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

Objective: To assess the value of the abdominal fluid score (AFS) in cats following trauma in determining surgical needs, transfusion needs, and mortality.

Design: Multicenter retrospective observational study utilizing data from the Veterinary Committee on Trauma (VetCOT) registry.

Setting: VetCOT Veterinary Trauma Centers.

Animals: A total of 2309 cats entered into the VetCOT registry between January 1, 2013, and December 31, 2020, were included.

Interventions: None.

Measurements and main results: Of the included cats, 148 had abdominal effusion on presentation (AFS 1-4, positive AFS [pAFS]). pAFS cats demonstrated a lower total plasma protein (6.2 g/dL, range: 2.8-9.2 g/dL vs 6.8 g/dL, range: 2.6-11 g/dL, P < 0.001) and a more negative base excess (BE) (-9, range: -23.7 to 10 vs -6.1, range: -31.7 to 1, P = 0.001) than cats without abdominal effusion (negative AFS [nAFS]). pAFS cats also had a higher baseline Animal Trauma Triage score (ATTS) than nAFS cats (5, range 0-12 vs 3, range 0-17, respectively, P < 0.001). pAFS cats were more likely to require blood transfusions (16% [23/148] vs 4% [94/2161], P < 0.001) than nAFS cats, but need for surgical intervention did not differ between groups. A pAFS was associated with increased need for hospitalization (62.8% [93/148] vs 47.7% [1030/2160], P < 0.001), but length of hospital stay did not differ. Cats with pAFS experienced higher mortality compared to nAFS cats (42.6% [63/148] vs 22.7% [491/2161], P < 0.001).

Conclusion: The presence of abdominal effusion in cats following trauma was associated with increased morbidity in this study, as demonstrated by greater need for transfusion, increased likelihood of hospitalization, and greater mortality. Cats in the pAFS group had more negative BE and higher ATTS, but need for surgery, length of hospitalization, PCV, and blood glucose, plasma lactate, and ionized calcium concentrations were not different between groups.

Objective: To investigate the volume kinetic between 2 crystalloid fluid bolus rates in anesthetized cats.

Design: Prospective, randomized, dose-response study.

Setting: University laboratory.

Animals: Ten convenience-sample, purpose-bred domestic shorthair and medium hair cats.

Interventions: Intravenous 20 mL/kg balanced crystalloid fluid over 10 (G10) or 40 (G40) minutes under anesthesia in a randomized order with at least a 5-day washout period.

Measurements and main results: Serial measurements of hemoglobin (Hb) concentration and PCV were performed up to 60 minutes after conclusion of the fluid bolus. Plasma dilution was calculated with the Hb dilution method and fitted to a 2-compartment microconstant kinetic model using nonlinear mixed-effect models. The apparent central plasma volume (V_c) was similar between the 2 groups (G10: 81.2 ± 23.8 mL/kg and G40: 78.8 ± 10.2 mL/kg). The apparent peripheral volume (V_p) of G10 (4.81E+8 ± 2.66E+8 mL/kg) was twice that of G40 (2.36E+8 ± 6.44E+7 mL/kg). The rate constant from V_c to V_p (K₁₂) of G10 (0.057 ± 0.0196/min) was almost twice that of G40 (0.0302 ± 0.00807/min). The elimination constant of G10 (0.0113 ± 0.00672/min) was almost twice that of G40 (0.00534 ± 0.00279/min). The peak plasma expansion was similar between G10 and G40 (20.7 ± 1.9 and 19.1 ± 5.1 mL/kg). Area under the curve for plasma dilution versus time of the first 90 minutes from the beginning of the boluses was not statistically different between G10 and G40.

Conclusions: The volume expansion over time was not different likely due to the slow elimination. The plasma dilution to crystalloid bolus between subjects is varied in anesthetized cats. Clinicians should consider the slow elimination and return of crystalloid fluid from the V_p to V_c when prescribing fluid therapy in anesthetized cats.

Objective: To describe a novel approach to tracheostomy management in dogs with upper airway trauma.

