Printer Friendly

Comparison of fluid types for resuscitation in acute hemorrhagic shock and evaluation of gastric luminal and transcutaneous [Pco.sub.2] in leghorn chickens.

Abstract: The objective of this study was to compare the effects of 3 different fluid types for resuscitation after experimentally induced hemorrhagic shock in anesthetized chickens and to evaluate partial pressures of carbon dioxide measured in arterial blood ([Paco.sub.2]), with a transcutaneous monitor (Tc[Pco.sub.2]), with a gastric intraluminal monitor (Gi[Pco.sub.2]), and by end tidal measurements ([Etco.sub.2]) under stable conditions and after induced hemorrhagic shock. Hemorrhagic shock was induced in 40 white leghorn chickens by removing 50% of blood volume by phlebotomy under general anesthesia. Birds were divided into 4 groups: untreated (control group) and treated with intravenous hetastarch (haes group), with a hemoglobin-based oxygen carrier (hemospan group), or by autotransfusion (blood group). Respiratory rates, heart rates, and systolic arterial blood pressure (SAP) were compared at 8 time points (baseline [TO]; at the loss of 10% [T10%], 20% [T20%], 30% [T30%], 40% [T40%], and 50% [T50%] of blood volume; at the end of resuscitation [RES]; and at the end of anesthesia [END]). Packed cell volume (PCV) and blood hemoglobin content were compared at 6 time points (TO, T50%, RES, and 1, 3, and 7 days after induced hemorrhagic shock). Measurements of [Paco.sub.2], Tc[Pco.sub.2], Gi[Pco.sub.2], and [Etco.sub.2] were evaluated at 2 time points (T0 and T50%), and venous lactic acid concentrations were evaluated at 3 time points (TO, T50%, and END). No significant differences were found in mortality, respiratory rate, heart rate, PCV, or hemoglobin values among the 4 groups. Birds given fluid resuscitation had significantly higher SAPs after fluid administration than did birds in the control group. In all groups, PCV and hemoglobin concentrations began to rise by day 3 after phlebotomy, and baseline values were reached 7 days after blood removal. At T0, Tc[Pco.sub.2] did not differ significantly from [Paco.sub.2], but Gi[Pco.sub.2] and [Etco.sub.2] differed significantly from [Paco.sub.2]. After hemorrhagic shock, Gi[Pco.sub.2] and Tc[Pco.sub.2] differed significantly from [Paco.sub.2]. The Tc[Pco.sub.2] or Gi[Pco.sub.2] values did not differ significantly at any time point in birds that survived or died in any of the groups and across all groups. These results showed no difference in mortality in leghorn chickens treated with fluid resuscitation after hemorrhagic shock and that the PCV and hemoglobin concentrations increased by 3 days after acute hemorrhage with or without treatment. The different C[O.sub.2] measurements document changes in C[O.sub.2]-values consistent with poor perfusion and may prove useful for serial evaluation of responses to shock and shock treatment.

Key words: hemorrhagic shock, colloids, hemoglobin-based oxygen carrying solution, avian, white leghorn chickens

Introduction

Acute blood loss and hemorrhagic shock can be seen in both birds and mammals as a consequence of trauma, internal bleeding associated with neoplasia or ulceration, or coagulopathies due to toxicoses or liver disease or after surgical interventions. (1-3) However, the pathophysiology of hemorrhagic shock in birds is less well understood and differs from that observed in mammals. (2-4) Irreversible shock can be seen in mammals after a loss of 40% of the intravascular volume, but some studies (1,2,4-7) revealed that birds may tolerate up to 70% loss of intravascular volume through a greater capacity to shift fluid from the interstitial space to the intravascular space. Despite a possible greater tolerance to blood loss, birds present unique challenges for veterinary clinicians in both the treatment and monitoring of hemorrhagic shock because of small patient size, species diversity, and lack of data on their responses to therapy. Nonetheless, general guidelines for fluid resuscitation in avian patients are similar to those used in small animal practice.

Restoring intravascular volume and stabilizing blood pressure to ensure perfusion of tissues and organs are primary goals in the treatment of shock. Fluids administered to achieve those goals in birds include crystalloids, colloids, and whole blood, (1,4,8) but, to our knowledge, only one previous study (4) attempted to compare outcome after resuscitation of hemorrhagic shock with different fluid types in birds, including a crystalloid, a colloid, and a hemoglobin-based oxygen carrier solution (HBOCS). In that study, a trend of decreased mortality was observed in the HBOCS group.

An important tool in monitoring shock therapy in veterinary and human medicine is assessing carbon dioxide partial pressure, which reflects oxygen delivery and consumption and, therefore, is an indirect measure of tissue perfusion. In dogs, an increased veno-arterial difference in C[O.sub.2] tension has been demonstrated to be a reliable marker of tissue hypoperfusion. (9) Although arterial, venous, and mixed blood gas analyses can be performed in leghorn chickens, (10) obtaining samples is invasive and often difficult to perform in clinical practice. (11) Carbon dioxide tension can also be measured by capnography, as well as with transcutaneous and transmucosal monitors.

End-tidal C[O.sub.2] tension [Etco.sub.2] measured by side-stream capnography, has been reported to be a useful tool for assessing ventilation during isoflurane anesthesia in African grey parrots (Psittacus erithacus), although [Etco.sub.2] overestimated the arterial partial pressure ([Paco.sub.2]) by approximately 5 mm Hg in that study. (12) Measurement of [Etco.sub.2] can be achieved easily in anesthetized birds. However, during shock or cardiac arrest, [Etco.sub.2] levels will be reflective of pulmonary blood flow and cardiac output and not minute ventilation. (13)

Transcutaneous C[O.sub.2] tension (Tc[Pco.sub.2]) can be measured noninvasively at the skin surface. During low-flow conditions, an increase in Tc[Pco.sub.2] due to decreased C[O.sub.2] removal from tissue can be an early sign of shock. (14) Indeed, YcPC[O.sub.2] recordings were found to be useful in monitoring experimentally induced hypoxia in fetal dogs. (15) Although Tc[Pco.sub.2] correlates with [Paco.sub.2] in dogs with normal cardiac output, Tc[Pco.sub.2] readings at different temperatures during shock do not correlate well with [Paco.sub.2] and offer, at best, trend information. (14) In a previous study in birds, Tc[Pco.sub.2] allowed good estimates of [Paco.sub.2] under stable anesthetic conditions (16) but, to our knowledge, no study has thus far investigated Tc[Pco.sub.2] in birds in hemorrhagic shock.

