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

Objective: To describe the clinical use of a novel, minimally invasive technique for fluoroscopic wire-guided esophagojejunal tube (FEJT) placement in dogs and cats.

Design: Retrospective study (February 2010-September 2013).

Setting: University veterinary teaching hospital.

Animals: Eighteen dogs and 2 cats with intolerance of, or contraindications to, gastric feeding that underwent attempted FEJT placement.

Interventions: All patients underwent attempted FEJT placement using a novel fluoroscopic wire-guided technique.

Measurements and main results: Patient data were collected including information about the FEJT placement and utilization of the tube postplacement. The primary diagnosis in dogs undergoing FEJT placement was pancreatitis in 61% of cases. The ability to achieve postpyloric access with the technique was 95% (19/20). Mean duration of the procedure in dogs where FEJT placement was successful was 63.8 minutes (SD, 28.6; min-max, 30-120 min). Mean fluoroscopy time was 19.4 minutes (SD, 11.5; min-max, 5.2-42.1-min). Esophagostomy site infection was a complication of FEJT placement in 2 dogs. The mean duration the FEJT remained in place in dogs was 3.8 days (SD, 2.2; min-max, 1-7 days), and mean duration of feeding was 3.6 days (SD, 2.2; min-max, 1-7 days). Vomiting was noted in 89% of patients prior to FEJT placement and was significantly reduced to only 24% of patients postplacement (P = 0.0001).

Conclusions: FEJT placement is a viable technique for providing postpyloric nutrition in dogs and cats intolerant of, or with contraindications to, gastric feeding.

Objective: To illustrate the application of the Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to the management of dogs and cats at risk of developing thrombosis using a case-based approach.

Etiology: Dogs and cats become at risk of developing thrombosis from a wide range of conditions. These conditions often involve a specific insult followed by an inflammatory response and when combined with other contributing factors (eg, hypercoagulability, vascular endothelial injury, hemodynamic changes) create favorable conditions for thrombosis.

Diagnosis: Development of thrombosis in small animals remains challenging to demonstrate. Compatible clinical signs, the presence of known risk factors, and supporting diagnostic tests may be highly suggestive of the development of thrombosis.

Therapy: Therapeutic recommendations in accordance with the CURATIVE guidelines for dogs and cats are described in specific case vignettes presented. Discussion is centered on antithrombotic drug choices and dosing protocols, as outlined in Domains 2 and 3 of the CURATIVE guidelines. Where appropriate, guidelines related to therapeutic monitoring (Domain 4) and discontinuation of antithrombotics (Domain 5) were included.

Prognosis: In small animals at risk of developing thrombosis, overall prognosis may be improved by following consensus-based recommendations on the use of antithrombotics as outlined in the CURATIVE guidelines. Whether such interventions have any impact on outcome requires further investigation.

Objective: To report the incidence of adverse events during euthanasia of client-owned dogs administered either intravenous pentobarbital/phenytoin (PP) or PP after propofol delivery.

Design/setting: Prospective, observational, multi-site study.

Animals: Four hundred thirty-six dogs undergoing client-elected euthanasia over a 1-year period.

Interventions: Interventions included placement of an IV catheter and delivery of euthanasia agents (PP for the PP group, propofol followed by PP for the propofol group). Seven pre-determined adverse events were recorded: agonal breaths, urination, defecation, vocalization, muscle activity, dysphoria, and catheter complications. Euthanasia scores for each patient were defined as the sum of all adverse events (0-7) the patient exhibited.

Measurements and main results: Two hundred thirty-six dogs were in the PP group and 200 dogs were in the propofol group. No significant differences were detected in the dose of PP administered (166.9 ± 105.6 mg/kg for PP group, 182.6 ± 109.8 mg/kg for propofol group). Propofol dogs received 4.5 ± 2.9 mg/kg propofol. The incidence of ≥ 1 adverse event was 35.2% in the PP group and 26.5% in the propofol group (P = 0.052). Mean euthanasia scores (0.47 PP group, 0.32 propofol group) were not significantly different (P = 0.08). Propofol significantly reduced the incidence of muscle activity (6% vs. 14%, odds ratio 0.39; P = 0.0079).

