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

Objective: To determine the effect of operator experience on the adverse events associated with pericardiocentesis. A secondary objective was to determine whether adverse events with inexperienced operators were less common in the presence of an experienced supervisor.

Design: Prospective observational clinical study.

Setting: Private practice specialty teaching hospital.

Animals: Forty-five client-owned dogs with pericardial effusion undergoing pericardiocentesis.

Interventions: Pericardial effusion was identified via point-of-care ultrasound (POCUS). Pericardiocentesis was performed according to standard protocol, with the operator chosen based on availability. An ECG was recorded before, during, and after pericardiocentesis, with optional postprocedural telemetry monitoring. POCUS was repeated to monitor for recurrent effusion. Operators completed a questionnaire to report their experience level and adverse events associated with pericardiocentesis. Medical records were reviewed to verify diagnostic results and adverse event occurrence.

Measurements and main results: Forty-five dogs undergoing pericardiocentesis were prospectively enrolled. Seventeen (37.8%) cases experienced adverse events, with 16 of 45 (35.6%) experiencing an arrhythmia requiring antiarrhythmic therapy during or after pericardiocentesis. There was one case of documented cardiocentesis. No spontaneous death occurred within 48 h. Adverse event occurrence did not differ based on the operator's role (intern, resident, or staff doctor) or the number of pericardiocenteses previously performed by the operator. Supervising operators were present during all pericardiocenteses performed by an intern or an operator who had never performed pericardiocentesis. Neoplasia was documented in 73.3% of cases. Adverse event occurrence was not associated with plasma lactate concentration at presentation or with the presence of neoplasia.

Conclusions: Operator experience level was not associated with adverse event occurrence related to pericardiocentesis. Adverse events were more common than previously reported in the veterinary literature.

Objective: This report describes an 8-day-old foal diagnosed with acute respiratory distress syndrome (ARDS) successfully managed using a novel approach of intratracheal oxygen delivery.

Case summary: An 8-day-old Standardbred filly presented for an acute onset of respiratory distress. Given the acute onset, known risk factors, bilateral diffuse infiltrate on thoracic radiographs, and low PaO₂:FiO₂ ratio of 170.5, the foal was diagnosed with acute respiratory distress syndrome. Initial treatment consisted of antimicrobial therapy (minocycline and metronidazole), nonsteroidal anti-inflammatories (flunixin meglumine), and intranasal oxygen. The filly responded poorly to intranasal oxygen therapy and clinically worsened in hospital, with poor response confirmed on arterial blood gas. Treatment was transitioned to intratracheal therapy via temporary tracheostomy to improve the FiO₂ delivered to the foal. After 24 h of therapy, the arterial oxygen saturation improved to 96.8% and PaO₂ improved to 154.1 mm Hg. The foal was able to avoid constant sedation, intubation, and mechanical ventilation with the use of a temporary tracheostomy. A blood culture was negative, and no transtracheal wash was performed; thus, the underlying etiology is unknown. Oxygen therapy was able to be discontinued on the seventh day of hospitalization, and on the 12th day, the foal was discharged with continued antimicrobial treatment. No complications were associated with placement of the temporary tracheostomy. Five months after discharge, the foal continues to do well at home.

New or unique information provided: This case supports the use of intratracheal oxygen therapy via temporary tracheostomy for the treatment of acute respiratory distress syndrome compared with previous reports of catheterization to improve oxygen delivery. Further investigation is warranted to determine the peak FiO₂ able to be delivered via temporary tracheostomy.

Objective: To (1) establish whether the erythrocyte sedimentation rate (ESR) at admission is related to mortality in dogs hospitalized in the ICU; (2) observe and evaluate the ESR trend during 48-72 h of hospitalization and determine how it relates to mortality; and (3) test whether ESR is a marker of sepsis.

Design: Prospective study using residual K3-EDTA blood samples of hospitalized dogs.

Setting: ICU of a university teaching hospital.

Animals: A total of 124 hospitalized dogs were included in the study. Sixty of the 124 dogs were used to test whether ESR is a marker of sepsis.