In humans, gastrointestinal intraluminal [Pco.sub.2] (Gi[Pco.sub.2]) measurements, reflecting gastrointestinal mucosal perfusion, can be used as an early indicator of shock and offers an easily accessible indicator of the efficacy and adequacy of resuscitative interventions. (17) This can be explained by the reduction of blood flow to viscera during low flow states, making the stomach one of the first organs affected by shock and one of the last to be restored to metabolic balance by resuscitation. Only a few trials have examined the use of gastric tonometry in animals. In one study, Gi[Pco.sub.2] was seen to increase in response to hemorrhage in dogs. (18) Other studies in animals included measurements of [Pco.sub.2] in the ileum, the gut lumen, and bladder lumen in pigs and rats. (19-22) To our knowledge, gastric tonometry has thus far not been reported in birds.

The aims of this study were, therefore, to compare the outcome of resuscitation in hemorrhagic shock with 3 different fluid types (hetastarch, a hemoglobin-based oxygen-carrying solution, and whole blood) and to examine [Etco.sub.2], Gi[Pco.sub.2], and Tc[Pco.sub.2] in anesthetized chickens under stable anesthetic conditions and during induced hemorrhagic shock.

Materials and Methods

Forty healthy, adult leghorn chickens (35 females and 5 males, all older than 1 year) were used in the study. Hens weighed a mean of 1747 g (range, 1406-2315 g); roosters weighed a mean of 3205 g (range, 2980-3500 g). The animals were considered healthy based on physical examination and blood biochemical and hematologic parameters. The study was performed at the Clinic for Zoo Animals, Exotic Pets and Wildlife of the Vetsuisse Faculty, University of Zurich, Switzerland, in accordance with rules of Animal Care and Use Committee of the canton of Zurich (License 207/2004). The birds were acclimated to their environment 1 week before the study was started. During the study, the animals were kept in groups in indoor cages and were fed a commercial chicken diet.

Anesthesia was induced by face mask with isoflurane (3.50/0-4.5%) in 100% oxygen followed by endotracheal intubation; anesthesia was maintained with isoflurane (1.5%-2.2%) in 100% oxygen. Mechanical ventilation was started immediately after intubation with a pressure-cycled respirator (SA VO3, Vetronics Services, Devon, United Kingdom) set to a maximum pressure of 12 cm [H.sub.2]O. Parameters measured during the study were heart rate (HR), respiratory rate (RR), systolic arterial pressure (SAP), Tc[Pco.sub.2], [Etco.sub.2], Gi[Pco.sub.2], oxygen saturation (Sp[O.sub.2]), [Paco.sub.2], venous packed cell volume (PCV), and venous lactic acid concentrations. Continuous electrocardiogram and [Etco.sub.2] measurements were performed with a critical care monitor (Cardiocap/5, Datex-Ohmeda, Helsinki, Finland). Although EtC[O.sub.2] measured by sidestream capnography in birds assesses the expired C[O.sub.2] fraction, rather than a true end-tidal C[O.sub.2], that fraction will be referred to as [Etco.sub.2] in this study for simplicity. A 24-gauge catheter was used to take arterial blood samples from the superficial ulnar artery for arterial blood gas analyses. These blood gas analyses were performed immediately after sampling with a portable clinical analyzer (iStat, Heska AG, Fribourg, Switzerland), which had been previously evaluated in leghorn chickens. (10) An 18-gauge catheter placed in the jugular vein was used for phlebotomy and fluid resuscitation and to sample blood for PCV and lactate concentrations with a portable analyzer (Accutrend-Lactate, Roche Diagnostics, Mannheim, Germany). Measurements of Sp[O.sub.2] were performed by pulse oximetry (NONIN 8600V, Nonin Medical Inc, Plymouth, MN, USA), and SAP was determined indirectly by Doppler blood flow detection beneath an inflated cuff (Ultrasonic Doppler Flow Detector Model 811-B, Parks Medical Electronics Inc, Aloha, OR, USA). Gastric intraluminal [Pco.sub.2] was measured by a gastric sensor (TONO-14F, Datex-Ohmeda, Helsinki, Finland) placed in the proventriculus. Transcutaneous [Pco.sub.2] was measured with a Severinghaus-type Tc[Pco.sub.2] Sensor (V-Sign Sensor, SenTec AG, Therwil, Switzerland). For this purpose, the chickens were deplumed at the chest above the pectoral muscles, and the skin was cleaned with alcohol and dried to ensure good adhesion of the attachment ring. The attachment ring was attached to the skin by gently pressing the adhesive on the skin as recommended by the manufacturer. Then, a small drop of SenTec Contact Gel was applied to the skin area in the center of the attachment ring and the sensor was snapped into the attachment ring.

After reaching a cardiovascular stable anesthetic condition, acute hemorrhagic shock was induced by removing approximately 50% of the birds' blood volume (estimated as 6% body weight) through the jugular catheter during a period of 40-50 minutes. The birds were then randomly assigned to receive either no resuscitation (control group, n = 10), autotransfusion of the blood volume removed (mixed 7:1 with sodium citrate) (blood group, n = 10), fluid replacement with a hemoglobin-based oxygen carrier (Hemospan, Sangart Inc, San Diego, CA, USA) (hemospan group, n = 10), or fluid replacement with a colloid (HAES-steril 200/0.5, Fresenius, Bad Homburg, Germany) (haes group, n = 10) during approximately 30 minutes until at least 90% of the removed volume was replaced. After fluid resuscitation, the birds were allowed to recover from anesthesia and were observed for 7 days.

Arterial blood gases were measured during stable anesthetic conditions before phlebotomy (TO), immediately after removing 50% of the animal's total blood volume (T50%), and 30 minutes after resuscitation. In addition, HR, RR, SAP, Sp[O.sub.2], [Etco.sub.2], Tc[Pco.sub.2], and Gi[Pco.sub.2] were measured during anesthesia under stable conditions (TO, baseline), after loss of 10% (T10%), 20% (T20%), 30% (T30%), 40% (T40%), and 50% (T50%) of the total blood volume, at the end of resuscitation (RES) and at the end of anesthesia (END).

The PCV and hemoglobin concentration were determined at TO, T50%, RES, and on days 1, 3, and 7 after induced hemorrhagic shock. Venous lactic acid concentrations were evaluated at TO, T50%, and END in each bird.

Statistical evaluation

Results are given as means [+ or -] standard deviation for HR, RR, and SAP, and as medians (25 75 percentiles) for C[O.sub.2] measurements, based on the results of the Kolmogorov Smirnov test. Results were analyzed by repeated measures analysis of variance (ANOVA), where sampling interval was the within-subjects factor, and group (control, autotransfusion, haes, and hemospan) was the between-subjects factor. Because parametric assumptions were not met in many instances (Shapiro-Wilk P > .05), all repeated measures ANOVAs were performed on ranked data. Where necessary, multiple comparisons tests were performed with Tukey's honestly significant difference post hoc test. These analyses were done with a general linear model in statistical software (GLM module, STATISTICA v8.0, StatSoft Inc [2007], www.statsoft.com). To determine whether there was an association between the type of fluid given and the number of birds that died in each group, a Fisher exact test was performed. Differences among C[O.sub.2] measurements were evaluated by Kruskal-Wallis ANOVA. The significance level was set to P < .05 throughout.

