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

Objectives: (1) To compare the results of a rapid test for qualitative detection of cardiac troponin I (cTnI) values >1 ng/mL with those obtained using a reference quantitative method and (2) to perform a semiquantitative assessment of rapid test results using this point-of-care (POC) assay.

Design: Prospective cross-sectional study from April 2015 to November 2020.

Setting: Secondary referral hospital.

Animals: Eighty dogs and 20 cats, with and without cardiovascular disease.

Interventions: None.

Measurements and main results: Serum samples were obtained, and cTnI rapid test was conducted in parallel with chemiluminescence assay (reference standard). Positive results from the rapid test were further classified as mild and strong positives, based on subjective assessment of the color intensity of the test line. Rapid test was deemed valid in all patients. There was agreement for positive samples between the qualitative and quantitative techniques in 31 dogs and 5 cats, and for negative samples in 43 dogs and 13 cats, resulting in a strong and moderate agreement, respectively. There was a significant difference between color scale groups.

Conclusions: The rapid test assessed provides a feasible POC option to determine concentrations of cTnI >1 ng/mL in dogs and cats and shows a moderate to strong agreement with a validated conventional quantitative assay. Furthermore, semiquantitative assessment allows estimation of the magnitude of the elevation.

Objective: To report summative data from the American College of Veterinary Emergency and Critical Care (ACVECC)-Veterinary Committee on Trauma (VetCOT) registry, with further individual evaluation of university and private practices and level I and II Veterinary Trauma Centers (VTCs).

Design: Multi-institutional registry data report, January 1, 2020, to December 31, 2021.

Setting: VTCs identified and verified by ACVECC-VetCOT.

Animals: Dogs and cats with evidence of trauma.

Interventions: Data were input to a web-based data capture system (REDCap) by data entry personnel trained in registry software use and operational definitions of data variables. Patient data on demographics, trauma type, preadmission care, trauma severity assessment at presentation (modified Glasgow Coma Score and Animal Trauma Triage score), key laboratory parameters, interventions, and outcome were collected. Summary descriptive data for each species are reported.

Measurements and main results: Twenty-two VTCs contributed data to the VetCOT registry during a 24-month period, culminating in a total of 9758 complete trauma case records for dogs and 11734 for cats. Head trauma in dogs and cats was seen at a higher percentage in both university-only VTCs (encompassing both level I and II) (20.1% and 24.1%, respectively) and level I-only VTCs (24.3% and 24.1%, respectively), in comparison to private-only VTCs (encompassing both level I and II) (13.5% and 16.2%, respectively) and individual level II VTCs (14.1% and 18.9%, respectively). Canine and feline surgical procedures were performed at a higher percentage at university VTCs (50% and 40.5%, respectively) compared to private VTCs (39.2% and 28.6%, respectively). Overall survival to discharge for dogs and cats remains high at 93.1% and 83.6%, respectively.

Conclusions: The VetCOT registry has continued to show powerful potential in collating a large, multifaceted, international dataset in trauma for both dogs and cats. As published in previous VetCOT registry reports, survival to discharge has remained static across both university and private practice veterinary hospitals; however, further breakdown has identified university and level I VTCs admitting and managing a higher number of head traumas, as well as university VTCs performing a higher proportion of surgical procedures. Data from this registry will continue to aid in the design of clinical trials, prospective observational studies, and translational research, which will improve the understanding and outcome of trauma patients.

Objective: To describe a case of concurrent septic pyothorax, peritonitis, and cholecystitis due to Staphylococcus pseudintermedius in a dog.

Case summary: A 10-year-old neutered male, medium-sized, mixed-breed dog presented with an acute abdomen. Initial investigations found the presence of a septic pyothorax, septic peritonitis, and bacterial cholecystitis. Exploratory celiotomy did not identify the source of infection, and no macroscopic communication between pleural and peritoneal space was detected. An abdominal Jackson-Pratt drain and bilateral small-bore thoracostomy tubes were placed for further management, with the dog receiving antimicrobial therapy and intensive supportive care. Subsequently, microbiological cultures confirmed scant growth of S. pseudintermedius in bile, pleural, and peritoneal fluid. The dog was discharged after 1 week of hospitalization. Antimicrobial therapy was discontinued 4 weeks after discharge due to an improvement of clinical signs and normalization of C-reactive protein concentration. A diagnosis of hyperadrenocorticism was made 6 weeks after discharge, and appropriate therapy was initiated.

New or unique information provided: Septic peritonitis and septic pyothorax are both common life-threatening conditions in veterinary medicine. To the authors' knowledge, this is the first report describing septic bicavitary effusion associated with a biliary staphylococcal infection in a dog. The exact mechanism by which the infection spread remains unclear, but hematogenous or lymphatic routes are considered the most probable. However, the presence of microscopic diaphragmatic defects and an anicteric gallbladder rupture cannot completely be excluded. The concurrent hyperadrenocorticism may have also contributed to an immunocompromised state, predisposing the dog to the development of infection.

