Measured and calculated variables of global oxygenation in healthy neonatal foals

David M. Wong Departments of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

Search for other papers by David M. Wong in
Current site
Google Scholar
PubMed
Close
 DVM, MS
,
Kate L. Hepworth-Warren Departments of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

Search for other papers by Kate L. Hepworth-Warren in
Current site
Google Scholar
PubMed
Close
 DVM
,
Beatrice T. Sponseller Departments of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

Search for other papers by Beatrice T. Sponseller in
Current site
Google Scholar
PubMed
Close
 Dr Med Vet
,
Joan M. Howard Departments of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

Search for other papers by Joan M. Howard in
Current site
Google Scholar
PubMed
Close
 VMD
, and
Chong Wang Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

Search for other papers by Chong Wang in
Current site
Google Scholar
PubMed
Close
 PhD

Abstract

OBJECTIVE To assess multiple central venous and arterial blood variables that alone or in conjunction with one another reflect global oxygenation status in healthy neonatal foals.

ANIMALS 11 healthy neonatal foals.

PROCEDURES Central venous and arterial blood samples were collected from healthy neonatal foals at 12, 24, 36, 48, 72, and 96 hours after birth. Variables measured from central venous and arterial blood samples included oxygen saturation of hemoglobin, partial pressure of oxygen, lactate concentration, partial pressure of carbon dioxide, and pH. Calculated variables included venous-to-arterial carbon dioxide gap, estimated oxygen extraction ratio, ratio of partial pressure of oxygen in arterial blood to the fraction of inspired oxygen, bicarbonate concentration, base excess, and blood oxygen content.

RESULTS Significant differences between arterial and central venous blood obtained from neonatal foals were detected for several variables, particularly partial pressure of oxygen, oxygen saturation of hemoglobin, and oxygen content. In addition, the partial pressure of carbon dioxide in central venous blood samples was significantly higher than the value for corresponding arterial blood samples. Several temporal differences were detected for other variables.

CONCLUSIONS AND CLINICAL RELEVANCE Results of this study provided information about several variables that reflect global oxygenation in healthy neonatal foals. Values for these variables in healthy foals can allow for comparison with values for critically ill foals in future studies. Comparison of these variables between healthy and ill foals may aid in treatment decisions and prognosis of clinical outcome for critically ill foals.

Abstract

OBJECTIVE To assess multiple central venous and arterial blood variables that alone or in conjunction with one another reflect global oxygenation status in healthy neonatal foals.

ANIMALS 11 healthy neonatal foals.

PROCEDURES Central venous and arterial blood samples were collected from healthy neonatal foals at 12, 24, 36, 48, 72, and 96 hours after birth. Variables measured from central venous and arterial blood samples included oxygen saturation of hemoglobin, partial pressure of oxygen, lactate concentration, partial pressure of carbon dioxide, and pH. Calculated variables included venous-to-arterial carbon dioxide gap, estimated oxygen extraction ratio, ratio of partial pressure of oxygen in arterial blood to the fraction of inspired oxygen, bicarbonate concentration, base excess, and blood oxygen content.

RESULTS Significant differences between arterial and central venous blood obtained from neonatal foals were detected for several variables, particularly partial pressure of oxygen, oxygen saturation of hemoglobin, and oxygen content. In addition, the partial pressure of carbon dioxide in central venous blood samples was significantly higher than the value for corresponding arterial blood samples. Several temporal differences were detected for other variables.

CONCLUSIONS AND CLINICAL RELEVANCE Results of this study provided information about several variables that reflect global oxygenation in healthy neonatal foals. Values for these variables in healthy foals can allow for comparison with values for critically ill foals in future studies. Comparison of these variables between healthy and ill foals may aid in treatment decisions and prognosis of clinical outcome for critically ill foals.

Contributor Notes

Address correspondence to Dr. Wong (dwong@iastate.edu).
  • 1. Prittie J. Optimal endpoints of resuscitation and early goal-directed therapy. J Vet Emerg Crit Care 2006; 16: 329–339.