Results

Of the 10 leghorn chickens included in each group in the study, 4 birds (40%) in the control group died after the end of anesthesia. Of those resuscitated with fluids, 2 birds (20%) in the blood group, 3 birds (30%) in the hues group, and 3 birds (30%) in the hemospan group died. Mortality rate did not differ significantly among the 4 groups, and no trend regarding mortality rate was observed (P = .78).

Results of statistical analysis for differences in RR, HR, and SAP measurements are given in Table 1. The mean RR of all 40 chickens was 10.3 [+ or -] 4.1 [min.sup.-1] under stable conditions at the beginning of the study (T = 0). During blood removal, RRs first decreased, but then, increased slightly again in all groups (Table 2; Fig 1). At the end of anesthesia, the RRs increased in all 4 groups. Although the effect of time on RR was significant, there were no differences among the treatment groups (Table 1).

The mean HR of all chickens was 240.4 [+ or -] 53.6 beats [min.sup.-1] at T = 0. During blood removal, HRs were highly variable in all groups, but after resuscitation, the HR increased in the 3 groups receiving fluids. At the end of anesthesia, HRs decreased in the 3 groups receiving fluids but increased in the control group (Table 3). No significant difference was found among treatments but general differences among time points were significant (Table 1).

The mean SAP was 123.1 [+ or -] 32.5 mm Hg in all chickens at T = 0. During blood loss, there was a constant decrease in SAP in all groups (Table 4; Fig 2). After resuscitation, SAP returned toward baseline values in the 3 groups receiving fluids but not in the control group. The highest SAP (105.6 [+ or -] 19.6 mm Hg) was observed in the hemospan group, and SAP was greater than 90 mm Hg only in the hemospan group and blood group. There was a significant effect of time and time/treatment interactions (Table 1).

Results of PCV, hemoglobin, and lactic acid measurements are given in Tables 5 through 7. Under stable anesthetic conditions (TO) and after hemorrhagic shock (T50%), the PCV and hemoglobin values did not differ significantly among the groups (see Table 8). However, after resuscitation, both PCV and hemoglobin were numerically higher in the blood group (Tables 5 and 6). Values returned to baseline in all groups after 7 days. Venous lactic acid measurements increased after induced hemorrhagic shock in all groups (Table 7); differences among the groups were not significant (Table 8). After resuscitation, values decreased in the 3 resuscitation groups but were still above baseline measurements.

Values for [Paco.sub.2], Tc[Pco.sub.2], and Gi[Pco.sub.2] were obtained in at least 6 anesthetized leghorn chickens per group (Table 9). Measurements of [Etco.sub.2] were obtained in all chickens. Under stable anesthetic

conditions (T0), Tc[Pco.sub.2] was less than, and Gi[Pco.sub.2] and [Etco.sub.2] were greater than, [Paco.sub.2]. At that time point, Gi[Pco.sub.2] and [Etco.sub.2] differed significantly from [Paco.sub.2] but Tc[Pco.sub.2] did not. After hemorrhagic shock (T50%), Tc[Pco.sub.2] and Gi[Pco.sub.2] increased and [Etco.sub.2] decreased from values at TO (Table 9). At T50%, Tc[Pco.sub.2] and Gi[Pco.sub.2] differed significantly from PaC[O.sub.2] but EtC[O.sub.2] did not. There were no significant differences in Tc[Pco.sub.2] or Gi[Pco.sub.2] at any time point between animals that survived and animals that died in any of the groups and across all groups. The Tc[Pco.sub.2] and Gi[Pco.sub.2] values did not return to normal at the end of the resuscitation in any of the treatment groups. For Tc[Pco.sub.2] measurements, the lowest values at the end of resuscitation could be observed in the haes group and the blood group. For Gi[Pco.sub.2] measurements, the most obvious decrease at the end of resuscitation could be observed in the haes group.

Discussion

In the present study, no significant difference in mortality rate was found between the control group and the 3 fluid resuscitation groups, although fewer birds died in the blood group. These results must be considered cautiously because of several limitations. The small number of birds used may have resulted in a nonsignificant difference in mortality between the control group and the 3 resuscitations groups. In addition, data regarding the response of birds to acute blood loss and fluid resuscitation in previous reports varies considerably depending on the type of fluid and volumes administered. (1,8,23-25) In the present study, 90% of the blood loss was replaced over a period of approximately 30 minutes, and responses over different time frames or with different volumes cannot be inferred. In addition, the possible effects of a combination of different fluid types might be advantageous. Because little data exist on the fluid requirements for birds in hemorrhagic shock, volumes and rates used in the present study may need to be increased in future studies.

A variety of different fluid types are commonly used for fluid resuscitation in avian medicine. Colloids, such as hetastarch, dextran, and HBOCS, are large-molecular substances that remain in the intravascular compartment and expand the intravascular volume. This renders them more effective and longer lasting than crystalloids. In previous studies, administration of colloids at a bolus of 10 to 20 mL/kg was found to be safe and effective in birds. (25) Other authors have recommended colloid administration of 5 mL/kg IV or IO in combination with crystalloids until systolic blood pressure is greater than 90 mm Hg (1,23), repeated administration of 10 mL/kg IV until clinical improvement, (26) and administration of 3 to 5 mL/kg IV in combination with hypertonic saline. (27) In the present study, the colloid used (HAES) was a 6% solution of pentastarch (200/0.5), which exerts a colloid osmotic pressure of 40 mm Hg and stays in the intravascular space, increasing colloid osmotic pressure. Administration of this colloid did not appear to offer any advantage in the treatment of hemorrhagic shock compared with treatment with either the other fluids evaluated or no treatment (control group). This was similar to the findings in a previous study that evaluated the effect of administration of 5 mL/kg HAES given over 5 minutes for resuscitation in mallard ducks (Anas platyrhynchos) after induced hemorrhagic shock. (4)

Although blood transfusions are rarely given to birds, they may offer advantages over crystalloids and colloids in hemorrhagic shock. (2) Findings in previous reports are controversial. Some authors have recommended blood transfusions in birds with a PCV of less than 15% to 20%, (8,24,28) but other authors found that pigeons (Columba livia) suffering from hemorrhagic shock were best treated with intravenous, balanced crystalloids rather than heterologous or homologous transfusions, (29) and there was no significant differences in PCV after 6 days in pigeons treated with homologous transfusions or given no treatment. (28) However, that is not surprising because it appears from our data that PCV will be corrected within 7 days. In the present study, no statistical differences were found in any of the measured parameters between the autotransfusion group and groups treated with other fluids or given no resuscitation, other than in PCV and hemoglobin content after resuscitation. However, those values returned to baseline in all groups after 7 days. Although immediate response in terms of blood cells and oxygen carrying capacity of the blood might be improved, usability and clinical advantage need further investigation.

