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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

2012; Wiley; Volume: 22; Issue: 4 Linguagem: Inglês

10.1111/j.1476-4431.2012.00769.x

1479-3261

Andreza Conti‐Patara, Juliana de Araújo Caldeira, Ewaldo de Mattos, Haley da Silva de Carvalho, Adriane Reinoldes, Bruno Gregnanin Pedron, Marcelo Patara, Mariana Semião Francisco Talib, Marcelo Faustino, Clair Motos de Oliveira, Srg Cortopassi,

Renal function and acid-base balance

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 (ScvO 2 ), lactate, and base deficit. Between survivors and nonsurvivors it was observed that the ScvO 2 , lactate, and base deficit on ICU admission were each related independently to death ( P = 0.001, P = 0.030, and P < 0.001, respectively). ScvO 2 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 ScvO 2 and base deficit are useful in predicting the prognosis of dogs with severe sepsis and septic shock; animals with a higher ScvO 2 and lower base deficit at admission to the ICU have a lower probability of death.