Measurements and main results: The ESR was measured on residual EDTA blood samples collected from hospitalized dogs as part of clinical evaluation. A total of 32 dogs died during hospitalization, while 92 were discharged. The ESR at admission (T0) was significantly higher in nonsurvivors (28 mm/h) compared with survivors (11 mm/h) (p = 0.03). Forty-one dogs had ESR monitored at T1 (24 h postadmission) and T2 (48-72 h postadmission). An increase in the ESR from T0 to T2 was seen in nonsurvivors (p < 0.01; medians: T0, 22 mm/h, T1, 37 mm/h, T2, 42 mm/h). Survivors showed a decrease in the ESR from T0 to T2 (p < 0.01; medians: T0, 12 mm/h, T1, 14 mm/h, T2, 5 mm/h). Twenty-eight dogs were diagnosed with sepsis and had a higher ESR than nonseptic dogs (35 vs. 10 mm/h; p < 0.0001). A cutoff of 22 mm/h may differentiate septic dogs from nonseptic dogs, with a sensitivity of 76% and a specificity of 81% (area under the curve = 0.8; p < 0.0001).

Conclusions: The ESR at admission can predict the mortality of hospitalized dogs. Its monitoring during hospitalization may add prognostic information. Given the challenges involved in screening septic patients, point-of-care testing may easily evaluate the ESR when used alongside other indicators.

Objective: In people, severe Hymenoptera stings can lead to systemic allergic reactions, acute kidney injury, rhabdomyolysis, hemolysis, shock, and even death. Hemolytic anemia as a result of multiple honeybee stings has been reported in dogs; however, there are no prior reports of hemolytic anemia due to wasp stings in the dog. In this report, we present a case of a dog that developed hemolytic anemia after a single wasp sting. We also report the vulnerability of RBCs to the wasp venom using an in vitro hemolysis assay.

Case summary: A 3-year-old neutered male Yorkshire Terrier presented with hemoglobinuria 4 h after a suspected single wasp sting and achieved complete remission after a short course of treatment with glucocorticoids and IV infusion, without long-term sequelae. An in vitro hemolysis assay using mastoparan, a major wasp venom constituent, was performed to test our hypothesis that increased sensitivity of the RBC membrane to wasp venom would lead to hemolysis after exposure to a small amount of venom by a single sting. Although no difference in the amount of mastoparan leading to hemolysis in 50% of the RBCs (HC₅₀) was seen between the patient and two healthy controls, the HC₅₀ was higher in whole blood samples.

New and unique information: This is the first report demonstrating that even a single wasp sting can cause hemolysis in dogs. In addition, based on our in vitro hemolysis assay, plasma may have an inhibitory effect on mastoparan-induced hemolysis.

Objective: The goal of this study was to describe the use of and complications associated with the administration of lyophilized platelets (LPs) in dogs with thrombocytopenia-associated hemorrhage and those with nonthrombocytopenia-associated hemorrhage. Secondary objectives were to report pretransfusion and posttransfusion values, including PCV, total plasma protein concentration, platelet count, blood product administration, and overall survival.

Design: Retrospective study between 2018 and 2022.

Setting: Two university veterinary teaching hospitals.

Animals: Sixty-eight dogs that received LPs.

Measurements and main results: Thirty-five dogs received LPs due to thrombocytopenia-associated hemorrhage, and 33 dogs received LPs due to nonthrombocytopenia-associated hemorrhage. The platelet count was lower in dogs with thrombocytopenia-associated hemorrhage, both before (p < 0.001) and after LP administration (p < 0.001), compared with dogs with nonthrombocytopenia-associated hemorrhage. Dogs with thrombocytopenia-associated hemorrhage had lower PCV values before LP administration (p = 0.007), but no difference was noted at 6-12 or 12-24 h after LP administration. There was no difference in the transfusion of other blood products (p = 0.620) or in survival to discharge (p = 1.000). Potential complications were noted in 6% of dogs.

Conclusions: LP administration may be considered for a variety of conditions, including both thrombocytopenia-associated hemorrhage and nonthrombocytopenia-associated hemorrhage.

Objective: To describe the use and feasibility of high-velocity nasal insufflation (HVNI) in cats.