Only a few previous studies have investigated the use of HBOCS in birds. In one study, (4) a trend of decreased mortality was observed in mallard ducks given 5 mL/kg oxyglobin during a 5-minute period compared with other fluids after acute blood loss. In the present study, Hemospan was administered as an oxygen carrier with high molecular size, a colloid osmotic pressure of 70 mm Hg, and increased oxygen affinity. In comparison to other HBOCS, Hemospan induces less vasoconstriction and reduction of blood flow and offers a prolonged intravascular retention time. (30) To our knowledge, Hemospan has not been previously examined for treatment of hemorrhagic shock in birds. In the present study, no advantages in survival were found after administration of Hemospan compared with the control group and the other resuscitation groups.

After acute blood loss in mammals, hypotension leads immediately to an increase in peripheral vascular resistance as a primary compensatory mechanism. Constriction of venous vessels improves the venous return to the right heart, whereas constriction of arteries in nonessential tissues helps to maintain perfusion of vital organs. In addition, HR increases because of the decreased stroke volume. This compensatory mechanism is not associated with a carotid baroreceptor response in chickens. (2) This may explain the lack of increase in HR observed in the present study during induced hemorrhagic shock. As expected, SAP decreased in all groups over time with blood removal and increased again with resuscitation, except in the control group. Significant differences in SAP were observed among the 4 groups and among time points. Therefore, volume replacement itself, irrespective of the type of fluid used, is important for the maintenance of a stable SAP in hemorrhagic shock.

In the present study, PCV and hemoglobin concentrations began to rise again by day 3 after phlebotomy, and baseline values were reached 7 days after blood removal in all groups. This early regenerative response is consistent with findings in a previous study, where signs of regeneration were evident within 24 hours after phlebotomy. (4) In contrast to the previous study, relative polychromasia was not evaluated in the present study. As previously described, it appears that the regeneration of blood cells is rapid in birds compared with mammals, possibly because mature cells in birds are nucleated and require less maturation time in bone marrow. (4)

In human medicine, TcPC[O.sub.2] measurements are used to evaluate skin perfusion in patients in the emergency department, particularly in infants and premature neonates. (31) In one study, patients in the emergency department that did not survive had higher initial Tc[Pco.sub.2] values as an early indicator for hemodynamic shock than did survivors. (31) In the present study, Tc[Pco.sub.2] increased at T50% compared with TO. That is consistent with reduced perfusion in hemorrhagic shock and an associated decreased C[O.sub.2] removal from tissue.

Gastric intraluminal C[O.sub.2] measurements have been found useful in treating human trauma patients requiring critical care and hold potential as a useful tool to monitor veterinary emergency and critical care patients. (17) A high Gi[Pco.sub.2] reflects inadequate gastrointestinal mucosal perfusion during shock and resuscitation; therefore, continuous measurements can be used to guide medical treatment and predict outcome. (17) In human patients requiring emergency treatment, a high initial Gi[Pco.sub.2] and longer time for improvement of Gi[Pco.sub.2] was associated with poor survival. (32) In pigs, GiPC[O.sub.2] reflected local mesenterial hypoperfusion, which could not be detected by arterial, mixed venous lactate concentrations, pH, and [Pco.sub.2] determinations. (20) In the present study, Gi[Pco.sub.2] increased at T50%, compared with T0, consistent with a low-flow condition in hemorrhagic shock.

In our study, [Etco.sub.2] measurements decreased at T50% compared with T0, which is consistent with a reduced circulating blood volume and decreased C[O.sub.2] delivery to the lungs during induced hemorrhagic shock. The [Etco.sub.2] differed significantly from [Paco.sub.2] at TO but not at T50%. Nevertheless, no correlation was found between [Etco.sub.2] and [Paco.sub.2] at T50%.

In conclusion, no difference in the mortality was found among the control group and the 3 resuscitation groups, and a clear benefit of resuscitation could, therefore, not be demonstrated. However, further studies with larger numbers of birds may be necessary to conclude whether resuscitation is beneficial and, if so, which fluids are most beneficial--considering the different osmolarity of avian blood compared with mammals. In the present study, erythrocyte regeneration was noted 3 days after phlebotomy, and baseline PCV and hemoglobin values were reached 7 days after blood removal, demonstrating early and rapid red cell regeneration in chickens. Measurements of Tc[Pco.sub.2], Gi[Pco.sub.2], and [Etco.sub.2] are technically achievable in leghorn chickens. Although results of the present study did not reveal these measurements as predictors of survival, changes in the values measured during shock were consistent with poor perfusion. These measurements may prove useful for serial evaluation of responses to shock and shock treatment. Further studies should be undertaken to better understand the mechanism of hemorrhagic shock in birds and their response to fluid resuscitation.

Acknowledgements: We thank Marcus Clauss and the team of the Clinic for Zoo Animals, Exotic Pets and Wildlife for their assistance. We also thank Sangart and SenTec AG for the contribution of material for the present study.

References

(1.) Lichtenberger M. Principles of shock and fluid therapy in special species. Semin Avian Exot Pet Med. 2004;13(3):142-153.

(2.) Jenkins JR. Avian critical care and emergency medicine. In: Altman RB, Clubb SL, Dorrestein GM, Quesenberry K, eds. Avian Medicine and Surgery. Philadelphia, PA: WB Saunders; 1997: 839-863.

(3.) Harrison G J, Lightfoot TL, Flinchum GB. Emergency and critical care. In: Harrison G J, Lightfoot TL, eds. Clinical Avian Medicine. Vol 1. Palm Beach, FL: Spix Publishing, 2006:213-232.

(4.) Lichtenberger M, Orcutt C, Cray C, et al. Comparison of fluid types for resuscitation after acute blood loss in mallard ducks (Anas plaotrhynchos). J Vet Emerg Crit Care. 2009;19(5):467-472.

(5.) Kovach AG, Szasz E, Pilmayer N. Mortality of various avian and mammalian species following blood loss. Acta Physiol Acad Sci Hung. 1969;35(2):109-116.

(6.) Ploucha JM, Scott JB, Ringer RK. Vascular and hematologic effects of hemorrhage in the chicken. Am J Physiol. 1981 ;240(1):H9-H17.

