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

Objective: To describe a case of traumatic endocardial rupture, without obvious clinical signs of cardiac injury, resulting in acute thrombosis of the forelimbs in a dog.

Case summary: A young adult male German Shepherd Dog presented with vehicular polytrauma. The dog was diagnosed with hypovolemic shock and traumatic pneumothorax and was stabilized, having displayed no clinical indicators of cardiac dysfunction. For 10 days, the dog was treated with no complications in the hospital for wounds but presented again shortly after discharge with bilateral forelimb paraparesis determined likely to be due to thrombosis. The dog was euthanized, and the body was submitted for necropsy. A diagnosis was made of left atrial endocardial rupture with thrombosis, multifocal pulmonary bullae and contusions, and cutaneous abrasions, all secondary to trauma. Based on the dog's physical examination on secondary presentation and the necropsy findings of a thrombus adherent to a left atrial tear, it was suspected that one or more thrombus fragments dislodged and occluded the major supplying vessels of the forelimbs.

New or unique information provided: Blunt cardiac injury may occur without overt clinical manifestations of dysfunction and may lead to thrombosis and associated complications.

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 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.

Objective: To evaluate ultrasonographic optic nerve sheath diameter (ONSD-US) as a dynamic biomarker of intracranial hypertension (ICH) following administration of mannitol in patients with clinically suspected ICH.

Design: Prospective observational study over 1 year. Patients were followed for 60 min beyond treatment.

Setting: University teaching hospital.

Animals: Ten prospectively recruited client-owned dogs with clinically suspected ICH (consecutive sample) and 10 weight-matched, healthy control dogs.

Interventions: Bilateral transpalpebral ONSD-US images were collected using a handheld ultrasound probe in dogs with clinically suspected ICH before (t₀) and at 30 min (t₃₀) and 60 min (t₆₀) after administration of mannitol therapy (1 g/kg IV). Measurements were collected and evaluated by three observers and compared for agreement. At each time point, a clinical examination was performed, vital parameters were recorded, and neurological scores were assigned using the Modified Glasgow Coma Scale, the Neurological Deficit Score, and the Animal Functional Capacity tools. Bilateral baseline ONSD-US measurements were also collected from weight-matched control dogs using the same technique.

Measurements and main results: Control dogs had a lower mean (± SD) ONSD-US (1.6 ± 0.4 mm) than dogs with suspected ICH at baseline (2.0 ± 0.6 mm; p = 0.006) on a paired t-test. Among dogs with suspected ICH, compared using a one-way ANOVA with Tukey's multiple comparisons test, ONSD-US was decreased from baseline (2.0 ± 0.6 mm) at t₃₀ (1.8 ± 0.6 mm; p = 0.005) and t₆₀ (1.7 ± 0.5 mm; p = 0.003). There was no difference between t₃₀ and t₆₀ (p = 0.17). Interrater and intrarater reliability were excellent (ICC >0.90). Physiological parameters and neurological scores did not change among the time points assessed, while the Neurological Deficit Score decreased over time (p = 0.04; R² = 0.51).

Conclusions: ONSD-US decreases over time with hyperosmolar therapy and may be a useful noninvasive, dynamic biomarker to identify and monitor ICH and response to therapy.

Objective: To describe abnormalities and clinically relevant complications in dogs following mitral valve repair. Secondarily, to assess demographic and intraoperative factors with clinically relevant complications, length of ICU stay, successful ICU discharge, and survival to hospital discharge. Finally, to analyze the relationship of clinically relevant complications with prolonged ICU stay, successful ICU discharge, and survival to hospital discharge.

Design: Retrospective observational study, May 2019 to January 2020.

Setting: University veterinary teaching hospital.

Animals: Forty-one dogs following mitral valve repair.

