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

Objective: To evaluate the applicability, reliability, and prioritization effectiveness of a 5-point Veterinary Triage System (VetTriS) in a busy primary and secondary emergency department. Additionally, it was determined whether target waiting times could be met. Triage assessments performed by veterinary technicians and veterinary students were retrospectively assessed by the authors.

Design: Prospective observational study with retrospective analysis of data on applicability, reliability, and prioritization.

Setting: Primary and secondary emergency department.

Animals: One hundred sixty-four cats and dogs presented at a primary and secondary emergency service.

Interventions: None.

Measurements and main results: Data from 164 dogs and cats admitted to a primary and secondary emergency department during the weekends of April to July of 2024 were analyzed. Triage performed using VetTriS by veterinary technicians and veterinary students demonstrated substantial interobserver agreement, with a kappa of 0.69. Overtriage occurred in 9.8% of patients and undertriage in 0.6%. The assigned target waiting time was met in 85.4%. VetTriS was unable to properly assess for prioritization within this study design and did not allow for good assessment of hydration status.

Conclusions: VetTriS is a reliable tool for use in veterinary emergency departments to triage patients and has substantial interobserver agreement. Although performing triage is difficult in a busy emergency center, the results of this study are promising. Further adjustments to VetTriS are needed, and future studies are needed to test for applicability and prioritization.

Objective: To evaluate the relationship between the lung ultrasound score (LUSS) and oxygenation indices.

Design: Retrospective study from January 2022 to December 2023.

Setting: Private veterinary center.

Animals: A total of 56 examinations from 42 dogs were used for the analysis.

Interventions: None.

Measurements and main results: Arterial blood gas analysis was performed on room air. By summing the score assigned to eight quadrants, a LUSS was created that ranged from 0/24 for fully aerated lungs to 24/24 for nonaerated lungs. Represented conditions included pneumonia (n = 25), cardiogenic pulmonary edema (CPE; 14), pulmonary hypertension (6), systemic or extrathoracic diseases (5), lung contusion (3), and pulmonary thromboembolism (3). The LUSS had a moderate correlation with oxygenation indices, showing a negative relationship with the ratio between arterial partial pressure of oxygen and fraction of inspired oxygen (PaO₂:FiO₂): r = -0.79 (95% confidence interval [CI]: -0.87 to -0.662; p < 0.001) and a positive relationship with the alveolar-arterial gradient (Grad(A-a)O₂): r = 0.68 (95% CI: 0.502-0.797; p < 0.001). In pneumonia, this correlation was moderate with an r of -0.61 (95% CI: -0.809 to -0.28; p = 0.001), while in CPE, it was very strong, with r = -0.81 (95% CI: -0.938 to -0.49; p < 0.001). The relationship between the LUSS and the Grad(A-a)O₂ was weaker, with r = 0.48 (95% CI: 0.111-0.738; p = 0.014) for pneumonia and 0.6 (95% CI: 0.105-0.858; p = 0.023) for CPE. The correlation between the PaO₂/FiO₂ ratio and the Grad(A-a)O₂ was very strong, with r = -0.89 (95% CI: -0.934 to -0.817; p < 0.001).

Conclusions: This study found a strong correlation between the LUSS and pulmonary oxygenation indices, suggesting that the LUSS is an effective tool for stratifying the severity of lung aeration loss and investigating respiratory status in healthy dogs as well as those with respiratory failure.

Objective: To describe abdominal compartment syndrome (ACS) associated with postobstructive diuresis (POD) in a cat with urethral rupture.

Case summary: A 6-month-old intact male Korean domestic shorthaired cat presented with suspected urethral rupture. Diagnostic imaging revealed multiple pelvic fractures and free fluid in the abdominal cavity, suggesting a uroabdomen secondary to traumatic urethral rupture. No evidence of urethral obstruction was observed, and the urinary bladder was empty. Uroabdomen and septic peritonitis were confirmed via abdominal fluid-to-serum creatinine and potassium concentration ratios and cytological analysis, respectively. Retrograde urethral catheterization using a 3-Fr urethral catheter was achieved and intraabdominal pressure (IAP) was measured, revealing intraabdominal hypertension with IAP of 28.5 mm Hg. Ultrasound-guided abdominocentesis removed 140 mL of free fluid, reducing IAP to 14.8 mm Hg after 30 min to alleviate the uroabdomen. Subsequent IAP measurements collected every 4 h revealed a gradual decrease. Following urethral catheterization, urine output was monitored at 1- to 4-h intervals, revealing urine output of 47.15 mL/kg/h during the first hour after catheterization, indicative of POD. Intravenous fluid therapy rate was adjusted based on urine output. Urine output progressively decreased to 5.2 mL/kg/h 14 h after catheterization and to 4.5 mL/kg/h at the time of discharge. The final IAP measurement, 24 h following abdominocentesis and urethral catheterization, was 12.1 mm Hg.