Design: Retrospective descriptive study from 2019 to 2022.

Setting: University teaching hospital.

Animals: Eight cats that failed traditional oxygen therapy and, based on clinical evaluation, required more aggressive oxygen supplementation.

Measurements and main results: Eight cats had HVNI instituted between 2019 and 2022. Four cats received HVNI for primary pulmonary disease, including two with severe nodular pulmonary patterns, one with acute respiratory distress syndrome secondary to septic shock, and one with diffuse hepatization of multiple lung lobes. Two cats received HVNI for airway disease, including one with feline asthma and one with chronic bronchiolar injury. One cat received HVNI due to pleural space disease secondary to failed herniorrhaphy repair for a peritoneal-pericardial diaphragmatic hernia, and one had an unknown cause of respiratory distress. No cat received HVNI due to cardiac disease. The median time spent on HVNI was 17 h (range, 2-76 h). The median flow rate was 1 L/kg (range, 0.612-2.68 L/kg). The median highest FiO₂ recorded was 100% (range, 50%-100%), and the median lowest was 52.5% (range, 40%-100%). Three cats had HVNI successfully discontinued, and two cats survived to discharge. All cats tolerated HVNI with no reported complications.

Conclusions: This is the first report to evaluate the use of HVNI for respiratory support in cats, demonstrating that HVNI is a feasible option in cats requiring more aggressive respiratory support than traditional oxygen therapy.

Objective: To determine the prevalence, case-fatality rate, and primary disease processes associated with corrected hypochloremia (hypo[Cl^-]) in dogs and cats.

Design: Single-center retrospective study.

Setting: Electronic medical records were reviewed to identify dogs and cats with at least one chloride and sodium concentration measured simultaneously during a 60-month period.

Animals: A total of 17,120 dogs and 4197 cats presented to a veterinary teaching hospital.

Interventions: None.

Measurements and main results: Measured hypo[Cl^-] was diagnosed in 23.3% (3981/17,120) dogs and 59.0% (2475/4197) cats. Corrected hypo[Cl^-] was diagnosed in 13.9% (2388/17,120) dogs and 34.9% (1463/4197) cats. The case-fatality rates were higher in animals with measured and corrected hypo[Cl^-] than those with normal corrected [Cl^-] (p < 0.0001). The case-fatality rate was also higher in cats with corrected hypo[Cl^-] than those with measured hypo[Cl^-] (p = 0.0002), but they were not different in dogs (p = 0.74). Of the dogs and cats with corrected hypo[Cl^-], a total of 74.5% (1779/2388) dogs and 74.6% (1091/1463) cats were categorized as prehospital corrected hypo[Cl^-], and a total of 20.9% (498/2388) dogs and 17.3% (253/1463) cats were categorized as hospital-acquired corrected hypo[Cl^-]. The case-fatality rates of dogs and cats with hospital-acquired corrected hypo[Cl^-] were higher than those with prehospital corrected hypo[Cl^-] (p < 0.0001). Various primary disease processes were identified in animals with corrected hypo[Cl^-]. Of these, urologic, cardiovascular, and gastrointestinal diseases were the three most common disease processes identified in dogs and cats with corrected hypo[Cl^-].

Conclusions: Corrected hypo[Cl^-] was a common electrolyte abnormality and was associated with higher case-fatality rates than normal corrected [Cl^-]. Various disease processes were associated with corrected hypo[Cl^-], and closer attention to corrected hypo[Cl^-] is warranted.

Objective: To analyze the effects of co-administering various drugs with canine whole blood (WB), canine fresh frozen plasma (FFP), or canine freeze-dried plasma (FDP), and determine whether alterations to the blood constituents or drugs exist within the admixture.

Design: In vitro experimental study.

Setting: Government blood and coagulation research laboratory.

