Jamie M. Burkitt-Creedon DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Benjamin M. Brainard VMC, DACVA, DACVECC, Gareth J. Buckley MA, VetMB, DACVECC, DECVECC, Steven E. Epstein DVM, DACVECC, Erik D. Fausak MSLIS, RVT, Kate Hopper BVSc, PhD, DACVECC, Selena L. Lane DVM, DACVECC, Elizabeth A. Rozanski DVM, DACVECC, DACVIM, Jacob Wolf DVM, DACVECC
Objective
After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring.
Design
These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks.
Setting
Transdisciplinary, international collaboration in university, specialty, and emergency practice.
Results
A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag–mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided.
Conclusions
While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.
{"title":"2024 RECOVER Guidelines: Updated treatment recommendations for CPR in dogs and cats","authors":"Jamie M. Burkitt-Creedon DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Benjamin M. Brainard VMC, DACVA, DACVECC, Gareth J. Buckley MA, VetMB, DACVECC, DECVECC, Steven E. Epstein DVM, DACVECC, Erik D. Fausak MSLIS, RVT, Kate Hopper BVSc, PhD, DACVECC, Selena L. Lane DVM, DACVECC, Elizabeth A. Rozanski DVM, DACVECC, DACVIM, Jacob Wolf DVM, DACVECC","doi":"10.1111/vec.13391","DOIUrl":"10.1111/vec.13391","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Transdisciplinary, international collaboration in university, specialty, and emergency practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag–mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 S1","pages":"104-123"},"PeriodicalIF":1.1,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kate Hopper BVSc, PhD, DACVECC, Steven E. Epstein DVM, DACVECC, Jamie M. Burkitt-Creedon DVM, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Erik D. Fausak MSLIS, RVT, Kim Mears MLIS, AHIP, Molly Crews MLS, the RECOVER Basic Life Support Domain Evidence Evaluators
<div> <section> <h3> Objective</h3> <p>To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps.</p> </section> <section> <h3> Design</h3> <p>Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.</p> </section> <section> <h3> Setting</h3> <p>Transdisciplinary, international collaboration in university, specialty, and emergency practice.</p> </section> <section> <h3> Results</h3> <p>Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag–mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation.</p> </section> <section> <h3> Conclusions</h3> <p>These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary re
{"title":"2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR","authors":"Kate Hopper BVSc, PhD, DACVECC, Steven E. Epstein DVM, DACVECC, Jamie M. Burkitt-Creedon DVM, DACVECC, Daniel J. Fletcher PhD, DVM, DACVECC, Manuel Boller Dr med vet, MTR, DACVECC, Erik D. Fausak MSLIS, RVT, Kim Mears MLIS, AHIP, Molly Crews MLS, the RECOVER Basic Life Support Domain Evidence Evaluators","doi":"10.1111/vec.13387","DOIUrl":"10.1111/vec.13387","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Transdisciplinary, international collaboration in university, specialty, and emergency practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag–mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary re","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 S1","pages":"16-43"},"PeriodicalIF":1.1,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marisa I. C. Lourenço DVM, Agustina Anson DVM, PhD, DECVDI, Ian M. DeStefano DVM, DACVECC, Katherine S. Logwood VMD, DACVR, Tiffany Stockman DVM, John Berg DVM, MS, DACVS
Objective
To describe the unique finding and treatment of a dog with cardiac herniation due to traumatic pericardial rupture.
Case Summary
A 6.5-year-old entire male Yorkshire Terrier was presented for further management after being hit by a car. Despite suspected significant intrathoracic trauma at that time, the patient regained hemodynamic stability and had orthopedic surgery to correct a right iliac fracture. The patient was readmitted to the hospital 12 days following the initial visit due to considerable respiratory difficulty after accidentally being dropped several feet. Thoracic radiographs revealed an unusual severe mediastinal shift to the left with an atypical position of the cardiac silhouette against the left lateral thoracic wall. Due to the severe respiratory compromise of the patient and newly developed pneumothorax, an exploratory thoracotomy was recommended, where a complete rupture of the pericardium was identified, with secondary left-sided prolapse of the heart. Other more common intrathoracic injuries (ie, lung perforation, rib fractures) were also identified and partially repaired. The patient recovered successfully and was discharged 4 days postoperatively.