New information provided: This case report describes a rare occurrence of POD following the alleviation of IAP in a cat with uroabdomen-induced ACS.

Objective: To document veterinary professionals' experiences discussing CPR and do-not-resuscitate (DNR) orders with clients.

Design: Internet-based survey.

Setting: Various small animal clinical practices.

Subjects: A total of 547 veterinary professionals, including veterinarians, medical support staff, and nonmedical support staff.

Measurements and main results: An electronic survey was distributed containing multiple-choice, Likert-type, and open-ended questions. Likert-type questions of interest were compared among groups of two using a Mann-Whitney U-test or a Kruskal-Wallis test with Dunn's test for post hoc analysis for groups of three or more. An ordinal regression model was fitted to explore factors that best predict greater comfort with discussing CPR, making recommendations, and offering specific advice. Most respondents (63.9%) reported working in hospitals with protocols for discussing CPR/DNR with clients, and the presence of a protocol increased the self-reported comfort with discussing CPR/DNR with clients (Estimate = 0.789, 95% CI: 0.354-1.224; p < 0.001). Respondents reported that most conversations about CPR/DNR are led by veterinarians (37.2%) or veterinary technicians/assistants (37.1%), followed by nonmedical support staff, such as receptionists or practice managers without medical training (23.1%), students (1.7%), and unspecified others (0.8%). From the open-ended questions, respondents commonly shared that they have never received formal training in how to discuss CPR/DNR with clients; rather, they learned from mentors or colleagues on the job. A greater number of years in emergency practice was correlated with greater self-reported comfort with making specific recommendations about CPR/DNR (Estimate = 0.067, 95% CI: 0.03-0.103; p < 0.001).

Conclusions: Veterinary professionals' comfort with discussing code status with clients appears to benefit from both formal protocols and accumulated experience in emergency practice. The lack of formal training highlights a gap that could be addressed to support more effective and confident communication in critical care discussions, potentially improving veterinary staff well-being.

Objective: To report the diagnostic results, treatments, and outcomes in 13 dogs with suspected canine infectious respiratory disease complex (CIRDC)-associated pneumonia and Mycoplasma cynos-positive polymerase chain reaction (PCR).

Design: Retrospective and prospective case series.

Setting: Emergency and referral hospital.

Animals: Thirteen client-owned dogs with suspected CIRDC-associated pneumonia and a positive PCR.

Interventions: None.

Measurements and main results: All dogs with history, clinical signs, and radiographs consistent with CIRDC-associated pneumonia and a positive upper respiratory PCR that presented during a cluster from August 15, 2023, to September 9, 2023, were retrospectively and prospectively included in the series. Among the 13 dogs included, M. cynos was the sole pathogen detected in the airways of eight dogs, while M. cynos and Bordetella bronchiseptica were detected in five dogs. No viral etiologies were detected in this sample. Doxycycline, amoxicillin-clavulanic acid, and fluoroquinolones were frequently prescribed for ≥2 weeks. Follow-up was performed until 1 week after resolution of cough, evidence of radiographic resolution, or death of the dog. Twelve dogs survived, and one was euthanized.

Conclusions: Mycoplasma cynos was detected as the sole or co-occurring infection during this 3-week period, indicating it may be an important agent in some CIRDC clusters.

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

Design: Single-center retrospective study.

Setting: Electrical 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 hyper[Cl^-] was diagnosed in 18.1% (3092/17,120) dogs and 9.4% (396/4197) cats. Corrected hyper[Cl^-] was diagnosed in 21.1% (3607/17,120) dogs and 9.1% (384/4197) cats. The case-fatality rates were higher in animals with corrected hyper[Cl^-] than in those with normal corrected [Cl^-] (p < 0.0001). The case-fatality rate was higher in dogs with measured hyper[Cl^-] than in those with corrected hyper[Cl^-] (p = 0.011). Of the dogs and cats with corrected hyper[Cl^-], a total of 50.9% (1835/3607) dogs and 38.3% (147/384) cats were categorized as prehospital corrected hyper[Cl^-], whereas a total of 39.5% (1424/3607) dogs and 48.7% (187/384) cats with corrected hyper[Cl^-] were categorized as hospital-acquired corrected hyper[Cl^-]. The case-fatality rate of dogs and cats with hospital-acquired corrected hyper[Cl^-] was higher than that of prehospital corrected hyper[Cl^-] in dogs (p < 0.0001) but not in cats (p = 0.9). Various primary disease processes, including neurologic and urologic diseases, were identified in animals with corrected hyper[Cl^-].