Case series summary: Two dogs with upper airway trauma presented to an emergency department and required immediate intubation. To minimize sedation time, tracheostomy tubes were placed in both dogs. A stepwise approach to decannulation was initiated, with both dogs receiving a 1-way speaking valve to facilitate a gradual approach to decannulation.

New or unique information provided: This is the first report of a 1-way speaking valve being used in the management of tracheostomy tubes in dogs.

Objective: To report the occurrence of neutropenia in dogs with suspected acute hemorrhagic diarrhea syndrome (AHDS) and to assess its association with survival. Secondary objectives were to assess whether neutropenia was associated with length of hospitalization, fulfillment of systemic inflammatory response syndrome (SIRS) criteria, and whether SIRS status was associated with survival. Finally, the association of antimicrobial use with neutropenia, SIRS status, and survival was evaluated.

Design: Single-center, retrospective study from the medical records of dogs diagnosed with AHDS between 2017 and 2022.

Setting: Private referral hospital.

Animals: Fifty-four dogs with suspected AHDS referred to the Emergency and Critical Care specialist service.

Interventions: None.

Measurements and main results: Of 54 dogs, 28 (52%) presented with or developed neutropenia during their treatment course. Overall, 9 (17%) dogs were nonsurvivors. A total of 8 of 28 (29%) dogs with neutropenia were nonsurvivors, while only 1 of 26 (4%) dogs with a normal neutrophil count was a nonsurvivor (P = 0.025). Upon hospital admission, neutropenic dogs were significantly more likely to fulfill SIRS criteria than nonneutropenic dogs (P = 0.0096). There was no difference in mortality between SIRS-positive (fulfilling ≥2 SIRS criteria) and SIRS-negative (fulfilling <2 SIRS criteria) dogs (P = 0.14). There was no difference in the median length of hospitalization between neutropenic and nonneutropenic dogs (P = 0.49).

Conclusions: The incidence of neutropenia is high in this population of dogs presenting with AHDS. In this retrospective study, neutropenia was significantly associated with an increased risk of nonsurvival and an increased likelihood of fulfilling SIRS criteria; however, a fulfillment of SIRS criteria could not be used to predict survival. Neutropenia in dogs with AHDS was not associated with an increased length of hospitalization.

Objective: To evaluate the effect of rescuer team size on objective skill measures of basic life support (BLS) and advanced life support (ALS) using high-fidelity canine CPR simulation.

Design: Prospective, experimental study.

Setting: Veterinary clinical simulation center.

Subjects: Forty-eight Reassessment Campaign on Veterinary Resuscitation CPR-certified veterinary students.

Measurements and main results: Five groups of participants each conducted 3 CPR simulations in configurations of 4, 6, and 8 rescuers. Simulations represented a shock patient declining into asystole, followed by ventricular fibrillation and return of spontaneous circulation. Resuscitation efforts were video-recorded to evaluate BLS and ALS tasks. Mean (±SD) was derived and data were compared among team sizes using ANOVA and Tukey's post hoc analysis. Significance was set at P < 0.05. Among teams of 4, 6, and 8 rescuers, time to first chest compression (13 s [±6], 9 s [±2], 8 s [±4]; P = 0.24) and positive-pressure breath (101 s [±37], 56 s [±15], 67 s [±24]; P = 0.05) were not significantly different. Chest compression (100/min [±5], 108/min [±6], 107/min [±6]; P = 0.12) and ventilatory rates (9/min [±1], respectively, P = 0.52) were not significantly different. Time without chest compressions/total length of CPR was not significantly different (72 s [±16], 61 s [±16], 54 s [±8]; P = 0.15). Capnography and ECG monitoring were used by all teams. Time to first vasopressor administration was significantly different among team sizes (268 s [±70], 164 s [±65], 174 s [±34]; P = 0.04), with vasopressors being most quickly administered by teams of 6 rescuers. Time to electrical defibrillation was not significantly different (486 s [±45], 424 s [±22], 488 s [±181]; P = 0.57). Incorrect ALS interventions occurred in 60%, 0%, and 40% of CPR events in 4, 6, and 8 rescuer teams, respectively.

