Comparison of the diagnostic accuracy of dynamic and static preload indexes to predict fluid responsiveness in mechanically ventilated, isoflurane anesthetized dogs

Published:January 29, 2019DOI:



      To compare the diagnostic accuracy of pulse pressure variation (PPV), stroke volume variation from pulse contour analysis (SVVPCA), plethysmographic variability index (PVI), central venous pressure (CVP) and global end-diastolic volume index measured by transpulmonary thermodilution (GEDVITPTD) to predict fluid responsiveness (FR) in dogs.

      Study design

      Prospective study.


      A group of 40 bitches (13.8–26.8 kg) undergoing ovariohysterectomy.


      Anesthesia was maintained with isoflurane under volume-controlled ventilation (tidal volume 12 mL kg–1; inspiratory pause during 40% of inspiratory time; inspiration:expiration ratio 1:1.5). Transpulmonary thermodilution cardiac output was recorded through a femoral artery catheter. FR was evaluated by a fluid challenge (lactated Ringer's, 20 mL kg–1 over 15 minutes) administered once (n = 21) or twice (n = 18) before surgery. Individuals were responders if stroke volume index measured by transpulmonary thermodilution increased >15% after the last fluid challenge.


      Of the 39 animals studied, 21 were responders and 18 were nonresponders. Area under the receiver operating characteristics curve (AUROC) was 0.976, 0.906, 0.868 and 0.821 for PPV, PVI, CVP and SVVPCA, respectively (p < 0.0001 from AUROC = 0.5). GEDVITPTD failed to predict FR (AUROC: 0.660, p = 0.078). Best cut-off thresholds discriminating responders and nonresponders, with respective zones of diagnostic uncertainty (gray zones) were: PPV >16% (15–16%), PVI >11% (10–13%), SVVPCA >10% (9–18%) and CVP ≤1 mmHg (0–3 mmHg). Percentage of animals within gray zone limits was 13% (PPV), 28% (PVI), 51% (SVVPCA) and 67% (CVP).