(7.) Gildersleeve RP, Galvin M J, Thaxton JP, McRee DI. Hematological response of Japanese quail to acute hemorrhagic stress. Comp Biochem Physiol A Comp Physiol. 1985;81 (2):403-409.

(8.) Steinohrt LA. Avian fluid therapy. J Avian Med Surg. 1999; 13(2): 83-91.

(9.) Van der Linden P, Rausin I, Deltell A, et al. Detection of tissue hypoxia by arteriovenous gradient for Pco2 and pH in anesthetized dogs during progressive hemorrhage. Anesth Analg. 1995; 80(2):269-275.

(10.) Steinmetz HW, Vogt R, Kastner S, et al. Evaluation of the i-STAT portable clinical analyzer in chickens (Gallus gallus). J Vet Diagn Invest. 2007;19(4):382-388.

(11.) Richardi JC, Nightingale TE. Comparison of brachial venous and mixed blood gas tensions and pH values in the chicken. Poult Sci. 1981;60(7): 1558-1560.

(12.) Edling TM, Degernes LA, Flammer K, Horne WA. Capnographic monitoring of anesthetized African grey parrots receiving intermittent positive pressure ventilation. J Am Vet Med Assoc. 2001;219(12): 1714-1718.

(13.) Bhende MS. End-tidal carbon dioxide monitoring in pediatrics: concepts and technology. J Postgrad Med. 2001;47(2): 153-156.

(14.) Tremper KK, Mentelos RA, Shoemaker WC. Effect of hypercarbia and shock on transcutaneous carbon dioxide at different electrode temperatures. Crit Care Med. 1980;8(11):608 612.

(15.) Monheit AG, Stone ML, Abitbol MM. Fetal heart rate and transcutaneous monitoring during experimentally induced hypoxia in the fetal dog. Pediatr Res. 1988;23(6):548-552.

(16.) Steinmetz HW, Vogt R, Kastner S, et al. Transcutaneous carbon dioxide partial pressure monitoring in avian medicine. Proc Annu Conf Am Assoc Zoo Vet. 2006;14-16.

(17.) Wall PL. GI [P.sub.i]co2: tissue specific monitoring for improving patient outcomes. J Vet Emerg Crit Care. 1996;6(1):7-11.

(18.) Wall PL, Davis D J, Buising CM, Henderson LL. Non-equivalence of canine tissue and intraluminal Pco2 responses at different sites during hemorrhage and during resuscitation. J Vet Emerg Crit Care. 2008;18(3):277-284.

(19.) Clavijo-Alvarez JA, Sims CA, Menconi M, et al. Bladder mucosa pH and Pco2 as a minimally invasive monitor of hemorrhagic shock and resuscitation. J Trauma. 2004;57(6):1199-1210.

(20.) Knichwitz G, Rotker J, Mollhoff T, et al. Continuous intramucosal Pco2 measurement allows the early detection of intestinal malperfusion. Crit Care Med. 1998;26(9):1550-1557.

(21.) Morgan TJ, Venkatesh B, Endre ZH. Continuous measurement of gut luminal [Pco.sub.2] in the rat: responses to transient episodes of graded aortic hypotension. Crit Care Med. 1997;25(9):1575-1578.

(22.) Knichwitz G, Rotker J, Brussel T, et al. A new method for continuous intramucosal [Pco.sub.2] measurement in the gastrointestinal tract. Anesth Analg. 1996;83(1):6-11.

(23.) Lichtenberger M. Shock and cardiopulmonary-cerebral resuscitation in small mammals and birds. Vet Clin North Am Exot Ani Pract. 2007;10(2):275-291.

(24.) Morrisey JK. Transfusion medicine in birds. Western Veterinary Conference 2004. Veterinary Information Network Online Proceedings Web site. http://www.vin.com/Members/Proceedings/ Proceedings.plxCID=wvc2004&PID=pr05739&O= VIN. Accessed May 1, 2006.

(25.) Redig P. Fluid therapy and acid-base balance in the critically ill avian patient. Proc Annu Conf Assoc Avian Vet. 1984:59-73.

(26.) De Matos R, Morrisey JK. Emergency and critical care of small psittacines and passerines. Semin Avian Exot Pet Med. 2005;14(2):90-105.

(27.) Fronefield S. The goal: quality avian medicine. J Exotic Pet Med. 2010;19(1):4-21.

(28.) Finnegan MV, Daniel GB, Ramsay EC. Evaluation of whole blood transfusions in domestic pigeons (Columbia livia). J Avian Med Surg. 1997;11(1):7-14.

(29.) Bos JH, Todd B, Tell LA, et al. Treatment of anemic birds with iron dextran therapy, homologous and heterologous blood transfusions. Proc Annu Conf Assoc A vian Vet. 1990:221-225.

(30.) Vandegriff KD, Winslow RM. Hemospan: design principles for a new class of oxygen therapeutic. ArtifOrgans. 2009;33(2):133-138.

(31.) Tatevossian RG, Wo CC, Velmahos GC, et al. Transcutaneous oxygen and CO2 as early warning of tissue hypoxia and hemodynamic shock in critically ill emergency patients. Crit Care Med. 2000;28(7): 2248-2253.

(32.) Ivatury RR, Simon R J, Havriliak D, et al. Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resuscitation after trauma: a prospective, randomized study. J Trauma. 1995;39(1): 128-136.

Morena B. Wernick, Dr Med Vet, Dipl ECZM (Avian), Hanspeter W. Steinmetz, Dr Med Vet, Dipl ACZM, Olga Martin-Jurado, Dr Med Vet, Judith Howard, Dr Med Vet, Dipl ACVIM, Barbara Vogler, Dr Med Vet, Rainer Vogt, Dr Med Vet, Dipl ECVAA, Daryl Codron, Dr Rer Nat, and Jean-Michel Hatt, Prof Dr Med, Vet Dipl ACZM, Dipl ECZM (Avian)

From the Clinic for Zoo Animals, Exotic Pets and Wildlife (Wernick, Steinmetz, Vogler, Codron, Hatt) and the Division of Anesthesiology (Martin-Jurado, Vogt), Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8052 Zurich, Switzerland; and the Clinical Laboratory, Vetsuisse Faculty, University of Bern, Laenggass-Strasse 124, 3001 Bern, Switzerland (Howard). Present address (Steinmetz): Knies Kinderzoo, Oberseestrasse, 8640 Rapperswil, Switzerland.

Table 1. General linear model showing the effects of
group, sampling interval, and group-sampling interval
interaction for respiratory rate (RR), heart rate (HR),
and systolic arterial blood pressure (SAP) in leghorn
chickens under general anesthesia during induced
hemorrhagic shock and resuscitation with different
fluid types.

