INS AND OUTS OF FOAL FLUID THERAPY
PAMELA WILKINS, DVM, MS, PHD, DACVIM-LA, DACVECC University of Illinois, Champaign-Urbana IL USA
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prompt the clinician to make necessary adjustments. Foals suffering from PAS and sepsis are the patients most at risk for significant hypotension and perfusion abnormalities. Perfusion is maintained by supporting cardiac output and blood pressure with judicious use of intravenous fluid support and inotrope/pressor support. The author does not aim for any specific target systolic, mean, or diastolic pressure. Instead the author monitors urine output, mentation, limb perfusion, gastrointestinal function, and respiratory function as indicators that perfusion is acceptable. For NICU patients to require inotrope and pressor therapy is not unusual, but in some cases hypoxic and septic
damage is sufficiently severe to blunt the response of the patient to the drugs. One must approach each patient as an individual, and no single inotrope/pressor protocol will suffice
One should obtain blood pressure measurements at regular intervals throughout the day because hypotension can be a problem in these patients, particularly in septic foals and foals suffering from PAS, and one may need to increase fluid therapy to maintain adequate vascular volume. Patients with hypotension may need inotrope and pressor support. 5 PRESSOR AND INOTROPE THERAPY IN NEONATES Inotrope and pressor therapy generally is restricted to referral centers where these drugs can be administered as constant rate infusions and blood pressure can be monitored closely. Blood pressure can be monitored directly or indirectly by the use of cuffs placed on the base of the tail. Both techniques have advantages and disadvantages. Although direct blood pressure measurements are considered the gold standard and are generally more accurate, the difficulty in placing and maintaining arterial catheters and lines in these patients severely restricts the utility of this method. Indirect techniques can be inaccurate and are affected by cuff size and placement. However, indirect techniques are easier to use in the NICU and can be useful if trained staff are using the equipment. Once the appropriate cuff size has been identified, that cuff should be dedicated to that patient for the duration of the hospitalization to decrease variability caused by using different cuffs. One should monitor the blood pressure of all recumbent patients at regular intervals, and trends upward or downward should
for all patients. DOBUTAMINE
Dobutamine is an adrenergic inotrope that is frequently used as first choice therapy in NICU patients. Its effects are best used in the foal at the lower dose range. Neonates have a limited ability to increase stroke volume in an effort to maintain cardiac output, and one may observe tachycardia in these patients as heart rate increases to maintain cardiac output and vascular pressure. (continued)
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