New or Unique Information Provided
This is the first case report in the veterinary literature of traumatic pericardial rupture and cardiac herniation. According to human case descriptions, this is a rare and often fatal occurrence, which can be significantly challenging to diagnose preoperatively or antemortem. Emergency veterinary clinicians should be aware of this rare but important complication of blunt thoracic trauma. Surgical intervention may be necessary in cases with suspected or confirmed entrapment of great vessels or cardiac chambers, although these abnormalities were not present in this case.
{"title":"Traumatic pericardial rupture with secondary cardiac herniation in a dog","authors":"Marisa I. C. Lourenço DVM, Agustina Anson DVM, PhD, DECVDI, Ian M. DeStefano DVM, DACVECC, Katherine S. Logwood VMD, DACVR, Tiffany Stockman DVM, John Berg DVM, MS, DACVS","doi":"10.1111/vec.13392","DOIUrl":"10.1111/vec.13392","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the unique finding and treatment of a dog with cardiac herniation due to traumatic pericardial rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Summary</h3>\u0000 \u0000 <p>A 6.5-year-old entire male Yorkshire Terrier was presented for further management after being hit by a car. Despite suspected significant intrathoracic trauma at that time, the patient regained hemodynamic stability and had orthopedic surgery to correct a right iliac fracture. The patient was readmitted to the hospital 12 days following the initial visit due to considerable respiratory difficulty after accidentally being dropped several feet. Thoracic radiographs revealed an unusual severe mediastinal shift to the left with an atypical position of the cardiac silhouette against the left lateral thoracic wall. Due to the severe respiratory compromise of the patient and newly developed pneumothorax, an exploratory thoracotomy was recommended, where a complete rupture of the pericardium was identified, with secondary left-sided prolapse of the heart. Other more common intrathoracic injuries (ie, lung perforation, rib fractures) were also identified and partially repaired. The patient recovered successfully and was discharged 4 days postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> New or Unique Information Provided</h3>\u0000 \u0000 <p>This is the first case report in the veterinary literature of traumatic pericardial rupture and cardiac herniation. According to human case descriptions, this is a rare and often fatal occurrence, which can be significantly challenging to diagnose preoperatively or antemortem. Emergency veterinary clinicians should be aware of this rare but important complication of blunt thoracic trauma. Surgical intervention may be necessary in cases with suspected or confirmed entrapment of great vessels or cardiac chambers, although these abnormalities were not present in this case.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"399-405"},"PeriodicalIF":1.1,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chele N. Lathroum MS, DVM, DACVECC, Hernan Lizardo Angulo Bracho MVZ, Esp, DVM, Kayla M. Alessandrino BVMS, Julie M. Walker DVM, DACVECC
Objective
To describe the clinical course and treatment of 3 dogs with peripheral vasopressor extravasation.
Case Series Summary
Although vasopressor extravasation (VE) is a well-documented complication in human medicine, literature describing VE and its management in veterinary patients is sparse. VE increases patient morbidity by causing local tissue injury and necrosis. The gold standard treatment for VE, phentolamine, has been periodically limited in supply in human medicine and is not consistently available for use in veterinary medicine. An alternative protocol proposed for use in people with VE combines topical nitroglycerin application with subcutaneous terbutaline infiltration. In this report, a treatment protocol utilizing these therapies was used to treat 3 dogs with VE and secondary tissue injury.
New or Unique Information Provided
This report describes 3 cases of VE-induced tissue injury in dogs. In addition, this report describes the use of perivascular terbutaline infiltration and topical nitroglycerin application as therapeutic management for VE in dogs.