Measurement        Effect                    F                P

RR            Group                 [F.sub.3,29] = 0.276     .84
              Sampling interval    [F.sub.6,174] = 7.920    <.001
              Group x             [F.sub.18,174] = 1.133     .33
                sampling
                interval

HR            Group                 [F.sub.3,23] = 1.086     .38
              Sampling interval    [F.sub.3,138] = 0.652     .69
              Group x             [F.sub.18,138] = 0.713     .79
                sampling
                interval

SAP           Group                 [F.sub.3,18] = 0.257     .86
              Sampling interval    [F.sub.6,108] = 52.713   <.001
              Group x             [F.sub.18,108] = 2.309     .00
                sampling
                interval

Table 2. Respiratory rates (mean [+ or -] SD) in leghorn chickens
under general anesthesia during induced hemorrhagic shock and
resuscitation with different fluid types.

                                       Respiratory rate, (b)
                                  mean [+ or -] SD, [min.sup.-1]

       Groups (a)                  T0                    T10%

Control (n = 10)           10.3 [+ or -] 1.8      7.3 [+ or -] 2.4
Autotransfusion (n = 10)   10.3 [+ or -] 4.5     10.1 [+ or -] 6.4
Haes (n = 10)              11.7 [+ or -] 5.5      9.6 [+ or -] 5.9
Hemospan (n = 10)           8.8 [+ or -] 3.6      8.1 [+ or -] 3.8
All groups (c) (n = 40)    10.3 [+ or -] 4.1 A    8.8 [+ or -] 4.9 BC

                                       Respiratory rate, (b)
                                  mean [+ or -] SD, [min.sup.-1]

       Groups (a)                 T20%                 T30%

Control (n = 10)           7.0 [+ or -] 1.9      7.6 [+ or -] 2.2
Autotransfusion (n = 10)   8.3 [+ or -] 2.4      9.1 [+ or -] 5.2
Haes (n = 10)              9.9 [+ or -] 5.9     10.3 [+ or -] 7.7
Hemospan (n = 10)          7.6 [+ or -] 2.9      8.0 [+ or -] 3.1
All groups (c) (n = 40)    8.2 [+ or -] 3.7 C    8.8 [+ or -] 4.9 C

                                       Respiratory rate, (b)
                                  mean [+ or -] SD, [min.sup.-1]

       Groups (a)                 T40%                  T50%

Control (n = 10)            7.2 [+ or -] 2.0      7.4 [+ or -] 2.2
Autotransfusion (n = 10)    9.5 [+ or -] 5.5      8.5 [+ or -] 4.8
Haes (n = 10)              10.5 [+ or -] 6.8     10.1 [+ or -] 6.9
Hemospan (n = 10)           7.8 [+ or -] 3.2      7.9 [+ or -] 3.1
All groups (c) (n = 40)     8.8 [+ or -] 4.8 C    8.5 [+ or -] 4.5 C

                                       Respiratory rate, (b)
                                  mean [+ or -] SD, [min.sup.-1]

       Groups (a)                 RES                  END

Control (n = 10)                  --           11.4 [+ or -] 8.6
Autotransfusion (n = 10)    8.5 [+ or -] 4.0   11.6 [+ or -] 9.5
Haes (n = 10)              10.9 [+ or -] 6.1   13.4 [+ or -] 10.3
Hemospan (n = 10)           8.1 [+ or -] 3.3    8.4 [+ or -] 3.2
All groups (c) (n = 40)     9.2 [+ or -] 4.6   11.2 [+ or -] 8.3 AB

(a) Animal groups: control group indicates no resuscitation given;
autotransfusion group, resuscitation with the blood removed during
phlebotomy; haes group, resuscitation with HAES-steril; hemospan
group, resuscitation with Hemospan.

(b) Time points: TO indicates before phlebotomy; T10%, after
removal of 10% blood volume; T20%, after removal of 20% blood
volume; T30%, after removal of 30% blood volume; T40%, after
removal of 40% blood volume; T50%, after removal of 50% blood
volume; RES, at the end of resuscitation; END, at the end of
anesthesia.

(c) Means with different small capital letters are significantly
different among time points.

Table 3. Heart rates (mean [+ or -] SD) in leghorn chickens under
general anesthesia during induced hemorrhagic shock and resuscitation
with different fluid types.

                           Heart rate, (b) mean [+ or -] SD, beats/min

       Groups (a)                  T0                   T10%

Control (n = 10)           222.6 [+ or -] 44.0   209.8 [+ or -] 50.5
Autotransfusion (n = 10)   244.8 [+ or -] 42.8   221.6 [+ or -] 40.6
Haes (n = 10)              245.5 [+ or -] 57.1   229.2 [+ or -] 38.0
Hemospan (n = 10)          248.4 [+ or -] 70.3     216 [+ or -] 70.4
All groups (n = 40)        240.4 [+ or -] 53.6   219.6 [+ or -] 50.1

                           Heart rate, h mean [+ or -] SD, beats/min

       Groups (a)                 T20%                  T30%

Control (n = 10)           223.1 [+ or -] 59.3   229.6 [+ or -] 56.5
Autotransfusion (n = 10)   236.1 [+ or -] 55.5   223.8 [+ or -] 64.3
Haes (n = 10)              241.7 [+ or -] 41.6   237.9 [+ or -] 37.1
Hemospan (n = 10)          206.7 [+ or -] 53.9   217.1 [+ or -] 58.3
All groups (n = 40)        225.9 [+ or -] 52.3   226.7 [+ or -] 53.4

                           Heart rate, h mean [+ or -] SD, beats/min

       Groups (a)                 T40%                   T50%

Control (n = 10)             174 [+ or -] 66.6   184.6 [+ or -] 98.1
Autotransfusion (n = 10)     226 [+ or -] 92.6   229.2 [+ or -] 66.8
Haes (n = 10)                215 [+ or -] 63.3   240.9 [+ or -] 84.1
Hemospan (n = 10)            231 [+ or -] 82.1   198.3 [+ or -] 103.4
All groups (n = 40)        210.0 [+ or -] 75.7   212.1 [+ or -] 88.9

                           Heart rate, h mean [+ or -] SD, beats/min

       Groups (a)                  RES                   END

Control (n = 10)                                 187.9 [+ or -] 116.8
Autotransfusion (n = 10)   236.8 [+ or -] 46.6   214.9 [+ or -] 81.2
Haes (n = 10)              259.3 [+ or -] 96.0   243.5 [+ or -] 91.7
Hemospan (n = 10)          233.7 [+ or -] 37.0   215.9 [+ or -] 40.4
All groups (n = 40)        243.5 [+ or -] 64.5   215.6 [+ or -] 85.9

(a) Animal groups: control group indicates no resuscitation given;
auto transfusion group, resuscitation with the blood removed during
phlebotomy; haes group, resuscitation with HAES-steril; hemospan
group, resuscitation with Hemospan.