      Conclusions and clinical relevance

      PPV has better diagnostic accuracy to predict FR (conclusive results in nearly 90% of population) than other preload indexes in healthy dogs. When invasive blood pressure is unavailable, PVI will predict FR with reasonable accuracy (conclusive results in approximately 70% of the population). PPV and PVI values above gray zone limits (>16% and >13%, respectively) can reliably predict responders to volume expansion.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bednarczyk J.M.
        • Fridfinnson J.A.
        • Kumar A.
        • et al.
        Incorporating dynamic assessment of fluid responsiveness into goal-directed therapy: a systematic review and meta-analysis.
        Crit Care Med. 2017; 45: 1538-1545
        • Biais M.
        • de Courson H.
        • Lanchon R.
        • et al.
        Mini-fluid challenge of 100 ml of crystalloid predicts fluid responsiveness in the operating room.
        Anesthesiology. 2017; 127: 450-456
        • Bucci M.
        • Rabozzi R.
        • Guglielmini C.
        • Franci P.
        Respiratory variation in aortic blood peak velocity and caudal vena cava diameter can predict fluid responsiveness in anaesthetised and mechanically ventilated dogs.
        Vet J. 2017; 227: 30-35
        • Cannesson M.
        • Desebbe O.
        • Rosamel P.
        • et al.
        Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre.
        Br J Anaesth. 2008; 101: 200-206
        • Cannesson M.
        • Le Manach Y.
        • Hofer C.K.
        • et al.
        Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach.
        Anesthesiology. 2011; 115: 231-241
        • Chu H.
        • Wang Y.
        • Sun Y.
        • Wang G.
        Accuracy of pleth variability index to predict fluid responsiveness in mechanically ventilated patients: a systematic review and meta-analysis.
        J Clin Monit Comput. 2016; 30: 265-274
        • Corcoran T.
        • Rhodes J.E.
        • Clarke S.
        • et al.
        Perioperative fluid management strategies in major surgery: a stratified meta-analysis.
        Anesth Analg. 2012; 114: 640-651
        • DeLong E.R.
        • DeLong D.M.
        • Clarke-Pearson D.L.
        Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.
        Biometrics. 1988; 44: 837-845
        • Drozdzynska M.J.
        • Chang Y.M.
        • Stanzani G.
        • Pelligand L.
        Evaluation of the dynamic predictors of fluid responsiveness in dogs receiving goal-directed fluid therapy.
        Vet Anaesth Analg. 2018; 45: 22-30
        • Endo Y.
        • Kawase K.
        • Miyasho T.
        • et al.
        Plethysmography variability index for prediction of fluid responsiveness during graded haemorrhage and transfusion in sevoflurane-anaesthetized mechanically ventilated dogs.
        Vet Anaesth Analg. 2017; 44: 1303-1312
        • Fantoni D.T.
        • Ida K.K.
        • Gimenes A.M.
        • et al.
        Pulse pressure variation as a guide for volume expansion in dogs undergoing orthopedic surgery.
        Vet Anaesth Analg. 2017; 44: 710-718
        • Garofalo N.A.
        • Teixeira-Neto F.J.
        • Rodrigues J.C.
        • et al.
        Comparison of transpulmonary thermodilution and calibrated pulse contour analysis with pulmonary artery thermodilution cardiac output measurements in anesthetized dogs.
        J Vet Intern Med. 2016; 30: 941-950
        • Hans G.A.
        • Sottiaux T.M.
        • Lamy M.L.
        • Joris J.L.
        Ventilatory management during routine general anaesthesia.
        Eur J Anaesthesiol. 2009; 26: 1-8
        • Jozwiak M.
        • Teboul J.L.
        • Monnet X.
        Extravascular lung water in critical care: recent advances and clinical applications.
        Ann Intensive Care. 2015; 5: 38
        • Jozwiak M.
        • Monnet X.
        • Teboul J.L.
        Pressure waveform analysis.
        Anesth Analg. 2018; 126: 1930-1933
        • Kim H.K.
        • Pinsky M.R.
        Effect of tidal volume, sampling duration, and cardiac contractility on pulse pressure and stroke volume variation during positive-pressure ventilation.
        Crit Care Med. 2008; 36: 2858-2862
        • Klein A.V.
        • Teixeira-Neto F.J.
        • Garofalo N.A.
        • et al.
        Changes in pulse pressure variation and plethysmographic variability index caused by hypotension-inducing hemorrhage followed by volume replacement in isoflurane-anesthetized dogs.
        Am J Vet Res. 2016; 77: 280-287
        • Litton E.
        • Morgan M.
        The PiCCO monitor: a review.
        Anaesth Intensive Care. 2012; 40: 393-409
        • Mallat J.
        • Meddour M.
        • Durville E.
        • et al.
        Decrease in pulse pressure and stroke volume variations after mini-fluid challenge accurately predicts fluid responsiveness.
        Br J Anaesth. 2015; 115: 449-456
        • Marik P.E.
        • Cavallazzi R.
        Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense.
        Crit Care Med. 2013; 41: 1774-1781
        • Marik P.E.
        • Cavallazzi R.
        • Vasu T.
        • Hirani A.
        Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature.
        Crit Care Med. 2009; 37: 2642-2647
        • Michard F.
        Changes in arterial pressure during mechanical ventilation.
        Anesthesiology. 2005; 103: 419-428
        • Michard F.
        • Lopes M.R.
        • Auler Jr, J.O.
        Pulse pressure variation: beyond the fluid management of patients with shock.
        Crit Care. 2007; 11: 131
        • Michard F.
        • Chemla D.
        • Teboul J.L.
        Applicability of pulse pressure variation: how many shades of grey?.
        Crit Care. 2015; 19: 144
        • Michard F.
        • Alaya S.
        • Zarka V.
        • et al.
        Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock.
        Chest. 2003; 124: 1900-1908
        • Min J.J.
        • Gil N.S.
        • Lee J.H.
        • et al.
        Predictor of fluid responsiveness in the 'grey zone': augmented pulse pressure variation through a temporary increase in tidal volume.
        Br J Anaesth. 2017; 119: 50-56
        • Monnet X.
        • Teboul J.L.
        Transpulmonary thermodilution: advantages and limits.
        Crit Care. 2017; 21: 147
        • Monnet X.
        • Persichini R.
        • Ktari M.
        • et al.
        Precision of the transpulmonary thermodilution measurements.
        Crit Care. 2011; 15: R204
        • Müller L.
        • Toumi M.
        • Bousquet P.J.
        • et al.
        An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study.
        Anesthesiology. 2011; 115: 541-547
        • Nishikawa T.
        • Dohi S.
        Errors in the measurement of cardiac output by thermodilution.
        Can J Anaesth. 1993; 40: 142-153
        • Ray P.
        • Le Manach Y.
        • Riou B.
        • Houle T.T.
        Statistical evaluation of a biomarker.
        Anesthesiology. 2010; 112: 1023-1040
        • Sakka S.G.
        • Reuter D.A.
        • Perel A.
        The transpulmonary thermodilution technique.
        J Clin Monit Comput. 2012; 26: 347-353
        • Silverstein D.C.
        • Kleiner J.
        • Drobatz K.J.
        Effectiveness of intravenous fluid resuscitation in the emergency room for treatment of hypotension in dogs: 35 cases (2000–2010).
        J Vet Emerg Crit Care. 2012; 22: 666-673
        • Valverde A.
        • Gianotti G.
        • Rioja-Garcia E.
        • Hathway A.
        Effects of high-volume, rapid-fluid therapy on cardiovascular function and hematological values during isoflurane-induced hypotension in healthy dogs.
        Can J Vet Res. 2012; 76: 99-108