Objective: To evaluate the changes in flow velocities of the middle cerebral artery before and after a carotid compression maneuver using transcranial color-coded duplex sonography (TCCD) in healthy anesthetized dogs under mechanical ventilation.

Design: Prospective study.

Setting: University teaching hospital.

Animals: Eleven healthy adult dogs.

Interventions: A 5-second carotid occlusion maneuver was performed to evaluate cerebral autoregulation (CA).

Measurements and main results: After 10 minutes of stable anesthesia, the middle cerebral artery was evaluated by TCCD. Dogs were positioned in sternal recumbency with the head raised to the level of the phlebostatic axis. The systolic peak velocity (Vp) was measured using pulsed Doppler mode. CA was evaluated through the transient hyperemia test (THT), which assesses changes in the Vp after a 5-second transient compression of the ipsilateral common carotid artery and is expressed as the ratio between the Vp flow before and after carotid compression. The Vp before and after carotid occlusion was compared using the Wilcoxon signed-rank test. The median Vp of the middle cerebral artery after the carotid compression maneuver was significantly higher than the median Vp before compression (median [interquartile range, IQR]: 47.7 cm/s [34.3] vs 64.1 cm/s [24.4]; P = 0.003). The median THT obtained was 1.20 (IQR: 0.37).

Conclusions: The current study demonstrated a significant increase in the Vp of the middle cerebral artery after a 5-second temporary occlusion of the ipsilateral carotid artery in healthy anesthetized dogs under mechanical ventilation. These findings suggest that the noninvasive TCCD methodology could be valuable for assessing CA in dogs. Additional studies using this technique in neurocritical animals are required to confirm its usefulness.

Objective: To describe the treatment of a unique cause of acute abdomen in a puppy.

Case summary: An 11-week, 5-day-old female intact Alaskan Malamute was presented to an emergency service for an acute onset of vomiting. On evaluation, the puppy was found to have cranial abdominal pain with an otherwise normal physical examination. An inflammatory leukogram with no other clinically significant findings was found on the initial diagnostics. An abdominal ultrasound showed peritoneal effusion and a lobulated structure in the left cranial abdomen. An emergency exploratory celiotomy was performed, during which evidence of torsion was found in the left limb of the pancreas, which was subsequently excised from the abdomen. The puppy was hospitalized overnight and discharged the next day. Histopathology of the pancreas was consistent with torsion.

Unique information provided: Pancreatic torsion is a rare but potential cause of acute abdomen in dogs and can be successfully treated with surgical excision.

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.

Objective: To examine owner experiences with and perceptions of owner-witnessed resuscitation (OWR) in veterinary medicine and to determine if previous experience with family-witnessed resuscitation (FWR) influenced perceptions.

Design: Multicenter survey.

Setting: Two academic and 2 private practice referral hospitals in the United States.

Subjects: Four hundred and seven clients presenting their small animal or exotic pet to the emergency service, or owners of patients hospitalized in the small animal ICU, April 1 to May 15, 2019.

Interventions: None MEASUREMENTS AND MAIN RESULTS: Anonymous, online survey. Demographic variables, familiarity with CPR, previous experience with FWR or OWR, and open-ended questions and 4-point Likert items assessing level of agreement with statements on OWR were included. Scores equal or greater than 2 represented positive agreement. An overall OWR mean score was calculated from Likert items. Seventy-nine (19.4%; 95% confidence interval [CI], 15.7%-23.7%) participants reported having been involved with FWR, and 13 (3.2%; 95% CI, 1.8%-5.5%) reported having witnessed CPR on their pet. Owners were significantly more likely to participate in OWR if they had been present for FWR (P = 0.0004). Ninety-two percent of respondents who had been present for OWR would elect to be present again (95% CI, 62.1%-99.6%). Whether present for OWR or not, owners believed there may be benefits from witnessing CPR and had overall positive feelings toward the practice (OWR mean score, 2.87, SD 0.45 and 2.68, SD 0.54, respectively). Most respondents (78.6%; 95% CI, 74.2%-82.4%) felt that owners should be offered the opportunity to witness CPR on their pets.

Conclusions: Owners expressed overall positive experiences with and attitudes toward OWR and believe the option for presence should be provided. As pet owners become more aware of FWR in human medicine, veterinarians may need to be prepared to entertain the possibility of OWR and owners' wishes to remain with their pet during CPR.

Objectives: To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations.

Design: A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats).

Results: Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism.

Conclusions: Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.