Monitoring and treating haemodynamic disturbances in critically ill neonatal foals. Part 2: Assessment and treatment

摘要

Assessment and treatment of haemodynamic disturbances are closely linked. The response to the previous treatment is the most reliable guide to further therapy and is especially important if direct cardiovascular monitoring is limited. Treatments should always be adapted if the intended response is not achieved. Fortunately, the rapid response of the cardiovascular system to change and the short half-life of many of the drugs used in critical care allow rapid appraisal of each therapeutic intervention, permitting a step-wise approach to treatment. One caveat is that the ultimate goal is adequate tissue oxygen delivery, not the correction of any measured haemodynamic variable. Therefore, assessments should include clinical and laboratory markers oftissue perfusion such as level of consciousness and blood lactate concentration, which may take hours rather than minutes for appreciable changes. In oliguric and anuric foals with little or no intrinsic renal dysfunction, restoration of urine output isoften the first sign of improved tissue perfusion.