(b) Time points: TO indicates before phlebotomy; T10%, after
removal of 10% blood volume; T20%, after removal of 20% blood
volume; T30%," after removal of 30% blood volume; T40%, after
removal of 40% blood volume; T50%, after removal of 50% blood
volume; RES, at the end of resuscitation; END, at the end of
anesthesia.

Table 4. Systolic blood pressure (mean [+ or -] SD) in leghorn
chickens under general anesthesia during induced hemorrhagic
shock and resuscitation with different fluid types.

                                  Systolic blood pressure, (b)
                                   mean [+ or -] SD, mm Hg

       Groups (a)                  T0                    T10%

Control (n = 10)          122.2 [+ or -] 37.8     71.1 [+ or -] 34.5
Autotransfusion (n = 10)  115.8 [+ or -] 29.5    103.3 [+ or -] 37.1
Haes (n = 10)             132.7 [+ or -] 26.3     94.6 [+ or -] 12.0
Hemospan (n = 10)         121.5 [+ or -] 38.4     90.1 [+ or -] 15.8
All groups (n = 40)       123.1 [+ or -] 32.5 A   89.9 [+ or -] 27.8 B

                                  Systolic blood pressure, (b)
                                   mean [+ or -] SD, mm Hg

       Groups (a)                 T20%                  T30%

Control (n = 10)          47.3 [+ or -] 17.0    47.4 [+ or -] 26.2
Autotransfusion (n = 10)  62.9 [+ or -] 36.5    46.0 [+ or -] 32.2
Haes (n = 10)             69.3 [+ or -] 30.9    46.0 [+ or -] 28.7
Hemospan (n = 10)         62.9 [+ or -] 31.6    40.9 [+ or -] 25.9
All groups (n = 40)       60.0 [+ or -] 29.2 C  44.9 [+ or -] 27.2 D

                                  Systolic blood pressure, (b)
                                   mean [+ or -] SD, mm Hg

       Groups (a)                 T40%                   T50%

Control (n = 10)          37.6 [+ or -] 27.2     32.9 [+ or -] 28.1
Autotransfusion (n = 10)  33.0 [+ or -] 22.2     43.2 [+ or -] 19.7
Haes (n = 10)             36.7 [+ or -] 20.7     39.8 [+ or -] 33.7
Hemospan (n = 10)         23.0 [+ or -] 4.0      30.0 [+ or -] 21.1
All groups (n = 40)       32.8 [+ or -] 20.2 D   36.3 [+ or -] 25.2 D

                                  Systolic blood pressure, (b)
                                   mean [+ or -] SD, mm Hg

       Groups (a)                 RES                   END

Control (n = 10)                  --            42.6 [+ or -] 31.8
Autotransfusion (n = 10)   94.4 [+ or -] 20.5   95.7 [+ or -] 41.1
Haes (n = 10)              85.1 [+ or -] 24.3   79.3 [+ or -] 32.1
Hemospan (n = 10)         103.6 [+ or -] 23.0  105.6 [+ or -] 19.6
All groups (n = 40)        94.4 [+ or -] 23.3   81.8 [+ or -] 38.9 B

(a) Animal groups: control group indicates no resuscitation
given; autotransfusion group, resuscitation with the blood
removed during phlebotomy; haes group, resuscitation with
HAES-steril; hemospan group, resuscitation with Hemospan.

(b) Time points: T0 indicates before phlebotomy; T10%, after
removal of 10% blood volume; T20%, after removal of 20% blood
volume; T30%, after removal of 30% blood volume; T40%, after
removal of 40% blood volume; T50%, after removal of 50% blood
volume; RES, at the end of resuscitation; END, at the end of
anesthesia.

(c) Means with different small capital letters are significantly
different among time points.

Table 5. Packed cell volume (mean [+ or -] SD) in leghorn
chickens during induced hemorrhagic shock and resuscitation with
different fluid types while under general anesthesia and days 1,
3, and 7 after anesthesia.

                           Packed cell volume, (b) mean [+ or -] SD, %

       Groups (a)                   T0                    T50%

Control (n = 10)           31 [+ or -] 4.2        21 [+ or -] 2.2
Autotransfusion (n = 10)   30 [+ or -] 6.3        20 [+ or -] 4.2
Haes(n = 10)               31 [+ or -] 4.5        21 [+ or -] 2.5
Hemospan (n = 10)          31 [+ or -] 4.2        21 [+ or -] 4.5
All groups (c) (n = 40)    31 [+ or -] 4.7 A      21 [+ or -] 3.4 B

                           Packed cell volume, (b) mean [+ or -] SD, %

       Groups (a)                  RES                   Day 1

Control (n = 10)                    --            22 [+ or -] 3.6
Autotransfusion (n = 10)   25 [+ or -] 5.5        28 [+ or -] 7.1
Haes(n = 10)               11 [+ or -] 1.8        20 [+ or -] 5.2
Hemospan (n = 10)          12 [+ or -] 3.0        19 [+ or -] 4.4
All groups (c) (n = 40)    16 [+ or -] 7.2        22 [+ or -] 6.2 B

                           Packed cell volume, (b) mean [+ or -] SD, %

       Groups (a)                 Day 3                  Day 7

Control (n = 10)           29 [+ or -] 3.3        33 [+ or -] 2.3
Autotransfusion (n = 10)   32 [+ or -] 8.2        34 [+ or -] 7.3
Haes(n = 10)               28 [+ or -] 4.7        32 [+ or -] 6.1
Hemospan (n = 10)          27 [+ or -] 3.8        32 [+ or -] 4.1
All groups (c) (n = 40)    29 [+ or -] 5.9 C      33 [+ or -] 5.2 D

(a) Animal groups: control group indicates no resuscitation given;
autotransfusion group, resuscitation with the blood removed during
phlebotomy; haes group, resuscitation with HAES-steril; hemospan
group, resuscitation with Hemospan.

(b) Time points: TO indicates before phlebotomy; T50%, after
removal of 50% blood volume; RES, at the end of resuscitation.

(c) Means with different small capital letters are significantly
different among time points.

Table 6. Hemoglobin concentration (mean [+ or -SD) in leghorn
chickens during induced hemorrhagic shock and resuscitation with
different fluid types while under general anesthesia and days 1,
3, and 7 after anesthesia.

