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

Objective: To characterize a population of cats with pelvic trauma and evaluate factors influencing transfusion requirement and outcome.

Design: Retrospective case series (2009-2014).

Setting: University teaching hospital.

Animals: One hundred twelve client-owned cats with pelvic trauma.

Interventions: None.

Measurements and main results: Twenty-one (18.8%) cats received a transfusion. Most cats required only 1 fresh whole blood transfusion (85.8%). Packed cell volume at admission was significantly lower in cats that required transfusion but was not associated with hospitalization time or survival to discharge. Increasing Animal Trauma Triage (ATT) score at admission was significantly associated with transfusion requirement (P = 0.0001) and nonsurvival to discharge (P = 0.03). Number of pelvic fractures was not associated with transfusion requirement but cats with sacroiliac luxations and pubic fractures were more likely to require a transfusion (P = 0.0015 and P = 0.0026, respectively). However, fracture type was not associated with survival to discharge. Most cats (86%) required a surgical procedure and half of transfusions were administered preoperatively. No surgical comorbidities were associated with transfusion requirement or survival. Transfusion requirement was associated with longer length of hospitalization but not survival to discharge.

Conclusions: Transfusion requirement in this population of cats with pelvic fractures was fairly high. Transfusion requirement was associated with lower packed cell volume, higher ATT score at admission, longer length of hospitalization, and certain types of pelvic fractures. Transfusion requirement was not associated with surgical comorbidities, surgical intervention, or survival to discharge. Lower ATT score at admission was associated with survival to discharge.

Objective: To investigate whether percentage changes in pulse wave transit time (PWTT%Δ) induced by mini-fluid challenges predict fluid responsiveness in mechanically ventilated anesthetized dogs.

Design: Prospective experimental trial.

Setting: University teaching hospital.

Animals: Twelve Harrier hounds.

Intervention: Each dog was anesthetized with propofol and isoflurane after premedication with acepromazine, mechanically ventilated, and had a fluid challenge. This was repeated 4 weeks later. The fluid challenge, 10 mL/kg of colloid administration over 13 minutes, consisted of 3 intermittent mini-fluid challenges (1 mL/kg of each over a minute) with a minute interval, and the remaining colloid administration (7 mL/kg) over 7 minutes.

Measurements and main results: Percentage change in velocity time integral of pulmonary arterial flow by echocardiography was calculated as an indication of change in stroke volume. Fluid responsiveness was defined as percentage change in velocity time integral ≥ 15% after 10 mL/kg colloid. Dogs responded on 14 fluid challenges and did not on 10. After 1, 2, 3, and 10 mL/kg of fluid challenge, PWTT%Δ_{1, 2, 3, 10} were measured. Receiver operator characteristic (ROC) curves were generated and areas under ROC curve were calculated for PWTT%Δ_{1, 2, 3} . A gray zone approach was used to identify the clinically inconclusive range. The area under the ROC curve for PWTT%Δ₃ was 0.91 (P = 0.001). Cutoff value for PWTT%Δ₃ was -2.5% (sensitivity: 86%, specificity: 90%). The gray zone for PWTT%Δ₃ was identified as between -2.9% to -1.9% for which fluid responsiveness could not be predicted reliably in 6 out of 24 fluid challenges.

Conclusions: In mechanically ventilated anesthetized dogs given a mini-fluid challenge of 3 mL/kg of colloid, PWTT%Δ could predict fluid responsiveness although the gray zone should be considered.

Objective: To compare intravenous and intraosseous blood aspirates using point-of-care diagnostic equipment available in veterinary hospitals.

Design: Prospective study.

Setting: Private referral hospital.

Animals: Dogs undergoing a tibial plateau leveling osteotomy or extracapsular anterior cruciate ligament stabilization procedure were enrolled.

Methods: Under general anesthesia, simultaneous 0.5 mL intravenous and intraosseous blood samples were collected from the jugular vein and proximal tibia, respectively. Samples were evaluated in duplicate within 10 minutes of collection and averaged for each of the following parameters: blood urea nitrogen (BUN), glucose, packed cell volume, total plasma protein (TPP), plasma lactate, sodium, potassium, chloride, urea, glucose, pH, anion gap, pO_2, and pCO₂ . Normalcy was tested with Kolmogorov-Smirnov test. A Student's t-test and Bland-Altman plot were used to compare intravenous and intraosseous samples.

Results: Twelve dogs were recruited into the study. There were statistically significant differences between intravenous and intraosseous samples for sodium (P = 0.0216), chloride (P = 0.0225), BUN (P = 0.014), and potassium (P < 0.0001), respectively. No significant differences were detected for the other parameters evaluated.