Conclusions: There was no difference in the likelihood of the studied adverse events during client-elected euthanasia in dogs when propofol was used prior to PP. There was a significant reduction in perimortem muscle activity if propofol was given prior to PP.

Objective: To investigate the association between synthetic colloids and biomarkers of acute kidney injury (AKI) in dogs with hemorrhagic shock.

Design: Experimental interventional study.

Setting: University.

Animals: Twenty-four healthy ex-racing Greyhounds.

Interventions: Anesthetized Greyhounds subjected to hemorrhage for 60 min were resuscitated with 20 mL/kg of fresh whole blood (FWB), 6% hydroxyethyl starch (HES) 130/0.4, 4% succinylated gelatin (GELO), or 80 mL/kg of isotonic crystalloid (CRYST) over 20 min (n = 6 per treatment). Concentrations of biomarkers of AKI were measured at baseline, end of hemorrhage, and at 40 (T60), 100 (T120), and 160 (T180) min after fluid bolus. Biomarkers included neutrophil gelatinase-associated lipocalin in urine and serum (uNGAL; sNGAL), and urine cystatin C (uCYSC), kidney injury molecule-1 (uKIM), clusterin (uCLUST), osteopontin, gamma-glutamyl transferase, monocyte chemoattractant protein-1 (uMCP), interleukin-6, interleukin-8, protein (uPROT), hyaluronan, and F₂ -isoprostanes. Renal histology was scored for tubular injury and microvesiculation. Biomarker fold-change from baseline was compared between groups using mixed effects models (Bonferroni-Holm corrected P<0.05). Frequencies of histology scores were compared by Fisher's exact test.

Measurements and main results: In dogs treated with GELO, uNGAL fold-change was markedly greater compared with all other groups at T60, T120, and T180 (all P<0.001), and uCYSC was greater at T60 compared with CRYST (P<0.001), and at T120 and T180 compared with all other groups (all P<0.001). Smaller, albeit significant, between-group differences in uKIM, uCLUST, uMCP, and urine protein concentration were observed across the FWB, GELO, and HES groups, compared with CRYST. The GELO group more frequently had marked tubular microvesiculation than the other groups (P = 0.015) although tubular injury scores were comparable.

Conclusion: In dogs with hemorrhagic shock, GELO was associated with greater magnitude increases in urine biomarkers of AKI and more frequent marked tubular microvesiculation, compared with FWB, CRYST, and HES.

Objectives: To determine if selected serum biomarkers are superior to the acute patient physiologic and laboratory evaluation (APPLE) complete score in predicting 30-day mortality in a non-homogeneous disease population of critically ill dogs.

Design: Prospective cohort study comparing the serum biomarkers adiponectin, leptin, C-reactive protein, and S100A12 concentrations between surviving and nonsurviving critically ill dogs.

Setting: University small animal teaching hospital.

Animals: Seventy critically ill dogs were prospectively recruited, and an APPLE complete score was calculated within 24 hours of being admitted to the intensive care unit. Logistic regression models were fit to estimate the association between biomarkers and 30-day survival. Results were interpreted at the 5% level of significance.

Measurements and main results: Leptin was the only biomarker that was significantly correlated with the APPLE complete score (P < 0.001). Only the APPLE complete score (P = 0.003) and illness duration of < 1 day (P = 0.043) were significantly associated with outcome.

Conclusion: Based on the results of this study, there appears to be no benefit in using biomarkers over the APPLE score for disease severity stratification. Serum leptin concentration was significantly correlated with disease severity as determined by APPLE scoring. Longer duration of illness prior to admission was associated with a higher risk of death. APPLE scores were highest in dogs with infectious and immune-mediated diseases and bite wounds.