Conclusions: Corrected hyper[Cl^-] was a common electrolyte abnormality identified in dogs and cats, and it was associated with higher case-fatality rates than normal corrected [Cl^-]. Hospital-acquired corrected hyper[Cl^-] was less common but was associated with a higher case-fatality rate than prehospital corrected hyper[Cl^-] in dogs. Further investigation of corrected hyper[Cl^-] in association with its morbidity and mortality and the role of therapy to target normal [Cl^-] is warranted.

Objective: To evaluate the impact of a Cardiopulmonary Resuscitation Video Decision Aid (CPR-VDA) on pet owners' resuscitation preferences, decisional confidence, conflict, and knowledge of CPR.

Design: Prospective, interventional survey study with data collected from January to March 2024. Owners of pets presenting through the Emergency Department completed a preintervention questionnaire. They then viewed a 7-min CPR-VDA and completed a postintervention questionnaire. Changes between pre- and postintervention scores were analyzed using Wilcoxon signed rank tests.

Setting: Private referral hospital SUBJECTS: Seventy-eight pet owners INTERVENTIONS: Viewing of a CPR-VDA MEASUREMENTS AND MAIN RESULTS: The preintervention questionnaire assessed pet owner demographics, resuscitation preferences, decisional confidence and conflict, and prior knowledge about CPR. The postintervention questionnaire reassessed resuscitation preferences, decisional confidence and conflict, and CPR knowledge, with additional questions evaluating owner' perceptions of the CPR-VDA. Preintervention, 56 of 78 (72%) participants expressed a preference for "resuscitation" of their pet, five of 78 (6%) opted for "do not attempt resuscitation," and 17 of 78 (22%) were "not sure." Most participants (56/78 [72%]) did not change their resuscitation preference following the intervention. Participants felt more confident in their decision after watching the CPR-VDA (p < 0.001). There was no difference in how conflicted they felt making this decision (median score on a rating scale of 1-5 was 2.25 preintervention and 2.42 postintervention; p = 0.192). Their knowledge of CPR improved (median correct answers increasing from 5.5/9 to 9/9; p < 0.001). Most participants rated the video "good" or "excellent" (72/78 [92%]), found the video helpful (62/78 [79%]), and were likely to recommend it to other pet owners (72/78 [92%]).

Conclusions: The use of a CPR-VDA improved pet owner knowledge of CPR and increased their confidence in decision making. The CPR-VDA was well received by pet owners and may be a useful tool to facilitate discussions regarding this topic.

Objective: To determine whether the SpO₂/FiO₂ (SF) ratio correlates with the PaO₂/FiO₂ (PF) ratio in mechanically ventilated dogs.

Design: Prospective, multicenter, longitudinal, observational study.

Setting: Private veterinary referral center and a veterinary medical teaching institution.

Animals: Thirty-seven client-owned dogs requiring mechanical ventilation between April 2021 and April 2023.

Interventions: None.

Measurements and main results: SpO₂ and FiO₂ values in mechanically ventilated dogs were recorded at the time of arterial blood gas sampling. SpO₂ values between 80% and 97%, PaO₂, and FiO₂ were used to calculate and determine the relationship between SF and PF ratios. The weighted Spearman correlation coefficient between the ratios was 0.70 (p < 0.0001), and the relationship between them was described by the following linear mixed model: SF = 0.50 × (PF) + 103. The linear model predicted that SF ratios of 153, 203, and 253 correspond with PF ratios of 100, 200, and 300, respectively. There was an adequate to outstanding discriminatory ability for SF to predict PF <100 (area under the curve [AUC] = 0.94, 95% CI: 0.91-0.97), PF <200 (AUC = 0.92, 95% CI: 0.88-0.96), and PF <300 (AUC = 0.77, 95% CI: 0.69-0.85).

Conclusions: In this population, SF and PF ratios were strongly correlated, suggesting that SF ratios may serve as a reliable, noninvasive substitute for PF ratios when assessing oxygenation in mechanically ventilated dogs. The linear mixed model identified SF values corresponding to PF ratios of 100, 200, and 300. However, given the wide level of agreement between SaO₂ and SpO₂ measurements in this study, arterial blood gas analysis remains the gold standard for assessing oxygenation. Further studies are warranted to investigate the ability of SF and PF ratios to predict clinical outcomes.

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.