  • 2. Nelson DP, Beyer C, Samsel RW, et al. Pathological supply dependence of O2 uptake during bacteremia in dogs. J Appl Physiol 1987; 63: 1487–1492.

  • 3. Shibutani K, Komatsu T, Kubal K, et al. Critical level of oxygen delivery in anesthetized man. Crit Care Med 1983; 11: 640–643.

  • 4. Iskander KN, Osuchowski MF, Stearns-Kurosawa DJ, et al. Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding. Physiol Rev 2013; 93: 1247–1288.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368–1377.

  • 6. Butler AL, Campbell VL. Assessment of oxygen transport and utilization in dogs with naturally occurring sepsis. J Am Vet Med Assoc 2010; 237: 167–173.

  • 7. Elliott DC. An evaluation of the end points of resuscitation. J Am Coll Surg 1998; 187: 536–547.

  • 8. de Oliveira CF, de Oliveira DSF, Gottschald AFC, et al. ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation. Intensive Care Med 2008; 34: 1065–1075.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9. Donati A, Loggi S, Preiser JC, et al. Goal-directed intraoperative therapy reduces morbidity and mortality and length of hospital stay in high-risk surgical patients. Chest 2007; 132: 1817–1824.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. Joshi R, de Witt B, Mosier JM. Optimizing oxygen delivery in the critically ill: the utility of lactate and central venous oxygen saturation (ScvO2) as a roadmap of resuscitation in shock. J Emerg Med 2014; 47: 493–500.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11. Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA 2010; 303: 739–746.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12. Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation or septic shock. N Engl J Med 2015; 372: 1301–1311.

  • 13. ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med 2014; 371: 1496–1506.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14. ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med 2014; 370: 1683–1693.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15. Palmer J. Update on the management of neonatal sepsis in horses. Vet Clin North Am Equine Pract 2014; 30: 317–336.

  • 16. Corley KTT, Donaldson LL, Furr MO. Arterial lactate concentration, hospital survival, sepsis and SIRS in critically ill neonatal foals. Equine Vet J 2005; 37: 53–59.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17. Borchers A, Wilkins PA, Marsh PM, et al. Admission L-lactate concentration in hospitalised equine neonates: a prospective multicenter study. Equine Vet J Suppl 2012;(41): 57–63.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18. Borchers A, Wilkins PA, Marsh PM, et al. Sequential L-lactate concentration in hospitalised equine neonates: a prospective multicenter study. Equine Vet J Suppl 2013;(45): 2–7.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19. Tánczos K, Nemeth M, Molnar Z. The multimodal concept of hemodynamic stabilization. Front Public Health 2014; 2: 34.

  • 20. Chawla LS, Zia H, Gutierrez G, et al. Lack of equivalence between central and mixed venous oxygen saturation. Chest 2004; 126: 1891–1896.

  • 21. Varpula M, Karlsson S, Ruokonen E, et al. Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock. Intensive Care Med 2006; 32: 1336–1343.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22. Reid M. Central venous oxygen saturation: analysis, clinical use and effects on mortality. Nurs Crit Care 2013; 18: 245–250.

  • 23. Du W, Wang XT, Long Y, et al. Combining central venous-to-arterial partial pressure of carbon dioxide difference and central venous oxygen saturation to guide resuscitation in septic shock. J Crit Care 2013; 28: 1110.e1–1110.e5.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24. Kocsi A, Demeter G, Erces D, et al. Central venous-to-arterial CO2 gap is a useful parameter in monitoring hypovolemiacaused altered oxygen balance: animal study. Crit Care Res Pract 2013; 2013: 583–598.

