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

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.

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 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 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 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.