Conclusions: Although the achievement of BLS tasks was comparable in teams of 4 rescuers, teams of 6 rescuers may be preferable based on differences in the rate of guideline-incompliant treatments and ALS task efficiency. Teams of 8 rescuers were neither more efficient nor more accurate at conducting BLS and ALS tasks.

Objective: To prospectively compare the shock index (SI) in a population of healthy cats with a population of cats presenting to the emergency room (ER) deemed to be in a state of shock.

Design: Prospective cohort study of cats.

Setting: University teaching hospital.

Animals: Twenty-seven healthy control cats were enrolled to establish a reference interval, and 27 cats were enrolled that were presented to the ER with clinical signs of shock. Shock was defined as abnormalities in at least 2 of the following inclusion criteria: plasma lactate concentration > 2.5 mmol/L; peripheral vasoconstriction (at least 2 of the following parameters: capillary refill time >3 s, rectal-interdigital temperature gradient [RITG] >8°C, femoral pulse not palpable, pale mucous membranes); or systolic blood pressure (SBP) < 100 mm Hg.

Interventions: Upon presentation, SI (SI = heart rate [HR]/SBP), HR, SBP, and RITG were recorded in both groups, along with peripheral venous blood sampling for lactate measurement.

Measurements and main results: The mean SI in the control group was 1.47 ± 0.2 and was 1.87 ± 0.47 in the shock group (P = 0.001). Using equality in sensitivity and specificity of 0.7, an SI cutoff point of 1.54 (95% confidence interval [CI]: 0.49-0.86) was determined with an estimated area under the receiver operating characteristic curve of 0.78 (95% CI: 0.65-0.90). HR, plasma lactate concentration, and RITG did not differ between the groups. Systolic arterial blood pressure (P = 0.01), rectal temperature (P = 0.02), and interdigital temperature (P = 0.04) differed significantly.

Conclusions: The SI is a noninvasive, easy, and reliable parameter for distinguishing cats in shock from normal cats.

Background: Venous blood gas and acid-base analysis is often performed in cats and requires appropriate reference intervals (RIs) for interpretation. The currently available RIs were created from small numbers of cats, while current guidelines suggest that a minimum number of 40 samples is required for the creation of an accurate/appropriate RI.

Key findings: In 41 healthy awake cats, pH, P_vCO₂, P_vO₂, sodium, potassium, ionized calcium, chloride, glucose, and plasma lactate concentrations were measured, while bicarbonate, standardized base excess, and anion gap were calculated. These data were used to calculate RIs, using a statistical approach that conforms to the American Society for Veterinary Clinical Pathology guidelines.

Significance: RIs for venous blood gas and traditional acid-base analysis from a relatively large population of healthy cats are now available for clinical use and standardized for future research studies.

Objective: To describe the acid-base balance of diabetic animals with ketosis and to identify underlying mechanisms of acid-base changes using semiquantitative analysis.

Design: Retrospective study.

Setting: University teaching hospital.

Animals: Eighty-one client-owned dogs and 15 client-owned cats with diabetes and concurrent ketosis presented to a university teaching hospital.

Interventions: None.

Measurements and main results: The medical records database was searched from January 2017 through December 2021 for dogs and cats with diabetes mellitus and ketones present in urine or blood samples that also had venous blood gas and serum biochemical assays performed within 24 hours of each other. Traditional analysis identified normal acid-base status in 20% of dogs and 7% of cats. A simple metabolic acidosis with an elevated anion gap was observed in 17% of dogs and 20% of cats, and a metabolic alkalosis was present in 4% of dogs and 7% of cats. The semiquantitative approach identified metabolic acid-base disorders in all animals. One or more acidifying processes were evident in 100% of dogs and 100% of cats, 1 or more alkalotic processes in 93% of dogs and 100% of cats, concurrent alkalotic and acidotic processes in 85% of dogs and 100% of cats, and unmeasured anions in all cases.