    • Search Google Scholar
    • Export Citation
  • 25. Weil MH, Rackow EC, Trevino R, et al. Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med 1986; 315: 153–156.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26. Vallet B, Teboul JL, Cain S, et al. Venoarterial CO2 difference during regional ischemic or hypoxic hypoxia. J Appl Physiol 2000; 89: 1317–1321.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27. Adrogué HJ, Rashad MN, Gorin AB, et al. Assessing acid-base status in circulatory failure. Differences between arterial and central venous blood. N Engl J Med 1989; 320: 1312–1316.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28. Mecher CE, Rackow EC, Astiz ME, et al. Venous hypercarbia associated with severe sepsis and systemic hypoperfusion. Crit Care Med 1990; 18: 585–589.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29. Surbatovic M, Radakovia S, Jevtic M, et al. Predictive value of serum bicarbonate, arterial base deficit/excess and SAPS III score in critically ill patients. Gen Physiol Biophys 2009; 28: 271–276.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30. Allen M. Lactate and acid base as a hemodynamic monitor and markers of cellular perfusion. Pediatr Crit Care Med 2011; 12(suppl): S43–S49.

  • 31. Park JS, Kim SJ, Lee SW, et al. Initial low oxygen extraction ratio is related to severe organ dysfunction and high in-hospital mortality in severe sepsis and septic shock patients. J Emerg Med 2015; 49: 261–267.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32. Kandel G, Aberman A. A mixed venous oxygen saturation: its role in the assessment of the critically ill patient. Arch Intern Med 1983; 143: 1400–1402.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33. Kasnitz P, Druger GL, Yorra F, et al. Mixed venous oxygen tension and hyperlactatemia. Survival in severe cardiopulmonary disease. JAMA 1976; 236: 570–574.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34. Powner DJ, Doshi PB. Central venous oxygen saturation monitoring: role in adult donor care? Prog Transplant 2010; 20: 401–405.

  • 35. Van Beest P, Wietasch G, Scheeren T, et al. Clinical review: use of venous oxygen saturations as a goal—a yet unfinished puzzle. Crit Care 2011; 15: 232:1–9.

    • Search Google Scholar
    • Export Citation
  • 36. Goodrich C. Endpoints of resuscitation: what should we be monitoring? AACN Adv Crit Care 2006; 17: 306–316.

  • 37. Wo CC, Shoemaker WC, Appel PL, et al. Unreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness. Crit Care Med 1993; 21: 218–223.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38. Rady MY, Rivers PE, Nowak RM. Resuscitation of the critically ill in the ED: responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactate. Am J Emerg Med 1996; 14: 218–225.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39. Sakr Y, Dubous MJ, De Backer D, et al. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 2004; 32: 1825–1831.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40. Hadian M, Pinsky MR. Evidence-based review of the use of the pulmonary artery catheter: impact data and complications. Crit Care 2006; 10(suppl 3): S8.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41. Cuschieri J, Rivers EP, Donnino MW, et al. Central venous-arterial carbon dioxide difference as an indicator of cardiac index. Intensive Care Med 2005; 31: 818–822.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42. Reinhart K, Kuhn HJ, Hartog C, et al. Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 2004; 30: 1572–1578.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43. Ince C, Sinaasappel M. Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 1999; 27: 1369–1377.

  • 44. De Backer D, Ospina-Tascon G, Salgado D, et al. Monitoring the microcirculation in the crucially ill patient: current methods and future approaches. Intensive Care Med 2010; 36: 1813–1825.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45. Perz S, Uhlig T, Kohl M, et al. Low and ‘supranormal’ central venous oxygen saturation and markers of tissue hypoxia in cardiac surgery patients: a prospective observational study. Intensive Care Med 2011; 37: 52–59.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46. Walley KR. Heterogeneity of oxygen delivery impairs oxygen extraction by peripheral tissues: theory. J Appl Physiol 1996; 81: 885–894.

  • 47. Zöllei E, Bertalan V, Nemeth A, et al. Non-invasive detection of hypovolemia or fluid responsiveness in spontaneously breathing subjects. BMC Anesthesiol 2013; 13: 40.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48. Squara P. Central venous oxygenation: when physiology explains apparent discrepancies. Crit Care 2014; 18: 579–587.