Interventions: Seven units of commercially acquired canine FFP, 7 units of canine FDP, and 8 units of canine WB were co-administered with multiple drugs, including fentanyl, midazolam, ketamine, hydromorphone, tranexamic acid (TXA), ampicillin/sulbactam, enrofloxacin, ceftriaxone, and ertapenem, and delivered simultaneously into an IV line via infusion pumps using clinically relevant doses. The resultant solutions were analyzed for coagulation factor activities and fibrinogen concentration. Liquid chromatography-tandem mass spectroscopy was used to assess drug concentration, and impedance aggregometry and cell-free hemoglobin were used to evaluate platelet function in the WB samples.

Measurement and main results: Platelet function decreased with each drug co-administered with WB in vitro. Cell-free hemoglobin increased when ketamine, fentanyl, and midazolam were co-administered with WB. Drug loss was seen when enrofloxacin was co-administered with FDP. Drug loss was also seen when hydromorphone was co-administered with FFP. Sulbactam and ertapenem resulted in drug loss when co-administered with FDP and FFP. Drug loss was seen when ceftriaxone, fentanyl, and midazolam were co-administered with each blood product. With each admixture, there were variable changes in coagulation factor activities. A statistically significant decrease in activity <50% was seen only in factors V and VIII when ceftriaxone and enrofloxacin, respectively, were co-administered with FDP.

Conclusions: Platelet function will likely be adversely affected by the co-administration of any of the selected drugs. Co-administration of ketamine, fentanyl, and midazolam with WB resulted in significant hemolysis and is not recommended. It is reasonable to consider co-administering ampicillin, TXA, and ketamine with FDP and FFP.

Objective: To review and summarize the human and veterinary literature pertaining to the diagnosis, treatment, and prevention of phlebitis.

Etiology: Phlebitis can occur in any patient with a vascular catheter, but the focus of this review is on its occurrence in association with peripheral venous catheters (PVCs). The three main categories of phlebitis are infectious, mechanical, and chemical; catheter-, patient-, or drug-related factors may increase the risk. The most devastating injuries likely result from the extravasation of chemotherapeutics and drugs with certain properties (e.g., vasoactive, acidic or alkaline, hyperosmolar or hypo-osmolar).

Diagnosis: Phlebitis is diagnosed based on clinical signs including erythema, swelling, edema, pain, and fever. In people, several grading scales exist to assess for the presence and progression or resolution of phlebitis, but no specific diagnostic or grading schemes exist for veterinary patients.

Therapy: Mild cases of phlebitis likely resolve after removal of the PVC; however, higher grades of phlebitis require more aggressive treatment. Nonpharmacologic therapies are instituted initially, and treatment is escalated to topical, local injectable, and parenteral therapies as indicated. There are several antidotes indicated after the extravasation of certain drugs, particularly chemotherapeutics. Nonpharmacologic phytotherapeutics have also been studied as ancillary therapies in people.

Prognosis: Phlebitis and extravasation injury are associated with morbidity and mortality in human and veterinary patients; however, the definitive prognosis for affected veterinary patients is unknown. It is advisable to implement prevention strategies. When considering prognosis, early identification and treatment of vascular injury are likely of greatest importance.

Objective: To assess the prognostic relevance of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) in critically ill dogs at the time of ICU admission.

Design: Retrospective, observational, descriptive study.

Setting: Private referral center.

Animals: 200 dogs were enrolled in the study, 190 of which completed the study.

Measurements and main results: Signalment, diagnosis, affected body system, pathologic mechanism, concurrent disease, medications, hematology results, duration of hospitalization, and survival time were derived from the clinical notes of all dogs admitted to the ICU of a small animal referral hospital between January 2020 and March 2022. Kaplan-Meier plots were used to visualize associations between the NLR, PLR, MPV, and survival time, and between the NLR, PLR, MPV, and time to discharge. Cox proportional hazard models were used to investigate associations between the NLR, PLR, and MPV and both survival and time to discharge, while adjusting for covariates. Shorter survival times were identified in dogs with higher-than-bnormal NLR values (p < 0.001), and markedly increased NLR values (> 15) were associated with longer hospitalization times (p = 0.037). Dogs with abnormal PLR values were more likely to die or be euthanized than dogs with normal values (p = 0.014).

Conclusions: An association between the NLR at the point of ICU admission and mortality and length of hospitalization suggests its potential use as prognostic biomarker.