Discussion: The intraosseous space provides an easily accessible, noncollapsible alternative for assessing blood parameters. Omitting potassium, the statistically significant differences noted between sites was not felt to be clinically significant. Although statistically insignificant, the large difference in hematocrit values indicates that the samples should not be used interchangeably.

Conclusion: Intraosseous aspirates, excluding potassium and hematocrit, appear to be a reliable alternative for assessing most point-of-care analytes in healthy dogs, although a larger sample size should be investigated. The application of these data in shock patients is unknown.

Objective: To describe the use of pericardial catheters in dogs with pericardial effusion (PE), and detail any associated adverse events.

Design: Retrospective study.

Setting: University teaching hospital.

Animals: Eighteen client-owned dogs that had pericardial catheters placed for pericardial fluid drainage between May 2007 and January 2015.

Interventions: None.

Measurements and main results: All pericardial catheters were placed within 5 hours of presentation, usually within 1 hour (median 72.5 min, range 45-300 min). Ten of 18 cases were sedated with butorphanol, and 4 with additional midazolam. Four had pericardial catheters positioned for single drainage only and were immediately removed. The other 14 pericardial catheters remained in situ for a median of 18 hours (range 2-88 h). Ten of the remaining 14 cases were redrained after pericardial catheter placement. The main adverse events reported were new arrhythmias in 6/18 cases, with 4 of these 6 patients being administered anti-arrhythmic therapy. No infectious or functional complications were reported. Ten patients were discharged, 1 died and 7 were euthanized.

Conclusions: Thoracic drainage catheters inserted into the pericardial space via a modified-Seldinger technique can be positioned in dogs to aid management of PEs. The main associated adverse event is arrhythmia. Minimal sedation is required for placement, and dogs tend not to require postprocedural analgesia. Catheters can remain in situ for repeated drainage, potentially decreasing staffing time requirement and repeat sedation. Their use is associated with a rate of arrhythmia requiring treatment of 22%, compared to that of needle pericardiocentesis alone at 13%. They are easy to position using equipment available in many facilities.

Objective: To evaluate the effect of intra-abdominal pressure (IAP) on plasma exogenous creatinine clearance in both conscious and anesthetized dog models using a balloon technique to generate intra-abdominal hypertension.

Design: Prospective, cross-over, experimental study.

Setting: University-based small animal research facility.

Animals: Six healthy male Beagle dogs.

Interventions: A balloon device comprising a Foley urinary catheter and latex balloon was placed in the intra-abdominal cavity. Plasma exogenous creatinine clearance was compared after intravenous administration of exogenous creatinine solution at 80 mg/kg under 4 different treatment conditions as follows: control and IAP levels of 25 mm Hg in conscious dogs and control and IAP levels of 25 mm Hg in anesthetized dogs (CC, C25, AC, and A25, respectively). Samples were obtained before (T0) and 10, 20, 30, 60, 90, 120, 240, 360, 480, and 600 min after administration of creatinine in all treatment groups.

Measurements and main results: There were no significant differences in plasma creatinine concentration for CC, AC, and C25 during the treatment period. However, in the A25 treatment condition, the plasma creatinine concentration increased significantly at 10, 20, 30, 60, 90, and 120 min after administration of creatinine (P < 0.05). Plasma creatinine clearances were 5.0 ± 0.5, 4.7 ± 1.2, 5.5 ± 0.9, and 2.5 ± 0.5 mL/kg/min for 600 min (CC, AC, C25, and A25, respectively). In the A25 treatment condition, the plasma exogenous creatinine clearance decreased significantly to 50%, 47%, and 55% of that under control conditions (CC, AC, and C25, respectively). After decompression of the abdomen, plasma creatinine concentrations declined rapidly and returned to basal concentrations.

Conclusions: Intra-abdominal hypertension under general anesthesia could cause renal hypoperfusion. Timely decompression may improve the outcome of acutely increased IAP when surgery and/or general anesthesia is required in canine patients.

Objective: To compare the efficacy of hydromorphone and dexmedetomidine at inducing emesis in cats.

Design: Prospective, blinded, randomized crossover study.

Setting: Veterinary university teaching hospital.

Animals: 12 healthy purpose-bred cats.

Interventions: Cats were randomly assigned to receive hydromorphone (0.1 mg/kg, subcutaneously) or dexmedetomidine (7 μg/kg, IM). Following administration, the incidences of emesis, number of emetic events, signs of nausea (hypersalivation, lip licking), temperature, heart rate, respiratory rate, and sedation score were recorded for 6 hours.