目的：描述 3 只患有外周血管加压外渗的狗的临床过程和治疗方法：病例系列摘要：虽然血管加压素外渗（VE）是人类医学中一种证据确凿的并发症，但描述兽医患者血管加压素外渗及其治疗的文献却很少。VE会造成局部组织损伤和坏死，从而增加患者的发病率。酚妥拉明是治疗VE的金标准，但在人类医学中的供应定期受到限制，在兽医学中也无法持续使用。建议用于 VE 患者的替代方案是将硝酸甘油局部应用与特布他林皮下浸润相结合。在本报告中，利用这些疗法的治疗方案治疗了 3 只患有 VE 和继发性组织损伤的狗：本报告描述了 3 例 VE 引起的犬组织损伤。此外，该报告还介绍了使用血管周围特布他林浸润和局部硝酸甘油来治疗犬 VE 的方法。
{"title":"The use of injectable subcutaneous terbutaline and topical nitroglycerin ointment in the treatment of peripheral vasopressor extravasation in 3 dogs","authors":"Chele N. Lathroum MS, DVM, DACVECC, Hernan Lizardo Angulo Bracho MVZ, Esp, DVM, Kayla M. Alessandrino BVMS, Julie M. Walker DVM, DACVECC","doi":"10.1111/vec.13393","DOIUrl":"10.1111/vec.13393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the clinical course and treatment of 3 dogs with peripheral vasopressor extravasation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Series Summary</h3>\u0000 \u0000 <p>Although vasopressor extravasation (VE) is a well-documented complication in human medicine, literature describing VE and its management in veterinary patients is sparse. VE increases patient morbidity by causing local tissue injury and necrosis. The gold standard treatment for VE, phentolamine, has been periodically limited in supply in human medicine and is not consistently available for use in veterinary medicine. An alternative protocol proposed for use in people with VE combines topical nitroglycerin application with subcutaneous terbutaline infiltration. In this report, a treatment protocol utilizing these therapies was used to treat 3 dogs with VE and secondary tissue injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> New or Unique Information Provided</h3>\u0000 \u0000 <p>This report describes 3 cases of VE-induced tissue injury in dogs. In addition, this report describes the use of perivascular terbutaline infiltration and topical nitroglycerin application as therapeutic management for VE in dogs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"393-398"},"PeriodicalIF":1.1,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gareth E. Zeiler BVSc(Hons), MMedVet(Anaesth), PhD, DECVECC, DECVAA, DACVAA, Brighton T. Dzikiti BVSc, MSc, PhD, Eva Rioja BVSc, DVM, PhD, DACVAA, Peter Kamerman BSc, PhD, Roxanne K. Buck BVSc, MMedVet(Anaesth), DECVAA, Friederike Pohlin BVSc, PhD, Andrea Fuller BSc, PhD
<div> <section> <h3> Objective</h3> <p>To describe and compare prothrombin time (PT), activated partial thromboplastin time (aPTT), thromboelastography (TEG), HCT, and platelet count measurements in a hemorrhage/over-resuscitation model.</p> </section> <section> <h3> Design</h3> <p>Randomized crossover study.</p> </section> <section> <h3> Setting</h3> <p>University teaching hospital.</p> </section> <section> <h3> Animals</h3> <p>Six cats.</p> </section> <section> <h3> Interventions</h3> <p>Anesthetized cats underwent 3 treatments at 2-month intervals. The treatments were as follows: NHR—no controlled hemorrhage and sham resuscitation; LRS—controlled hemorrhage and lactated Ringer's solution (LRS) for resuscitation; and Voluven—controlled hemorrhage and 6% tetrastarch 130/0.4 for resuscitation. The LRS and Voluven were administered at 60 and 20 mL/kg/h, respectively, for 120 minutes. Blood samples were drawn for PT, aPTT, TEG, HCT, and platelet count measurements at a healthy check (T − 7d), after controlled hemorrhage (T0), at 60 and 120 minutes of resuscitation (T60 and T120), and at 24 hours after completion of resuscitation (T24h). Data were analyzed using a general linear mixed model approach (significance was <i>P</i> < 0.05).</p> </section> <section> <h3> Measurements and Main Results</h3> <p>Total median blood loss (controlled hemorrhage and blood sampling from T0 to T120) at T120 was 11.4, 31.0, and 30.8 mL/kg for NHR, LRS, and Voluven, respectively. PT and aPTT during LRS and Voluven were prolonged at T60 and T120 compared to NHR (<i>P</i> < 0.001). On TEG, the reaction time, kinetic time, and alpha-angle were within reference intervals for cats at all time points in all treatments, while maximum amplitude was less than the reference interval (40 mm) at T0, T60, and T120 during Voluven and at T60 and T120 during LRS compared to NHR (both <i>P</i> < 0.001). The HCT and platelet count were significantly lower at T60 and T120 during LRS and Voluven compared to NHR (<i>P</i> < 0.001).</p> </section> <section> <h3> Conclusions</h3> <p>Hypocoagulopathy was observed during hemorrhage and liberal fluid resuscitation. Prolongation of PT and aPPT and decreased clot strength may have been caused by hemodilution and platelet loss.</p>
