Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)最新文献

Background: In veterinary medicine, high-flow nasal cannula oxygen therapy (HFNT) has gained popularity in managing hypoxemic respiratory failure, bridging the gap between conventional oxygen therapy and mechanical ventilation. The SpO₂:FiO₂ (SF) ratio could be useful in assessing oxygenation impairment in dogs undergoing HFNT. The current study aimed to determine whether the SF ratio correlates with the PaO₂:FiO₂ (PF) ratio in dogs undergoing HFNT.

Key findings: A total of 30 data pairs with concurrent SpO₂ and PaO₂ measurements were identified from 19 dogs treated with HFNT from two university veterinary teaching hospitals. PF and SF ratios were measured when PaO₂ fell between 74 and 129 mm Hg. The median SF and PF ratios were 186 (interquartile range: 97-243) and 168 (interquartile range: 108-297), respectively. SF ratios were strongly correlated with PF ratios (rho = 0.86 [95% confidence interval: 0.73-0.93], P < 0.001, weighted r = 0.89 [95% confidence interval: 0.74-0.96]).

Significance: Preliminary results suggest a statistically significant positive correlation between SF and PF ratios in dogs treated with HFNT. This study provides data that can be used to calculate appropriate sample sizes for subsequent studies investigating the specific SF ratios corresponding with the PF ratios as the criteria for assessing hypoxemia.

Objective: To assess the splenic flow resistance index (RI) and its response to a fluid bolus in dogs showing circulatory abnormalities upon hospital admission.

Design: Prospective clinical study.

Setting: Veterinary referral hospital.

Animals: Nine dogs with circulatory shock and nine dogs without circulatory abnormalities.

Interventions: Dogs with circulatory abnormalities received an IV bolus of 30 mL/kg of balanced isotonic crystalloid fluid.

Measurements and main results: The splenic flow RI and the baseline aortic velocity-time integral of both groups of dogs were evaluated upon hospital admission. Measurements were repeated after the fluid bolus in dogs with circulatory shock. The Mann-Whitney U-test or the Wilcoxon rank sign test was used as appropriate. The median RI in dogs with circulatory shock was higher than that in dogs without hemodynamic disorders (median [interquartile range]: 0.64 [0.62-0.77] vs. 0.54 [0.51-0.54], P < 0.001). The best cutoff value to discriminate between the two groups was 0.61, with an area under the receiver operating characteristic curve of 1.00 (95% confidence interval [CI]: 1.00-1.00), a sensitivity of 100% (95% CI: 66.4-100), a specificity of 100% (95% CI: 66.4-100), a positive predictive value of 100% (95% CI: 66.4-100), and a negative predictive value of 100% (95% CI: 66.4-100). After fluid expansion, a significant decrease in the median splenic flow RI was observed (0.57 [0.54-0.71], P = 0.007 vs. basal).

Conclusions: The splenic flow RI may be a dependable tool for identifying circulatory shock in dogs and assessing their response to fluid therapy. Additional studies are required to evaluate the use of this index for the monitoring of organ perfusion, changes in cardiac output, and fluid responsiveness in critically ill dogs.

Objective: To describe a case of clinically significant norepinephrine extravasation in a dog with a successful outcome following the use of subcutaneous phentolamine infusion.

Case summary: An 8-year-old male neutered Labrador Retriever experienced norepinephrine extravasation from a cephalic, peripheral intravenous catheter while under anesthesia for an exploratory laparotomy. Upon recognition of norepinephrine extravasation, moderate subcutaneous edema and a painful dermal plaque were apparent at the extravasation site. Ten milligrams of phentolamine mesylate, a potent alpha-adrenergic receptor antagonist, were diluted in 10 mL of sterile saline and administered subcutaneously in small aliquots at multiple sites in the area of extravasation. The patient remained hemodynamically stable during and after the infusion. Most phentolamine injections produced instantaneous erythematous macules that resolved 24-36 h later, and the integument in the extravasation area rapidly changed from a "blanched" to a "pink" color. The subcutaneous edema gradually resolved within 7 days post-extravasation. At 12 h following extravasation, the dermal plaque progressed into a necrotic focus, which later developed into an ulcer (36 h), then a small crust (7 days), and finally healed epidermis (9 days). When the patient was euthanized 10 days after surgery due to continued decline secondary to systemic disease, there remained only a small superficial crust at the site of extravasation.

Unique information: To the authors' knowledge at the time of submission, this case report documented the first reported clinical use of subcutaneous phentolamine infusion for the management of norepinephrine extravasation in a veterinary species.

Objective: To evaluate the frequencies of in-hospital complications and survival to discharge in dogs with surgically placed gastrostomy tubes (G-tubes) and to assess the association between G-tube complications and primary disease, serum albumin concentration, and plasma total protein concentration.

Design: A retrospective multicenter study was performed at two university teaching hospitals between January 2010 and December 2020, including 133 dogs with surgically placed G-tubes.

Results: Nine dogs (6.7%) experienced a complication associated with the surgically placed G-tube. The most common complication was stoma site infection/inflammation (8/133 dogs [6%]), which was managed with topical therapy alone. One dog had septic peritonitis secondary to gastrointestinal leakage (1/133 [0.75%]). There was no association between primary etiology, serum albumin concentration, or plasma total protein concentration and complications. No dog died or was euthanized as a result of G-tube complications.