Conclusions: Dogs and cats with diabetic ketosis can have variable and complex acid-base disorders that may be better recognized using semiquantitative analysis. Diagnostic criteria such as low pH or a high anion gap may prevent the clinical recognition of diabetic ketoacidosis.

Objective: To retrospectively compare and report vasopressor duration and mortality of septic dogs with hypotension refractory to vasopressor administration (presumed critical illness-related corticosteroid insufficiency [CIRCI]) treated with or without dexamethasone sodium phosphate (DxSP).

Design: Retrospective study (2017-2022).

Setting: Tertiary referral and teaching hospitals.

Animals: Sixty client-owned dogs with confirmed or presumed sepsis and vasopressor-resistant hypotension. Hypotension was defined as systolic arterial pressure < 90 mm Hg or MAP < 65 mm Hg. Vasopressor resistance was defined as hypotension despite therapy with moderate- to high-dose vasopressors (> 0.5 µg/kg/min of norepinephrine IV).

Interventions: None.

Measurements and main results: Twenty-six dogs received DxSP (DxSP group, 0.002-0.39 mg/kg IV, variable frequency), and 34 dogs did not receive a glucocorticoid (non-DxSP group). The median time to vasopressor discontinuation was 20 hours (interquartile range [IQR]: 21; n = 6) in the DxSP group and 27 hours (IQR: 11; n = 5) in the non-DxSP group. In the DxSP group, 23% (6/26) of dogs survived to discharge compared with 15% (5/34) of dogs in the non-DxSP group, which was not significantly different (relative risk: 0.90, 95% confidence interval: 0.70-1.16; P = 0.41). There was no significant difference between the 2 groups in time from vasopressor administration to weaning in dogs that survived to discharge (P = 0.43). The median time from steroid administration to vasopressor wean was 15 hours (IQR: 19; n = 6), and the median time from steroid administration to sustained normotension (a systolic blood pressure > 90 mm Hg or a MAP >65 mm Hg for at least 4 h) was 1 hour (IQR: 5; n = 11).

Conclusions: There was no association between DxSP therapy and survival, duration of vasopressor therapy, or time between steroid administration and discontinuation of vasopressor therapy in dogs being treated for sepsis, vasopressor resistance, and suspected CIRCI.

Objective: To evaluate if variation in the end-tidal CO₂ partial pressure (∆Petco₂) after a fluid challenge could predict fluid responsiveness with a sensitivity of 75% and a specificity of 70% in healthy anesthetized and mechanically ventilated dogs.

Design: Diagnostic accuracy study.

Setting: University hospital.

Animals: Twenty-seven dogs admitted for neutering.

Interventions: To obtain a balanced sample between fluid responder and nonresponder dogs, a 10-mL/kg lactated Ringer's solution was administered over 15 minutes to half of the population before the baseline measurements. All animals then received a fluid challenge of 10 mL/kg lactated Ringer's solution in 5 minutes.

Measurements and main results: The velocity-time integral of aortic blood flow (VTI_Ao) was evaluated with Doppler echocardiography before and after a fluid challenge to classify the included dogs as fluid responders or nonresponders. Fluid responsiveness was defined as an increase of ≥15% of the VTI_Ao after the fluid challenge. Petco₂ was evaluated at 1, 5, and 10 (T1, T5, T10) minutes after fluid expansion. Area under the receiver operating characteristic curve (AUROC) analysis was used to assess the ability of ∆Petco₂ to predict fluid responsiveness at different time points. A total of 13 dogs were fluid responders, and 14 were nonresponders. The best predictive capacity for ∆Petco₂ was observed at T10. The AUROC with its 95% confidence interval (CI) for ∆Petco₂ at T10 was 0.75 (0.56-0.93), with a sensitivity of 84.62% (95% CI, 54.60-98.10), a specificity of 64.29% (95% CI, 35.10-87.20), a positive predictive value of 68.80% (95% CI, 41.30-89.00), and a negative predictive value of 81.80% (95% CI, 48.20-97.70). The optimal cutoff was 1 mm Hg.

Conclusions: The current study showed that, although minimal, ∆Petco₂ predicted fluid responsiveness in the dogs studied.