  • 49. Wong DM, Alcott CJ, Wang C, et al. Physiologic effects of nasopharyngeal administration of supplemental oxygen at various flow rates in healthy foals. Am J Vet Res 2010; 71: 1081–1088.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50. Madigan JE, Thomas WP, Backus KQ, et al. Mixed venous blood gases in recumbent and upright positions in foals from birth to 14 days of age. Equine Vet J 1992; 24: 399–401.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51. Wilkins PA, Otto CM, Baumgardner JE, et al. Acute lung injury and acute respiratory distress syndromes in veterinary medicine: consensus definitions: the Dorothy Russell Havemeyer Working Group on ALI and ARDS in Veterinary Medicine. J Vet Emerg Crit Care 2007; 17: 333–339.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 52. Tamura J, Itami T, Ishizuka T, et al. Central venous blood gas and acid-base status in conscious dogs and cats. J Vet Med Sci 2015; 77: 865–869.

  • 53. Futier E, Robin E, Jabaudon M, et al. Central venous O2 saturation and venous-to-arterial CO2 difference as complementary tools for goal-directed therapy during high-risk surgery. Crit Care 2010; 14: R193, 1–11.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54. Vallée F, Vallet B, Mathe O, et al. Central venous-to-arterial carbon dioxide difference: additional target for goal-directed therapy in septic shock? Intensive Care Med 2008; 34: 2218–2225.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55. Haskins S, Pascoe PJ, Ilkiw JE, et al. Reference cardiopulmonary values in normal dogs. Comp Med 2005; 55: 156–161.

  • 56. Contenti J, Corraze H, Lemoel F. Effectiveness of arterial, venous, and capillary blood lactate as sepsis triage tool in ED patients. Am J Emerg Med 2015; 33: 167–172.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57. Bloom B, Pott J, Freund Y, et al. The agreement between abnormal venous lactate and arterial lactate in the ED: a retrospective chart review. Am J Emerg Med 2014; 32: 596–600.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58. Browning R, Datta D, Gray AJ, et al. Peripheral venous and arterial lactate agreement in septic patients in the emergency department: a pilot study. Eur J Emerg Med 2014; 21: 139–141.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59. Middleton P, Kelly AM, Brown J, et al. Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate. Emerg Med J 2006; 23: 622–624.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60. Castagnetti C, Pirrone A, Mariella J, et al. Venous blood lactate evaluation in equine neonatal intensive care. Theriogenology 2010; 73: 343–357.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 61. Gattinoni L, Carlesso E. Supporting hemodynamics: what should we target? What treatments should we use? Crit Care 2013; 17(suppl 1): S1–S8.

    • Search Google Scholar
    • Export Citation
  • 62. Gogos CA, Lekkou A, Papageorgiou O, et al. Clinical prognostic markers in patients with severe sepsis: a prospective analysis of 139 consecutive cases. J Infect 2003; 47: 300–306.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63. Slawuta P, Noszczyk-Nowak A, Nowakowski H. Acid-base balance parameters and a value of anion gap of arterial and venous blood in Malopolski horses. Pol J Vet Sci 2010; 14: 581–585.

    • Search Google Scholar
    • Export Citation
  • 64. Smith I, Kumar P, Molloy S, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 2001; 27: 74–83.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 65. Montassier E, Batard E, Segard J, et al. Base excess is an accurate predictor of elevated lactate in ED septic patients. Am J Emerg Med 2012; 30: 184–187.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66. Martin M, FitzSullivan E, Salim A, et al. Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit. Arch Surg 2005; 140: 745–751.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 67. Fioretto JR, de Carvalho WB. Temporal evolution of acute respiratory distress syndrome definitions. J Pediatr 2013; 89: 523–530.

  • 68. Dunkel B, Dolente B, Boston RC. Acute lung injury/acute respiratory distress syndrome in 15 foals. Equine Vet J 2005; 37: 435–440.

  • 69. Stewart JH, Rose RJ, Barko AM. Respiratory studies in foals from birth to seven days old. Equine Vet J 1984; 16: 323–328.

Advertisement