Objective: To measure tissue oxygen saturation (StO₂ ) in a population of dogs with naturally occurring shock and to evaluate the relationship of StO₂ with an established veterinary severity scoring system (Acute Patient Physiologic and Laboratory Evaluation) and patient survival.

Design: Prospective observational study.

Setting: University teaching hospital.

Animals: Twenty-five adult dogs presenting in shock, as determined by the presence of hypotension, the calculated shock index, and hyperlactatemia.

Interventions: StO₂ was measured prior to any therapeutic interventions. Blood samples were also collected for measurement of plasma lactate, complete blood count, and a serum biochemical profile. Abdominal and thoracic focused assessment with sonography was also performed.

Measurements and main results: Dogs enrolled in this study had lower mean (±SD) StO₂ values (65.12 ± 17.7%) than previously reported in experimental models of canine hemorrhagic shock. There was a moderate correlation between lower StO₂ and increasing Acute Patient Physiologic and Laboratory Evaluation scores. A single StO₂ value, assessed prior to therapeutic intervention, was not a sensitive predictor of mortality in this population.

Conclusions: Dogs with naturally occurring shock have lower mean StO₂ values than those previously reported in dogs with experimentally induced shock. A lower initial StO₂ was associated with worse disease severity but was not a significant predictor of survival in this population.

Objective: To describe the management and resolution of acute liver failure (ALF) in two dogs following ingestion of cheese tree (Glochidion ferdinandi) roots.

Case summaries: A 2-year-old male entire Bullmastiff and a 5-year-old female neutered German Shepherd dog were presented for acute-onset lethargy and vomiting after chewing on tree roots of a cheese tree. Both dogs developed clinical abnormalities consistent with ALF, including hepatic encephalopathy, marked increase in alanine aminotransferase activity and bilirubin concentration, and prolonged coagulation times. Treatment included administration of intravenous fluids, hepatoprotectants, vitamin K₁ , antibiotics, lactulose, antacids, antiemetics, and multiple fresh frozen plasma transfusions. Follow-up examinations performed 30 days after initial presentation revealed the dogs to be clinically healthy with serum biochemical and coagulation profiles within reference intervals.

New or unique information: This is the first report describing ALF in two dogs following ingestion of cheese tree (G. ferdinandi) roots. In this clinical setting, despite a poor prognosis, survival and recovery of adequate liver function were possible with medical management.

Objective: To review the sources, adverse effects, diagnosis, treatment, and prevention of psychogenic stress in hospitalized human and veterinary patients.

Data sources: Data were collected by searching PubMed for veterinary and human literature from the past 10 years.

Human data synthesis: Psychogenic stress has been linked to immune suppression; gastrointestinal, cardiovascular, and cutaneous diseases; delayed wound healing; alterations in pain perception; and neurologic impairment. Sources of psychogenic stress include environmental alterations such as excessive noise and light, social and physical factors, sleep disruption, drugs, and underlying disease. Nonpharmacologic options for stress reduction include environmental and treatment modifications, music therapy, and early mobilization. Pharmacologic options include sedation with benzodiazepines and dexmedetomidine. Trazodone and melatonin have been examined for use in sleep promotion but are not currently recommended as standard treatments in ICU.

Veterinary data synthesis: Activation of the stress response in veterinary patients is largely the same as in people, as are the affected body systems. Possible sources of stress can include social, physical, and environmental factors. No gold standard currently exists for the identification and quantification of stress. A combination of physical examination findings and the results of serum biochemistry, CBC, and biomarker testing can be used to support the diagnosis. Stress scales can be implemented to identify stressed patients and assess severity. Nonpharmacologic treatment options include low-stress handling, pheromones, environmental modifications, and sleep promotion. Pharmacologic options include trazodone, benzodiazepines, dexmedetomidine, and melatonin.

Conclusion: The prevalence and clinical significance of psychogenic stress in hospitalized veterinary patients is unknown. Future studies are needed to specifically examine the causative factors of psychogenic stress and the effects of various therapies on stress reduction. The recognition and reduction of psychogenic stress in veterinary patients can lead to improvements in patient care and welfare.