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

Objective: To describe the development and management of an iatrogenic pneumothorax in a cat after placement of a continuous glucose monitor sensor.

Case summary: A 13-year-old neutered male domestic shorthair cat was presented to the emergency department for signs related to unregulated diabetes mellitus. A continuous glucose monitor was placed to facilitate glycemic monitoring during hospitalization. After placement of the sensor, the cat developed a unilateral iatrogenic pneumothorax that required placement of a thoracostomy tube for intermittent evacuation. The cat's pneumothorax resolved with medical management, and the cat was successfully discharged from the hospital. Two weeks after discharge, the cat was euthanized due to progression of systemic disease. No further clinical signs of pneumothorax were noted.

New or unique information provided: To the authors' knowledge, iatrogenic pneumothorax in a cat after placement of a continuous glucose sensor has not been previously reported in the veterinary literature.

Objective: To confirm the reproducibility of the cardiac baroreceptor reflex (CBR) and bradycardia induced by ephedrine administration and to evaluate the safety of administering prophylactic atropine to prevent the CBR in anesthetized dogs.

Design: Experimental, single-blind, crossover study.

Setting: Veterinary university research facility.

Animals: Six healthy Beagle dogs.

Interventions: Dogs were anesthetized with propofol and maintained with isoflurane. After various biological monitors were attached, dogs received IV premedication with saline (saline-ephedrine [SE] group) or atropine (0.04 mg/kg; atropine-ephedrine [AE] group). Subsequently, ephedrine (0.1 mg/kg) was administered intravenously.

Measurements and main results: Cardiovascular parameters (invasive arterial blood pressure, heart rate [HR], stroke volume index, and cardiac index) and immediate parasympathetic tone activity (PTAi) were recorded 15 min after premedication (baseline [BL]) and for 30 min after ephedrine administration. All data were recorded by the same blinded recorder. Consequently, the MAP in the SE and AE groups significantly increased after ephedrine administration. The HR in the SE group significantly decreased from BL; two dogs exhibited bradycardia (<50/min), and atrioventricular block was seen in one dog. In the AE group, the HR significantly increased from BL; no tachycardia was observed. The cardiac index in the SE group was maintained at BL, but the cardiac index in the AE group was significantly higher than that at BL during the experimental period. In both groups, PTAi rapidly decreased after ephedrine administration at 1 min. In the SE group, PTAi recovered to BL after 2 min. However, PTAi in the AE group remained significantly lower at 1-3 min than at BL and was significantly lower than that at 1-4 min in the SE group.

Conclusions: We confirmed the CBR-induced bradycardia after ephedrine administration in anesthetized dogs, showing that atropine administration for prevention of ephedrine-induced bradycardia is safe with no adverse events.

Objective: To evaluate and compare characteristics and outcomes of dogs with gastrointestinal (GI) and non-gastrointestinal (non-GI) causes of septic peritonitis.

Design: Retrospective study from 2009 to 2022.

Setting: A Midwest veterinary teaching hospital and a West Coast private practice in the United States.

Animals: A total of 161 dogs diagnosed with septic peritonitis based on intracellular bacteria or a positive culture from peritoneal effusion.

Interventions: None.

Measurements and main results: Of 161 dogs included in the study, 114 (70.8%) survived. Dogs that survived were younger (p = 0.011) and, compared with nonsurvivors, had higher total plasma protein (TP) concentrations (p = 0.039), higher serum albumin concentrations (p = 0.0021), and higher systolic blood pressures (SBP) (p = 0.0025) on presentation. Plasma lactate concentration on presentation was not associated with survival (p = 0.097). There was no difference in survival between dogs diagnosed with a GI versus non-GI etiology of septic peritonitis. Dogs with GI etiologies weighed more than dogs with non-GI etiologies (p = 0.0169). There were no differences in age, temperature, heart rate, SBP, PCV, TP, serum blood glucose concentration, plasma lactate concentration, serum albumin concentration, or Acute Patient Physiologic and Laboratory Evaluation-fast scores upon presentation in dogs with GI etiologies compared with dogs with non-GI etiologies. In a subgroup analysis, dogs with hepatobiliary etiologies were older (p = 0.0004) and weighed less (p = 0.003) compared with dogs with GI and other non-hepatobiliary etiologies, but there was no difference in survival (p = 0.958).

Conclusions: This study found no difference in survival to discharge in dogs with GI compared with non-GI etiologies of septic peritonitis. Regardless of the etiology of septic peritonitis, age, TP, serum albumin concentration, and SBP upon presentation were significantly associated with survival.

Objective: To describe the use of activated carbon hemoperfusion (HP) and hemodialysis (HD) to treat a meloxicam overdose in a dog.

Case summary: A 2-year-old neutered male Basset Hound mix was presented for an accidental overdose of meloxicam of up to 5.5 mg/kg. The dog was asymptomatic on presentation with mild azotemia. In-series activated carbon HP and HD were performed. Fifteen blood volumes were processed over 207 min, resulting in an 87.5% decrease in the serum meloxicam concentration, with the greatest reduction occurring within the first hour of treatment. The dog developed self-limiting hematochezia but otherwise had no clinical concerns. Eight weeks after HP/HD treatment, follow-up bloodwork showed a relatively static, mild azotemia.

New or unique information: This is the first clinical report to describe the successful use of activated carbon HP and HD in veterinary medicine and the first to document the use of HP to treat meloxicam toxicosis.

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.