Conclusions: A low in-hospital complication frequency was found to be associated with surgically placed G-tubes in dogs with a variety of primary disease processes. Stoma site infection or inflammation was the major complication noted. Surgically placed G-tubes may be useful in patients undergoing abdominal surgery that are likely to need ongoing nutritional support.

Objective: To describe hemothorax secondary to the spontaneous rupture of an aneurysmal dilation of a collateral vascular structure potentially resulting from chronic pulmonary thromboembolism in a dog.

Case summary: An 11-year-old male neutered Schnauzer mix weighing 12.6 kg was presented to the emergency service of a veterinary specialty referral hospital for an episode of collapse. The dog was diagnosed with spontaneous (atraumatic) hemothorax and stabilized. Contrast-enhanced computed tomography (CT) of the thorax identified a large, aneurysmal dilation of a suspected collateral vascular structure in the mediastinum with a large thrombus in the dilatation, consistent with a recent rupture. In addition, multiple mineralized pulmonary arterial thrombi were identified. These findings were suggestive of chronic, thromboembolic pulmonary hypertension with suspected secondary acquired collateral circulation and subsequent aneurysmal dilatation and rupture of one of these structures, resulting in the bilateral hemothorax. The underlying cause of the thrombi was not identified despite an extensive workup. Upon resolution of the hemothorax, the dog was discharged with clopidogrel and has had no recurrence in 4 years.

New or unique information provided: This is the first description of canine hemothorax possibly caused by the rupture of an aneurysmal dilation of suspected pulmonary hypertension-related vascular collaterals in a dog. CT is indicated in dogs with atraumatic hemothorax and evidence of chronic pulmonary thromboembolism.

Objective: To evaluate the variables associated with unsuccessful tracheal decannulation in brachycephalic breeds after upper airway surgery.

Design: Retrospective study from 2010 to 2022.

Setting: University teaching hospital.

Animals: Fifty-one client-owned dogs requiring a temporary tracheostomy after upper airway surgery for brachycephalic obstructive airway syndrome (BOAS).

Procedures: Medical records of dogs receiving a temporary tracheostomy after upper airway surgery for BOAS were reviewed. Dogs that underwent a tracheostomy decannulation attempt were included. Data were extracted from the medical record, including signalment, patient size, type of airway surgery, presence of hypoplastic trachea, presence of laryngeal collapse, prophylactic versus emergency tracheostomy, frequency of cannula suctioning, and time from tracheostomy to decannulation attempt. The association of these factors with successful decannulation and the number of decannulation attempts were evaluated.

Results: Of 699 dogs with BOAS that had upper airway surgery, 54 (7.7%) had a temporary tracheostomy performed. Dogs with an increased frequency of tracheostomy tube suctioning in the 24-h period before the first decannulation attempt were less likely to have a successful decannulation (P = 0.03). Dogs with laryngeal collapse were less likely to have a successful decannulation at first attempt (P = 0.04). The overall probability of successful decannulation was 88.2% at a median of 50 postoperative hours. Forty-five percent of patients had a successful first decannulation.

Conclusions: Results indicated that an increased frequency of tracheostomy tube suctioning or a diagnosis of laryngeal collapse was negatively associated with successful decannulation. The use of alternative methods to reduce respiratory secretions and the development of specific suctioning protocols may be warranted. Patients with laryngeal collapse requiring temporary tracheostomy may have a poorer prognosis. Multiple statistical comparisons were made without correction, so these data should be considered preliminary, and future studies are required to confirm these risk factors.

Objective: To describe the development and implementation of a small animal hemovigilance program at a university veterinary teaching hospital.

Design: Retrospective observational descriptive study performed between October 2014 and March 2019.

Setting: University teaching hospital.

Animals: Dogs and cats receiving blood product transfusions .

Interventions: None.

Measurements and main results:  A hemovigilance working group composed of veterinary specialists in clinical pathology, internal medicine, and emergency and critical care was established. This group developed evidence-based definitions of transfusion reactions, reaction classification systems, and a transfusion reaction reporting form. The reporting form contained sections for patient information, transfusion information, administration details, and reaction details. Reaction events were classified by reaction type, severity grade, and imputability to the transfusion. Following implementation of the hemovigilance program, transfusion reaction data were collected and examined for the period spanning October 2014 and March 2019. During the study period, 718 canine transfusions (4 whole blood, 400 packed RBC [pRBC], 300 fresh frozen plasma [FFP], 7 platelet rich plasma, and 7 cryoprecipitate) and 124 feline transfusions (5 whole blood, 95 pRBC, and 24 FFP) were administered. There were 32 total reactions (27 canine and 5 feline), with the most common reaction being febrile nonhemolytic transfusion reactions (19/32; 59%). The incidence rate of transfusion reactions was found to be 3.8% in dogs and 4.0% in cats. For the confirmed reactions, classification criteria for case definition, reaction severity grade, and imputability were able to be determined and recorded. This allowed targeted interventions to be implemented in order to potentially reduce future reactions.

Conclusions: A hemovigilance program can be instituted successfully in a veterinary hospital setting and once developed, standardized reporting tools could be utilized by multiple hospitals and provide the basis for more widespread reaction reporting in veterinary medicine.