{"title":"Prothrombin and activated partial thromboplastin times, thromboelastography, hematocrit, and platelet count in a feline hemorrhage/over-resuscitation model using lactated Ringer's solution or 6% tetrastarch 130/0.4","authors":"Gareth E. Zeiler BVSc(Hons), MMedVet(Anaesth), PhD, DECVECC, DECVAA, DACVAA, Brighton T. Dzikiti BVSc, MSc, PhD, Eva Rioja BVSc, DVM, PhD, DACVAA, Peter Kamerman BSc, PhD, Roxanne K. Buck BVSc, MMedVet(Anaesth), DECVAA, Friederike Pohlin BVSc, PhD, Andrea Fuller BSc, PhD","doi":"10.1111/vec.13376","DOIUrl":"10.1111/vec.13376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe and compare prothrombin time (PT), activated partial thromboplastin time (aPTT), thromboelastography (TEG), HCT, and platelet count measurements in a hemorrhage/over-resuscitation model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Randomized crossover study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University teaching hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Six cats.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Anesthetized cats underwent 3 treatments at 2-month intervals. The treatments were as follows: NHR—no controlled hemorrhage and sham resuscitation; LRS—controlled hemorrhage and lactated Ringer's solution (LRS) for resuscitation; and Voluven—controlled hemorrhage and 6% tetrastarch 130/0.4 for resuscitation. The LRS and Voluven were administered at 60 and 20 mL/kg/h, respectively, for 120 minutes. Blood samples were drawn for PT, aPTT, TEG, HCT, and platelet count measurements at a healthy check (T − 7d), after controlled hemorrhage (T0), at 60 and 120 minutes of resuscitation (T60 and T120), and at 24 hours after completion of resuscitation (T24h). Data were analyzed using a general linear mixed model approach (significance was <i>P</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>Total median blood loss (controlled hemorrhage and blood sampling from T0 to T120) at T120 was 11.4, 31.0, and 30.8 mL/kg for NHR, LRS, and Voluven, respectively. PT and aPTT during LRS and Voluven were prolonged at T60 and T120 compared to NHR (<i>P</i> < 0.001). On TEG, the reaction time, kinetic time, and alpha-angle were within reference intervals for cats at all time points in all treatments, while maximum amplitude was less than the reference interval (40 mm) at T0, T60, and T120 during Voluven and at T60 and T120 during LRS compared to NHR (both <i>P</i> < 0.001). The HCT and platelet count were significantly lower at T60 and T120 during LRS and Voluven compared to NHR (<i>P</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hypocoagulopathy was observed during hemorrhage and liberal fluid resuscitation. Prolongation of PT and aPPT and decreased clot strength may have been caused by hemodilution and platelet loss.</p>\u0000 ","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"356-367"},"PeriodicalIF":1.1,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Issue Information - Prelim","authors":"","doi":"10.1111/vec.13305","DOIUrl":"https://doi.org/10.1111/vec.13305","url":null,"abstract":"","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 3","pages":"205-208"},"PeriodicalIF":1.3,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141326773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amanda E. Chromiak DVM, MS, Joanna Finstad DVM, MS, Edward Cooper VMD, MS, DACVECC
Objective
To describe a dog with suspected cerebral salt wasting syndrome (CSWS) secondary to traumatic brain injury (TBI).
Case Summary
A 2-month-old intact male Chihuahua-American Pitbull Terrier mix weighing 1.94 kg presented to a veterinary teaching emergency room after suffering bite wound-penetrating trauma to the head. Treatment was initiated with hyperosmotic agents, fluid resuscitation, and analgesia. The dog's neurologic dysfunction warranted hospitalization and continuous monitoring. Within 24 hours, the dog developed hyponatremia (133 mmol/L compared to 143 mmol/L on presentation [reference interval 142–149 mmol/L]). As the dog had concurrent tachycardia, increase in urine sodium concentration, polyuria, and weight loss, a diagnosis of cerebral salt wasting was suspected. A 2% hypertonic saline constant rate infusion was administered for volume replacement, and the patient showed improvement in clinical signs and blood sodium concentration. The dog was discharged on Day 5. Recheck examination showed significant neurologic improvement with sodium just below the low end of the reference range (141 mmol/L [reference interval 142–149 mmol/L]).
New or Unique Information Provided
This is the first description of suspected CSWS in veterinary medicine. Hyponatremia is a common finding in critically ill neurologic people, including those with TBI, and is typically associated with either syndrome of inappropriate antidiuretic hormone or CSWS. As treatment recommendations for syndrome of inappropriate antidiuretic hormone and CSWS are diametrically opposed, identifying the presence of hyponatremia and distinguishing between these 2 clinical entities is critical for improving patient care for those with TBI. This case highlights the characteristics and clinical progression regarding the diagnosis and management of suspected CSWS.
{"title":"Suspected cerebral salt wasting syndrome secondary to traumatic brain injury in a dog","authors":"Amanda E. Chromiak DVM, MS, Joanna Finstad DVM, MS, Edward Cooper VMD, MS, DACVECC","doi":"10.1111/vec.13375","DOIUrl":"10.1111/vec.13375","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe a dog with suspected cerebral salt wasting syndrome (CSWS) secondary to traumatic brain injury (TBI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Summary</h3>\u0000 \u0000 <p>A 2-month-old intact male Chihuahua-American Pitbull Terrier mix weighing 1.94 kg presented to a veterinary teaching emergency room after suffering bite wound-penetrating trauma to the head. Treatment was initiated with hyperosmotic agents, fluid resuscitation, and analgesia. The dog's neurologic dysfunction warranted hospitalization and continuous monitoring. Within 24 hours, the dog developed hyponatremia (133 mmol/L compared to 143 mmol/L on presentation [reference interval 142–149 mmol/L]). As the dog had concurrent tachycardia, increase in urine sodium concentration, polyuria, and weight loss, a diagnosis of cerebral salt wasting was suspected. A 2% hypertonic saline constant rate infusion was administered for volume replacement, and the patient showed improvement in clinical signs and blood sodium concentration. The dog was discharged on Day 5. Recheck examination showed significant neurologic improvement with sodium just below the low end of the reference range (141 mmol/L [reference interval 142–149 mmol/L]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> New or Unique Information Provided</h3>\u0000 \u0000 <p>This is the first description of suspected CSWS in veterinary medicine. Hyponatremia is a common finding in critically ill neurologic people, including those with TBI, and is typically associated with either syndrome of inappropriate antidiuretic hormone or CSWS. As treatment recommendations for syndrome of inappropriate antidiuretic hormone and CSWS are diametrically opposed, identifying the presence of hyponatremia and distinguishing between these 2 clinical entities is critical for improving patient care for those with TBI. This case highlights the characteristics and clinical progression regarding the diagnosis and management of suspected CSWS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 3","pages":"285-290"},"PeriodicalIF":1.3,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141163033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blood donors are screened for medication use to determine their health status and to ensure that the collection will be safe and efficacious for transfusion. Although stringent medication deferral guidelines exist for human blood donors, no consensus exists as to which medications should be permitted among canine donors.
Methods
A brief survey regarding canine donor screening methods was distributed to an online hematology and transfusion medicine group and included questions pertaining to commonly prescribed medications and consumption of a raw food diet.
Key Findings
The survey results demonstrate that more than half of the respondents accept canine donors given thyroid supplements, whereas respondents were split as to whether they accept canine donors given antihistamines chronically. Most survey respondents exclude canine donors taking anti-inflammatory or anti-itch medications unless in acute circumstances and only after a washout period. More than half of the survey respondents exclude dogs fed a raw food diet.
Significance
The survey results demonstrate that there is no obvious agreement regarding which medications to permit in canine donors. Evidence-based guidelines are needed to inform best practices and the subsequent decisions made by donor programs.
{"title":"A survey of medication and raw food use among canine blood donors","authors":"Marie K. Holowaychuk DVM, DACVECC","doi":"10.1111/vec.13381","DOIUrl":"10.1111/vec.13381","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Blood donors are screened for medication use to determine their health status and to ensure that the collection will be safe and efficacious for transfusion. Although stringent medication deferral guidelines exist for human blood donors, no consensus exists as to which medications should be permitted among canine donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A brief survey regarding canine donor screening methods was distributed to an online hematology and transfusion medicine group and included questions pertaining to commonly prescribed medications and consumption of a raw food diet.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Findings</h3>\u0000 \u0000 <p>The survey results demonstrate that more than half of the respondents accept canine donors given thyroid supplements, whereas respondents were split as to whether they accept canine donors given antihistamines chronically. Most survey respondents exclude canine donors taking anti-inflammatory or anti-itch medications unless in acute circumstances and only after a washout period. More than half of the survey respondents exclude dogs fed a raw food diet.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>The survey results demonstrate that there is no obvious agreement regarding which medications to permit in canine donors. Evidence-based guidelines are needed to inform best practices and the subsequent decisions made by donor programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 3","pages":"302-306"},"PeriodicalIF":1.3,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141163028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebecca R. Gelé DVM, Priscilla Burnotte DVM, Annelies Valcke DVM, Thomas G. Walker DVM, DACVECC, Christopher R. Kennedy BVetMed, DACVECC, Anne-Christine Merveille DMV, PhD, DECVIM, Kris Gommeren DVM, PhD, DECVIM, DECVECC
<div> <section> <h3> Objective</h3> <p>To determine if emergency and critical care residents can identify moderate to severe precapillary pulmonary hypertension on cardiologist-obtained cineloops using a pulmonary hypertension score (PHS) and report the interobserver variability of the PHS.</p> </section> <section> <h3> Design</h3> <p>Multicenter, retrospective, case–control study from 2017 to 2021.</p> </section> <section> <h3> Setting</h3> <p>Private referral center and veterinary teaching hospital.</p> </section> <section> <h3> Animals</h3> <p>One hundred and thirty-five client-owned dogs that underwent diagnostic echocardiography.</p> </section> <section> <h3> Interventions</h3> <p>None.</p> </section> <section> <h3> Measurements and Main Results</h3> <p>Medical records of dogs with stage B1 myxomatous mitral valve disease (MMVD) and dogs diagnosed with precapillary pulmonary hypertension (PCPH) via echocardiograms were reviewed. Dogs were categorized by a cardiologist into 5 groups (normal, B1 MMVD, mild, moderate, and severe PCPH) based on Doppler pulmonary pressure gradients and right heart morphology. Cineloops from each case were subjectively evaluated by emergency and critical care residents for the presence of right atrial and ventricular enlargement, right ventricular hypertrophy, interventricular septal flattening, and pulmonary artery and trunk enlargement to form a composite pulmonary hypertension score out of 8 (PHS8). When available, signs of peritoneal effusion and distention of the caudal vena cava were subjectively assessed to generate a pulmonary hypertension score out of 10 (PHS10). There was excellent discrimination of moderate to severe PCPH versus grouped absent to mild PCPH using PHS8 (area under the receiver operator curve [AUC] [95% confidence interval, CI] = 0.90 [0.84–0.95], <i>P </i>< 0.0001) and PHS10 (AUC [95% CI] = 0.89 [0.81–0.97], <i>P </i>< 0.0001). PHS8 ≥3 was 64% sensitive and 98% specific for moderate to severe PCPH (positive likelihood ratio [LR+] 32, negative likelihood ration [LR−] 0.37). PHS10 ≥ 3.3 was 64% sensitive and 92% specific for moderate to severe PCPH (LR+ 8, LR− 0.39). Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC] = 0.74 [95% CI: 0.66–0.80], <i>n</i> = 135).</p> </section> <section> <h3> Conclusions</h3> <p>Residents identified moderate to severe PCPH in dogs using PHS on cineloops previousl
{"title":"Retrospective evaluation of a right heart parameter score in the assessment of precapillary pulmonary hypertension in dogs (2017–2021): 135 cases","authors":"Rebecca R. Gelé DVM, Priscilla Burnotte DVM, Annelies Valcke DVM, Thomas G. Walker DVM, DACVECC, Christopher R. Kennedy BVetMed, DACVECC, Anne-Christine Merveille DMV, PhD, DECVIM, Kris Gommeren DVM, PhD, DECVIM, DECVECC","doi":"10.1111/vec.13394","DOIUrl":"10.1111/vec.13394","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine if emergency and critical care residents can identify moderate to severe precapillary pulmonary hypertension on cardiologist-obtained cineloops using a pulmonary hypertension score (PHS) and report the interobserver variability of the PHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Multicenter, retrospective, case–control study from 2017 to 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Private referral center and veterinary teaching hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>One hundred and thirty-five client-owned dogs that underwent diagnostic echocardiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>None.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>Medical records of dogs with stage B1 myxomatous mitral valve disease (MMVD) and dogs diagnosed with precapillary pulmonary hypertension (PCPH) via echocardiograms were reviewed. Dogs were categorized by a cardiologist into 5 groups (normal, B1 MMVD, mild, moderate, and severe PCPH) based on Doppler pulmonary pressure gradients and right heart morphology. Cineloops from each case were subjectively evaluated by emergency and critical care residents for the presence of right atrial and ventricular enlargement, right ventricular hypertrophy, interventricular septal flattening, and pulmonary artery and trunk enlargement to form a composite pulmonary hypertension score out of 8 (PHS8). When available, signs of peritoneal effusion and distention of the caudal vena cava were subjectively assessed to generate a pulmonary hypertension score out of 10 (PHS10). There was excellent discrimination of moderate to severe PCPH versus grouped absent to mild PCPH using PHS8 (area under the receiver operator curve [AUC] [95% confidence interval, CI] = 0.90 [0.84–0.95], <i>P </i>< 0.0001) and PHS10 (AUC [95% CI] = 0.89 [0.81–0.97], <i>P </i>< 0.0001). PHS8 ≥3 was 64% sensitive and 98% specific for moderate to severe PCPH (positive likelihood ratio [LR+] 32, negative likelihood ration [LR−] 0.37). PHS10 ≥ 3.3 was 64% sensitive and 92% specific for moderate to severe PCPH (LR+ 8, LR− 0.39). Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC] = 0.74 [95% CI: 0.66–0.80], <i>n</i> = 135).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Residents identified moderate to severe PCPH in dogs using PHS on cineloops previousl","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 3","pages":"277-284"},"PeriodicalIF":1.3,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141163029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rose E. Tallon MA, VetMB, MVetMed, DACVIM, Sarah E. Allen BVetMed, MSc PhD, Bruce M. Bladon BVM&S, DESTS, DECVS, Kate F. McGovern BVetMed, MS DACVIM, DECEIM
<div> <section> <h3> Objective</h3> <p>To determine the effect of a single intraoperative dose of dexamethasone on the risk of postoperative reflux (POR) in horses undergoing small intestinal surgery and to investigate its association with incisional complications and short-term survival.</p> </section> <section> <h3> Design</h3> <p>Retrospective cohort study over an 11-year period (2008–2019).</p> </section> <section> <h3> Setting</h3> <p>UK-based private referral center.</p> </section> <section> <h3> Animals</h3> <p>Two hundred and forty client-owned horses >6 months of age undergoing exploratory laparotomy for treatment of a small intestinal lesion.</p> </section> <section> <h3> Interventions</h3> <p>Ninety-seven horses received a single intraoperative dose of dexamethasone (0.1 mg/kg, IV).</p> </section> <section> <h3> Measurements and Main Results</h3> <p>Of 97 horses that received dexamethasone, 52 (53.6%) required small intestinal resection. Of 143 horses that did not receive dexamethasone, small intestinal resection was performed in 78 (54.5%). A total of 70 horses (29%) developed POR. There was no difference in the risk of POR between horses that received dexamethasone (25/97; 26%) and those that did not (45/143; 31%, <i>P </i>= 0.34). Risk factors associated with the development of POR included small intestinal resection (odds ratio [OR]: 4.55, 95% confidence interval [CI]: 2.27–9.11, <i>P </i>< 0.001), a PCV >40% 24 hours postoperatively (OR: 4.11, 95% CI: 2–8.45, <i>P </i>< 0.001), and a WBC count >10 × 10<sup>9</sup>/L on admission (OR: 3.29, 95% CI: 1.47–7.41, <i>P </i>= 0.004). Dexamethasone was not associated with the odds of POR. Horses undergoing repeat laparotomy had a higher risk of incisional infection (OR: 8.07, 95% CI: 1.98–32.81, <i>P</i> = 0.004). Dexamethasone administration was not associated with incisional infection. The development of POR was negatively associated with short-term survival (OR: 0.07, 95% CI: 0.03–0.17, <i>P</i> ≤ 0.001). Dexamethasone administration was not retained in the final multivariable model for survival.</p> </section> <section> <h3> Conclusions</h3> <p>Intraoperative dexamethasone was not associated with the development of POR in this study population, nor did it have an effect on postoperative survival or incisional infection in horses undergoing surgical management of small intestinal disease.</p> </section>
{"title":"Retrospective evaluation of the effects of a single intraoperative dose of dexamethasone in horses undergoing exploratory laparotomy for small intestinal lesions (2008–2019): 240 cases","authors":"Rose E. Tallon MA, VetMB, MVetMed, DACVIM, Sarah E. Allen BVetMed, MSc PhD, Bruce M. Bladon BVM&S, DESTS, DECVS, Kate F. McGovern BVetMed, MS DACVIM, DECEIM","doi":"10.1111/vec.13374","DOIUrl":"10.1111/vec.13374","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the effect of a single intraoperative dose of dexamethasone on the risk of postoperative reflux (POR) in horses undergoing small intestinal surgery and to investigate its association with incisional complications and short-term survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study over an 11-year period (2008–2019).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>UK-based private referral center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Two hundred and forty client-owned horses >6 months of age undergoing exploratory laparotomy for treatment of a small intestinal lesion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Ninety-seven horses received a single intraoperative dose of dexamethasone (0.1 mg/kg, IV).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>Of 97 horses that received dexamethasone, 52 (53.6%) required small intestinal resection. Of 143 horses that did not receive dexamethasone, small intestinal resection was performed in 78 (54.5%). A total of 70 horses (29%) developed POR. There was no difference in the risk of POR between horses that received dexamethasone (25/97; 26%) and those that did not (45/143; 31%, <i>P </i>= 0.34). Risk factors associated with the development of POR included small intestinal resection (odds ratio [OR]: 4.55, 95% confidence interval [CI]: 2.27–9.11, <i>P </i>< 0.001), a PCV >40% 24 hours postoperatively (OR: 4.11, 95% CI: 2–8.45, <i>P </i>< 0.001), and a WBC count >10 × 10<sup>9</sup>/L on admission (OR: 3.29, 95% CI: 1.47–7.41, <i>P </i>= 0.004). Dexamethasone was not associated with the odds of POR. Horses undergoing repeat laparotomy had a higher risk of incisional infection (OR: 8.07, 95% CI: 1.98–32.81, <i>P</i> = 0.004). Dexamethasone administration was not associated with incisional infection. The development of POR was negatively associated with short-term survival (OR: 0.07, 95% CI: 0.03–0.17, <i>P</i> ≤ 0.001). Dexamethasone administration was not retained in the final multivariable model for survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intraoperative dexamethasone was not associated with the development of POR in this study population, nor did it have an effect on postoperative survival or incisional infection in horses undergoing surgical management of small intestinal disease.</p>\u0000 </section>\u0000 ","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 3","pages":"245-251"},"PeriodicalIF":1.3,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141163031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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