgery, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Marcelo Patara MD,

    1. College of Medical Sciences Santa Casa de São Paulo, São Paulo, SP, Brazil
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  • Mariana Semião Francisco Talib DVM,

    1. Department of Animal Reproduction, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Marcelo Faustino DVM,

    1. Department of Animal Reproduction, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Clair Motos de Oliveira DVM, MSc, PhD,

    1. Department of Animal Reproduction, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Silvia Renata Gaido Cortopassi DVM, MSc, PhD

    Corresponding author
    • From the Department of Veterinary Surgery, School of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, SP, Brazil
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  • Financial support: FAPESP—Foundation of Support to Research of the State of São Paulo.

  • Authors declare no conflict of interests.

  • Presented in part at the 16th International Veterinary Emergency and Critical Care Symposium, San Antonio, TX, September 2010.

Address correspondence and reprint requests toDr. Silvia Renata Gaido Cortopassi, Department of Veterinary Surgery, College of Veterinary Medicine and Zootechnics, University of São Paulo, São Paulo, Av. Prof. Orlando Marques de Paiva, 87, Cidade Universitária. São Paulo, São Paulo 05508-270, Brazil.

Email: acontipatara@yahoo.com.br

Abstract

Objective

To evaluate the changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization in the ICU and their relation to outcome.

Design

Prospective observational study.

Setting

ICU of a veterinary university medical center.

Animals

Thirty dogs with severe sepsis or septic shock caused by pyometra who underwent surgery and were admitted to the ICU.

Measurements and Main Results

Severe sepsis was defined as the presence of sepsis and sepsis-induced dysfunction of one or more organs. Septic shock was defined as the presence of severe sepsis plus hypotension not reversed with fluid resuscitation. After the presumptive diagnosis of sepsis secondary to pyometra, blood samples were collected and clinical findings were recorded. Volume resuscitation with 0.9% saline solution and antimicrobial therapy were initiated. Following abdominal ultrasonography and confirmation of increased uterine volume, dogs underwent corrective surgery. After surgery, the animals were admitted to the ICU, where resuscitation was guided by the clinical parameters, central venous oxygen saturation (ScvO2), lactate, and base deficit. Between survivors and nonsurvivors it was observed that the ScvO2, lactate, and base deficit on ICU admission were each related independently to death (P = 0.001, P = 0.030, and P < 0.001, respectively). ScvO2 and base deficit were found to be the best discriminators between survivors and nonsurvivors as assessed via receiver operator characteristic curve analysis.

Conclusion

Our study suggests that ScvO2 and base deficit are useful in predicting the prognosis of dogs with severe sepsis and septic shock; animals with a higher ScvO2 and lower base deficit at admission to the ICU have a lower probability of death.

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