                            Hemoglobin, (b) mean [+ or -] SD, g/dL

       Groups (a)                  T0                  T50%

Control (n = 10)           9.5 [+ or -] 1.4     6.7 [+ or -] 0.9
Autotransfusion (n = 10)   9.6 [+ or -] 1.7     6.5 [+ or -] 1.4
Haes (n = 10)              9.7 [+ or -] 1.4     6.5 [+ or -] 0.8
Hemospan (n = 10)          9.8 [+ or -] 1.1     6.7 [+ or -] 1.3
All groups (c) (n = 40)    9.7 [+ or -] 1.4 A   6.6 [+ or -] 1.1 B

                            Hemoglobin, (b) mean [+ or -] SD, g/dL

       Groups (a)                 RES                 Day 1

Control (n = 10)                   --           6.6 [+ or -] 1.3
Autotransfusion (n = 10)   7.7 [+ or -] 2.0     8.3 [+ or -] 2.0
Haes (n = 10)              3.4 [+ or -] 0.5     6.1 [+ or -] 1.6
Hemospan (n = 10)          5.3 [+ or -] 0.8     5.8 [+ or -] 0.9
All groups (c) (n = 40)    5.5 [+ or -] 2.1     6.7 [+ or -] 1.8 B

                            Hemoglobin, (b) mean [+ or -] SD, g/dL

       Groups (a)                Day 3                 Day 7

Control (n = 10)           8.2 [+ or -] 1.4      9.3 [+ or -] 0.9
Autotransfusion (n = 10)   9.5 [+ or -] 2.9     10.2 [+ or -] 2.5
Haes (n = 10)              7.8 [+ or -] 1.5      9.2 [+ or -] 1.8
Hemospan (n = 10)          7.8 [+ or -] 1.9      9.5 [+ or -] 1.3
All groups (c) (n = 40)    8.4 [+ or -] 2.1 C    9.6 [+ or -] 1.8 A

(a) Animal groups: control group indicates no resuscitation given;
autotransfusion group, resuscitation with the blood removed during
phlebotomy; haes group, resuscitation with HAES-steril; hemospan
group, resuscitation with Hemospan.

(b) Time points: TO indicates before phlebotomy; T50%, after
removal of 50% blood volume; RES, at the end of resuscitation.

(c) Means with different small capital letters are significantly
different among time points.

Table 7. Venous lactic acid concentration (mean [+ or -] SD)
in leghorn chickens under general anesthesia during
induced hemorrhagic shock and resuscitation with
different fluid types.

                             Venous lactic acid (b)
                            mean [+ or -] SD, mmol/L

   Groups (a)              T0                  T50%

Control (n = 10)   1.3 [+ or -] 0.1     6.0 [+ or -] 2.2
Autotransfusion    1.0 [+ or -] 0.2     4.4 [+ or -] 1.4
  (n = 10)
Haes (n = 10)      1.1 [+ or -] 0.3     6.0 [+ or -] 2.1
Hemospan           1.2 [+ or -] 0.4     5.4 [+ or -] 2.0
  (n = 10)
All groups (c)     1.2 [+ or -] 0.3 A   5.5 [+ or -] 2.0 B
 (n = 40)

                    Venous lactic acid (b)
                   mean [+ or -] SD, mmol/L

   Groups (a)                END

Control (n = 10)              --
Autotransfusion    3.1 [+ or -] 1.4
  (n = 10)
Haes (n = 10)      4.6 [+ or -] 3.4
Hemospan           3.3 [+ or -] 0.8
  (n = 10)
All groups (c)     3.7 [+ or -] 2.1
 (n = 40)

(a) Animal groups: control group indicates no resuscitation given;
autotransfusion group, resuscitation with the blood removed
during phlebotomy; haes group, resuscitation with HAES-steril;
hemospan group, resuscitation with Hemospan.

(b) Time points: T0 indicates before phlebotomy; T50%, after
removal of 50% blood volume; END, at the end of anesthesia.

(c) Means with different small capital letters are significantly
different among time points.

Table 8. General linear model showing the effects of
group, sampling interval, and group-sampling interval
interaction for packed cell volume (PCV), hemoglobin
(Hb), and venous lactic acid concentrations (Lactate) in
white leghorn chickens (n = 40) with induced
hemorrhagic shock.

Measurement        Effect                    F                P

PCV           Group                [F.sub.3,20] = 0.156      .92
              Sampling interval    [F.sub.4,80] = 82.536    <.001
              Group x             [F.sub.12,80] = 3.140     <.01
                sampling
                interval

Hb            Group                [F.sub.3,20] = 0.200      .86
              Sampling interval    [F.sub.4,80] = 79.427    <.001
              Group x             [F.sub.12,80] = 3.822     <.01
                sampling
                interval

Lactate       Group                [F.sub.3,20] = 1.741      .19
              Sampling interval    [F.sub.1,20] = 415.878   <.001
              Group x              [F.sub.3,20] = 0.655      .59
                sampling
                interval

Table 9. Arterial, transcutaneous, gastrointestinal, and
end-tidal partial pressures of C[O.sub.2] in leghorn chickens
(n = 40) under general anesthesia before and during
induced hemorrhagic shock.

                  C[O.sub.2] partial pressures, (a,b)
                 median (25th-75th percentiles), mm Hg

                        T0                  T50%

[Paco.sub.]2    22.3 (19.5-25.8) A   20.0 (18.7-32.1) A
Tc[Pco.sub.2]   17.0 (12.1-27.1) A   38.9 (27.4-48.9) B
Gi[Pco.sub.2]   31.5 (27.9-38.4) B   51.0 (39.0-62.4) B
[Etco.sub.2]    33.0 (25.5-42.0) B   22.0 (17.0-26.0) A

Abbreviations: [Paco.sub.2] indicates arterial partial pressure of
C[O.sub.2]; Tc[Pco.sub.2], transcutaneous partial pressure of
C[O.sub.2]; Gi[Pco.sub.2], gastrointestinal luminal partial
pressure of C[O.sub.2]; [Etco.sub.2], end-tidal partial pressure of
C[O.sub.2].

(a) Time points: TO indicates before phlebotomy; T50%, after
removal of 50% blood volume.

(b) Means with different small capital letters within columns are
significantly different (Kruskal-Wallis analysis of variance).
COPYRIGHT 2013 Association of Avian Veterinarians
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2013 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Original Studies
Author:Wernick, Morena B.; Steinmetz, Hanspeter W.; Martin-Jurado, Olga; Howard, Judith; Vogler, Barbara; V
Publication:Journal of Avian Medicine and Surgery
Article Type:Report
Date:Jun 1, 2013
Words:8011
Previous Article:Plasma protein electrophoresis in birds: comparison of a semiautomated agarose gel system with an automated capillary system.
Next Article:A technique for evisceration as an alternative to enucleation in birds of prey: 19 cases.
Topics:

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters