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

Objective: To assess platelet function, storage lesion development, and bacterial contamination in canine platelet concentrate (PC) units stored at 4°C for 14 days.

Design: Prospective, in vitro experimental study.

Setting: University teaching hospital.

Animals: Six units of canine PC.

Interventions: PC units were stored at 4°C for 14 days without agitation and sampled on Days 0, 5, 7, 9, 12, and 14. Testing included automated platelet count, platelet indices, WBC and RBC counts, blood gases, lactate, glucose, and electrolyte concentrations, light transmission aggregometry, alpha-granule secretion, phosphatidylserine externalization via flow cytometry, and aerobic/anaerobic bacterial culture.

Measurements and main results: Platelet count remained stable during storage, with median daily values >500,000/µL. Lactate concentration increased over time, with a median (range) value of 2.1 mmol/L (1.7-2.4 mmol/L) on Day 0 increasing to 9.6 mmol/L (8.1-10.3 mmol/L) on Day 14 (p < 0.0001). All pH measurements remained >7.1. While platelets remained viable throughout storage, platelet function varied over time and response was agonist dependent. Response to ADP was minimal on aggregometry, and alpha-granule secretion increased on Days 12 and 14. Thrombin-induced aggregation was higher compared to ADP and collagen until Day 12, but alpha-granule secretion decreased after Day 7. Collagen failed to elicit robust aggregation response throughout the storage period, but activation with convulxin induced significant activation. Flow cytometry demonstrated variable P-selectin and Annexin V expression in unstimulated and agonist-treated platelets. Bacterial cultures revealed growth in one sample on Day 14.

Conclusions: In canine PC units stored at 4°C for 14 days, there was evidence of loss of platelet function that was agonist dependent, but there were limited or expected changes in hematologic values, metabolic parameters, and platelet viability. Findings support further investigation of cold storage as an option for prolonging canine PC shelf life.

Objective: To determine the cardiovascular and respiratory effects of bolus IV isotonic crystalloid fluid therapy before pericardiocentesis in dogs with pericardial effusion.

Design: Prospective, randomized, nonblinded clinical trial (January 2021 to November 2022).

Setting: University teaching hospital.

Animals: Thirty dogs diagnosed with pericardial effusion.

Interventions: Dogs were randomized to receive a 10-mL/kg IV bolus of compound sodium lactate (IV fluid bolus [IVFB] group) or no fluid bolus (no-IVFB group) over 10 min before pericardiocentesis.

Measurements and main results: Cardiovascular parameters, respiratory rate, peripheral blood lactate concentration, and point-of-care ultrasound (POCUS) findings were assessed. Shock index (SI) was calculated as heart rate divided by systolic blood pressure. Measurements were recorded at four time points (T): baseline (T0), 15 min later (T1, after fluid bolus for the IVFB group), immediately after pericardiocentesis (T2), and 4 h after pericardiocentesis (T3). Significant decreases in SI were observed in the no-IVFB group between T1 and T2 and between T1 and T3, and in the IVFB group between T1 and T3 (p = 0.034, p = 0.003, and p = 0.027, respectively). No differences in SI were found between the groups when compared at the same time point. Administration of an IVFB did not result in adverse respiratory effects, as no dogs required supplemental oxygen by T3, and there were no differences in respiratory rate. The no-IVFB group had a higher incidence of new B-lines compared with the IVFB group (60% vs. 20%), but the median B-line score was ≤1 at all POCUS sites at T0 and T3. Twenty-four dogs survived to hospital discharge with no difference in survival between groups.

Conclusions: Administering an IVFB of 10 mL/kg isotonic crystalloid before pericardiocentesis in dogs with pericardial effusion did not alter SI. This dose appears to be safe, with no adverse respiratory effects seen. However, the current study was underpowered to detect a significant difference, and further studies are needed.

Objective: To assess the association between the oxygenation index (OI) and survival in mechanically ventilated dogs with primary pulmonary parenchymal disease.

Design: Retrospective, multicenter study.

Setting: Three veterinary medical teaching institutions and one private veterinary referral center.

Animals: Seventy-nine client-owned dogs.

Interventions: None.

Methods: OI, calculated as (mean airway pressure × FiO₂ × 100) / PaO₂, and the PaO₂/FiO₂ (PF) ratio were calculated for dogs undergoing mechanical ventilation for primary pulmonary disease. Median OI was lower in survivors (2.6) than nonsurvivors (6.6; p < 0.001), while PF was higher in survivors (317.9 vs. 177.9; p < 0.001). OI predicted mortality with an area under the receiver operating characteristic curve of 0.73, sensitivity of 65%, and specificity of 80% at an optimal cutoff of 4.3. Median PF had an area under the receiver operating characteristic curve of 0.72, sensitivity of 70%, and specificity of 73% at an optimal cutoff of 237.8. Each 1-unit increase in OI was associated with a 35% higher mortality risk (odds ratio: 1.35; 95% confidence interval: 1.14-1.61). Survivors showed greater improvement in OI during ventilation (p = 0.004). Using Pediatric Acute Lung Injury Consensus Conference and pediatric acute respiratory distress syndrome thresholds, survival likelihood declined with increasing severity, with no survivors in the severe category (OI >16). Similar trends were observed using updated Pediatric Acute Lung Injury Consensus Conference-2 criteria and acute respiratory distress syndrome severity classifications.

Conclusions: Higher OI values and lower PF ratios were associated with mortality in this group of mechanically ventilated dogs, with both metrics demonstrating similar predictive accuracy. Results suggest species-specific OI and PF thresholds are needed.

Objective: To describe and compare a large multicenter cohort of dogs with head injury and dogs with a change in modified Glasgow Coma Scale (MGCS) score as an exploratory definition of traumatic brain injury (TBI).

Design: Retrospective evaluation of veterinary trauma registry data.

Setting: Veterinary Committee on Trauma-identified veterinary trauma centers.

Animals: A total of 9607 dogs with data entered in the Veterinary Committee on Trauma registry.

Measurement and main results: Dogs with an MGCS score <18 had a lower chance of survival (793/1172 [67.7%]) compared with dogs with an MGCS score of 18 (8216/8401 [97.8%]) (p < 0.001). Age and size correlated with lower MGCS score, with younger and smaller dogs more likely to have an MGCS score <18 (p < 0.001 and p < 0.001, respectively). An MGCS score <18 was most commonly associated with blunt trauma (830/1183 [70.2%]) when compared with dogs with an MGCS score of 18 (3335/8422 [39.8%]) (p < 0.001). Dogs with an MGCS score of 18 had an incidence of head injury of 8.4%, and dogs with an MGCS score <18 had an incidence of head injury of 32.8%.

Conclusions: This epidemiologic study describes the clinical and prognostic characteristics of dogs with head injury and with changes in MGCS score. Although associated with many aspects of traumatic injury, a change in MGCS score as a surrogate for TBI is not ideal and is not always consistent with the Animal Trauma Triage neurologic score or the presence of head injury. This study enhances our understanding of head injury, MGCS scoring, and the challenges of recognizing TBI in dogs. Additionally, this study helps to further develop a translational model of TBI through the comparative power of the MGCS to the human GCS.

Objective: To compare the outcome of treatment with extracorporeal therapy (ECT) and medical therapy (MED) in dogs with baclofen intoxication.

Design: Multicenter retrospective study between June 1, 2013, and October 31, 2023.

Setting: Six university teaching hospitals and three private specialty hospitals.

Animals: Eighty dogs treated for baclofen intoxication.

Interventions: None.

Measurements and main results: Twenty-nine of 80 (36%) dogs required endotracheal intubation, and 18 (23%) required mechanical ventilation (MV). Twenty-one (26%) dogs were treated with ECT, and 59 (74%) dogs received MED. The median estimated maximal exposure dose was 8.3 mg/kg (range: 3.6-48 mg/kg) in the ECT group and 5.7 mg/kg (range: 0.46-132 mg/kg) in the MED group (p = 0.044). Nine of 21 (43%) dogs treated with ECT had an improvement in their level of consciousness. The mean duration of MV was 20 ± 11 h in dogs treated with ECT and 23 ± 23 h in dogs treated with MED. The median hospitalization time was 58 h (range: 17-124 h) in the ECT group and 24 h (range: 0.5-188 h) in the MED group. Survival was 95% for dogs treated with ECT and 92% for dogs treated with MED. Multivariable Poisson regression modeling was performed, controlling for estimated maximal exposure dose (mg/kg). ECT was associated with a shorter duration of MV (incidence rate ratio [IRR]: 0.76 [95% CI: 0.58-0.99]; p = 0.038). However, ECT was associated with longer hospitalization times (IRR: 1.57 [95% CI: 1.45-1.71]; p < 0.001). No association was found between the use of ECT and survival (odds ratio: 1.61 [95% CI: 0.16-16.13]; p = 0.684).

Conclusions: ECT is associated with high survival despite large estimated exposure doses. Although ECT was associated with a shorter duration of MV, no difference was found in survival or hospitalization time.

Objective: To evaluate whether the velocity-time integral of aortic blood flow (VTI_Ao) assessed by transthoracic echocardiography is increased after the passive leg-raising maneuver (PLRM) in anesthetized and mechanically ventilated, fluid-responder pigs.

Design: Prospective laboratory study.

Setting: University teaching hospital.

Animals: Eight healthy Landrace pigs.

Interventions: Pigs were anesthetized, mechanically ventilated, and subjected to the PLRM. Ultrasound-guided VTI_Ao measurements were compared before and after the PLRM to assess changes. A fluid challenge was then performed, and changes in VTI_Ao were assessed again to classify pigs as fluid responders or nonresponders.

Measurements and main results: Seven of the eight animals were responders, and one was a nonresponder. After the PLRM, fluid responders exhibited an increase in VTI_Ao compared with baseline (p = 0.017). An optimal cutoff of 11.2% for changes in ultrasound-guided VTI_Ao was calculated for predicting fluid responsiveness after the PLRM, with an area under the receiver operating characteristic curve of 1.00 (95% confidence interval [CI]: not estimated), sensitivity of 100% (95% CI: 59-100), specificity of 100% (95% CI: 2.5-100), positive predictive value of 100% (95% CI: 59-100), and negative predictive value of 100% (95% CI: 2.5-100).

Conclusions: Despite limitations, this study demonstrates the potential of using ultrasound-guided VTI_Ao measurements associated with the PLRM to predict fluid responsiveness in anesthetized pigs. An ultrasound-guided VTI_Ao cutoff of ≥11.2% could serve as a reference for identifying fluid-responsive pigs under anesthesia and mechanical ventilation, and offer a noninvasive alternative to fluid challenges.

Objective: To report the use of high-flow nasal cannula oxygen therapy (HFNOT) in three dogs with carbon monoxide poisoning resulting from smoke inhalation.

Series summary: Three dogs were presented to the emergency room with carbon monoxide poisoning associated with house fires. Blood CO-oximetry at the time of presentation confirmed markedly increased carboxyhemoglobin levels. The dogs were treated with 4-7 h of HFNOT to eliminate carboxyhemoglobin. The calculated half-lives of carboxyhemoglobin during HFNOT for Dogs 1, 2, and 3 were 79, 86, and 77 min, respectively. All three dogs survived to discharge, and no delayed complications of carbon monoxide poisoning were reported.

New or unique information provided: To the authors' knowledge, this is the first case series of dogs treated with HFNOT for carbon monoxide poisoning. HFNOT was shown to be effective at removing carbon monoxide, reducing the half-life of carboxyhemoglobin from 77 to 86 min. The half-life of carboxyhemoglobin and the effectiveness of HFNOT should be further investigated in a larger sample of dogs.

Objective: To assess the efficacy of a new equine F[ab']₂ antivenom (US Department of Agriculture code 6101.05) in removing serum venom and lowering the snakebite severity score (SSS) in animals suffering from naturally occurring viperid envenomation.

Design: Retrospective study, April 2020 to October 2021.

Setting: Veterinary hospitals across four North American regions.

Animals: Twenty-two dogs, one cat, and one horse.

Interventions: All patients received the new antivenom intravenously and were assessed for clinical response. Most dogs required one vial for clinical control of signs.

Measurements and main results: Among the dogs and cats with detectable initial serum venom, 94.4% showed a strong response to antivenom administration, with a reduction in serum venom ranging from 94% to >99% at 2 h. Animals that experienced a 90% reduction of serum venom within 2 h greatly exceeded the 0% expected of an ineffective antivenom. The canine and feline SSS improved relative to the initial SSS at 2, 6, and 12 h in 57.9%, 77.8%, and 90.9% of cases, respectively. A favorable reduction in SSS was also appreciated in the single horse in the study.

Conclusions: In the canine, feline, and equine cases of North American viperid envenomation studied, antivenom 6101.05 adequately removed serum venom and lowered the SSS.

Objective: To describe admission variables in dogs with bite wound trauma and to evaluate the relationship of these variables with the type of bite wound (penetrating, blunt, combination) and survival outcome.

Design: Retrospective evaluation of multi-institutional veterinary trauma registry data on dogs presenting with bite wound trauma.

Setting: Veterinary Committee on Trauma-identified Veterinary Trauma Centers (VTCs).

Animals: A total of 12,412 dogs with bite wound trauma presented to VTCs with data entered in the Veterinary Committee on Trauma registry from April 1, 2017, to December 31, 2021.

Interventions: None MEASUREMENTS AND MAIN RESULTS: Admission variables and outcome were evaluated for dogs suffering from penetrating bite trauma (10,942/12,412; 88.16%), blunt bite trauma (479/12,412; 3.86%), and a combination of these (991/12,412; 7.98%). Among all groups, 95.06% (11,799/12,412) survived to discharge, 1.01% (125/12,412) died, and 3.93% (488/12,412) were euthanized. Patient sex (p < 0.001), modified Glasgow Coma Scale score (p < 0.001), Animal Trauma Triage score (p < 0.001), lactate concentration (p < 0.001), base excess (p < 0.001), blood glucose concentration (p < 0.001), ionized calcium concentration (p < 0.001), and PCV/total plasma protein concentration (p < 0.001/p < 0.001) were each associated with survival outcome. Head injury (p < 0.001) or spinal trauma (p < 0.001) at time of admission, or the requirement for blood product transfusion (p < 0.001), was associated with a negative survival outcome. Treatment by a Doctor of Veterinary Medicine prior to arrival to VTC was associated with survival. In multivariate analysis, higher body weight and surgical intervention were associated with survival. Older age and glucose dysregulation were associated with a negative survival outcome.

Conclusion: Dogs sustaining bite wound trauma have an excellent prognosis for survival. These findings may help guide discussion with caregivers regarding patient care, resource requirements, and prognosis.