Measurements and main results: Medical records were retrospectively reviewed. Abnormalities occurred in all dogs. All dogs received red blood cell transfusions, exhibited postoperative pleural hemorrhage, and had increased C-reactive protein concentration. Common abnormalities included anemia, hypoalbuminemia, pulmonary dysfunction, acidemia, hypokalemia, ventricular premature complexes, hypernatremia, and corrected hyperchloremia. Clinically relevant complications occurred in 75.6% of dogs, with the most common being hyperlactatemia, increased red cell transfusion requirement, excessive pleural hemorrhage, IV fluid bolus requirement, postoperative furosemide administration, and severe hypernatremia. Several complications had altered odds for prolonged ICU hospitalization, successful ICU discharge, and survival to hospital discharge; those with appropriately narrow confidence intervals (CIs) included excessive pleural hemorrhage and increased red cell transfusion requirement, both having reduced odds of survival to hospital discharge (odds ratio [OR] 0.08, 95% CI 0.01-0.58 and OR 0.04, 95% CI 0.00-0.42, respectively). Neurological complications were negatively associated with successful ICU discharge (p = 0.004) and survival to hospital discharge (p = 0.002). Revision surgery was associated with reduced odds of survival to hospital discharge (OR 0.06, 95% CI 0.00-0.80).

Conclusions: Postoperative abnormalities are common in dogs undergoing mitral valve repair, with many expected given the nature of surgery performed. Many dogs experienced complications requiring deviation from standard protocol. This study provides the first exploratory analysis of dogs undergoing mitral valve repair at a single center.

Objectives: To investigate the characteristics of stair-related injuries in dogs and estimate injury frequencies in patients presenting to veterinary trauma centers.

Design: Retrospective evaluation of medical records in canine trauma cases.

Setting: Two university teaching hospitals.

Animals: Sixty-one dogs presented to university-based emergency centers after falling down the stairs between January 2017 and July 2022.

Interventions: None.

Measurements and main results: Sixty-one dogs presenting with a history of falling down the stairs that underwent complete physical examination were included. Dogs with severe preexisting comorbidities and cats were excluded. Injuries were categorized based on the body system affected (head, spine, extremity, thorax, abdomen) and further subcategorized based on the level of severity (mild, moderate, severe). Geriatric and nongeriatric populations were compared. Mild (ambulatory paraparesis), moderate (nonambulatory paraparesis), and severe (paraplegia) myelopathies occurred in 18% (n = 11), 11% (n = 7), and 5% (n = 3) of cases, respectively. Mild (lameness), moderate (lameness with tendon or ligament disruption or bony luxation), and severe (bony fracture) extremity injuries had a prevalence of 28% (n = 17), 7% (n = 4), and 13% (n = 8), respectively. Traumatic brain injury was documented in 8% of cases, and no cases of thoracic or abdominal trauma were documented. There were no differences in odds of traumatic brain injury, extremity injury, spinal cord injury, or severity of injuries between geriatric and nongeriatric patients. Forty-five (74%) cases were discharged from the hospital.

Conclusion: Falls involving stairs are associated with various forms of injury in dogs. Many cases were mild, allowing for outpatient management. In some cases, it may be difficult to determine whether the fall caused the injury or whether disease precipitated the fall (e.g., myelopathy, pathological fracture). The small sample size of this population likely limited the ability to detect significant differences in pattern of injury between geriatric and nongeriatric patients. Further investigation with a larger population size is warranted.

Objective: To evaluate the relationship between the BUN-to-albumin (BUN/ALB) ratio and markers of illness severity including mortality, length of hospitalization, oxygen dependence, duration of oxygen therapy, and presence of multilobar pneumonia in canine patients with bacterial pneumonia.

Design: Retrospective medical records review, 2018-2023.

Setting: A private practice referral hospital and a university teaching hospital.

Animals: Thirty dogs with confirmed bacterial pneumonia MEASUREMENTS AND MAIN RESULTS: We found a higher BUN/ALB ratio was correlated with increased length of hospitalization, need for initial oxygen supplementation, presence of multilobar pneumonia, and decreased odds of survival in dogs with bacterial pneumonia.

Conclusions: Although the BUN/ALB ratio shows promise as a marker of severity of bacterial pneumonia in canine patients, future studies are warranted to determine optimal cutoff values and how it can be used to predict disease severity.