Measurements and main results: Emesis was successful in 9 of 12 (75%) cats when treated with hydromorphone and in 7 of 12 (58%) cats when treated with dexmedetomidine (P = 0.67). Dexmedetomidine was more likely to cause sedation than hydromorphone (P < 0.001). Heart rate in cats was significantly decreased at 1 and 2 hours post-hydromorphone (P = 0.003, 0.014, respectively) and at 1, 2, 3, 5, 6 hours post-dexmedetomidine (P = 0.001, 0.003, 0.038, 0.013, 0.001, respectively). Cats were more likely to develop an increase in body temperature with hydromorphone administration although this was not clinically significant.

Conclusions: Results of the present study indicate that hydromorphone is an effective alternative to dexmedetomidine for the induction of emesis in cats. Hydromorphone appears to cause less sedation and less decrease in heart rate. Further investigation into the most adequate dose of hydromorphone for optimizing emesis is warranted.

Objectives: To compare markers of inflammation after transfusion of leukoreduced (LR) packed RBCs (pRBCs) versus non-LR pRBCs in dogs with critical illness requiring blood transfusion, and to report survival to discharge and rates of transfusion reactions in these dogs.

Design: Prospective randomized blinded clinical study June 2014-September 2015.

Setting: University veterinary teaching hospital.

Animals: Twenty-three client-owned critically ill dogs, consecutively enrolled.

Interventions: Dogs requiring a single pRBC transfusion were randomized into the LR or non-LR pRBC group. Exclusion criteria included: requirement for multiple blood products, history of previous blood transfusion, and administration of anti-inflammatory or immunosuppressive medication prior to enrollment.

Measurements: Blood samples were obtained immediately prior to transfusion, then 2 and 24 hours following transfusion. Parameters measured at each time point included: PCV, WBC count, segmented and band neutrophil counts, fibrinogen, and plasma lactate and C-reactive protein concentrations. Acute patient physiologic and laboratory evaluation fast score was calculated on admission.

Results: Eleven dogs were included in the LR group and 12 in the non-LR group; scores of illness severity were not significantly different between groups. Total WBC count was significantly higher in the non-LR versus LR group 24 hours following pRBC transfusion, but this difference was not evident 2 hours following transfusion. No other inflammatory parameters at any time point were significantly different between LR versus non-LR pRBC transfused dogs. Survival rates to discharge for LR and non-LR groups were 8/11 and 9/12, respectively. Acute transfusion reactions were identified in 1/11 and 2/12 dogs in the LR and non-LR group, respectively. All transfused blood was stored ≤12 days.

Conclusions: Most markers of inflammation did not significantly increase following transfusion of LR versus non-LR pRBCs stored ≤12 days in ill dogs. Further prospective, randomized trials are needed in clinically ill dogs to determine the benefit of prestorage leukoreduction.

Objective: To determine the association between thoracic injuries evaluated by computed tomography (CT) and arterial blood gas and acid-base status in dogs with blunt thoracic trauma caused by motor vehicle accidents.

Design: Prospective observational clinical study.

Setting: University teaching hospital.

Animals: Thirty-one client owned traumatized dogs and 15 healthy dogs.

Procedures: All trauma group dogs underwent a CT scan and simultaneous arterial blood gas analysis within 24 hours, but not before 4 hours, after the traumatic incident within a 45-month enrollment period.

Measurements and main results: Thorax injuries were classified as pulmonary, pleural space, or rib cage and each of these components was scored for severity using a CT composite pulmonary, pleural, and rib score. The trauma group arterial blood gas and acid-base status were evaluated for statistical difference from the control group. The pulmonary-arterial oxygen pressure was significantly lower in the trauma group compared to the control group that was supported by significant differences in the calculated variables of arterial blood oxygenation as well. There was also a significant correlation between the composite lung score and pleural score and the variables of arterial oxygen status. The pulmonary-arterial carbon dioxide pressure was not significantly different to any of the thoracic injury variables indicating normal alveolar ventilation. Acid-base imbalances were generally mild, insignificant, and variable.

Conclusions and clinical relevance: Blunt thoracic trauma causes significant pulmonary and pleural injury and the blood oxygen economy is significantly affected by this. The functional measures of arterial blood oxygenation were well correlated with thoracic CT pathology. Alveolar ventilation was mostly spared but a clinically significant ventilation perfusion mismatch was present.