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

Background: Arterial blood pressure (BP) is a relevant clinical parameter that can be measured in standing conscious horses to assess tissue perfusion or pain. However, there are no validated oscillometric noninvasive blood pressure (NIBP) devices for use in horses.

Animals: Seven healthy horses from a teaching and research herd.

Hypothesis/objective: To evaluate the accuracy and precision of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) in conscious horses obtained with an oscillometric NIBP device when compared to invasively measured arterial BP.

Methods: An arterial catheter was placed in the facial or transverse facial artery and connected to a pressure transducer. A cuff for NIBP was placed around the tail base. The BP was recorded during normotension, dobutamine-induced hypertension, and subnormal BP induced by acepromazine administration. Agreement analysis with replicate measures was utilized to calculate bias (accuracy) and standard deviation (SD) of bias (precision).

Results: A total of 252 pairs of invasive arterial BP and NIBP measurements were analyzed. Compared to the direct BP measures, the NIBP MAP had an accuracy of -4 mm Hg and precision of 10 mm Hg. SAP had an accuracy of -8 mm Hg and a precision of 17 mm Hg and DAP had an accuracy of -7 mm Hg and a precision of 14 mm Hg.

Conclusions and clinical relevance: MAP from the evaluated NIBP monitor is accurate and precise in the adult horse across a range of BP, with higher variability during subnormal BP. MAP but not SAP or DAP can be used for clinical decision making in the conscious horse.

Objective: To determine the accuracy of an immunochromatographic cartridge (IC) test for blood typing feline type A, B, and AB blood samples.

Design: Prospective observational study.

Setting: University teaching hospital.

Samples: Fifty-one nonanemic and 19 anemic feline blood samples.

Interventions: Samples were blood typed by both card agglutination (CA) and IC techniques. Discordant results were analyzed using a back-typing technique for the presence of alloantibodies. Repeatability and reproducibility of the IC method were evaluated. Accuracy of the IC method was determined for feline whole blood anticoagulated with EDTA and citrate phosphate dextrose adenine (CPDA1), for feline-packed RBCs with CPDA1 and saline adenine glucose-mannitol, and for autoagglutinated and hemolytic samples. Accuracy of IC testing was determined for feline blood after room temperature, 4 ± 2, -20, and -80°C storage following 24, 48, 72, and 96 hours, and after 1, 2, 3, and 4 weeks of storage.

Measurements and main results: In anemic and nonanemic samples the IC technique had a specificity, sensitivity, positive predictive value, and negative predictive value of 100% in detecting feline blood types A, B, and AB, outperforming a CA test. Results were repeatable and reproducible. Using IC it was possible to blood type samples anticoagulated with EDTA and CPDA1, packed RBC samples with CPDA1 and saline adenine glucose-mannitol, autoagglutinated and hemolytic samples, and samples stored at 4 ± 2°C and at room temperature for up to 1 month.

Conclusions: The IC technique is an accurate assay for the identification of A, B, and AB blood types in anemic and nonanemic feline blood. It has a higher sensitivity and specificity than the CA test, and can be used in samples stored with common anticoagulants or preservative solutions used in feline transfusion medicine.

Objective: To evaluate the clinical usefulness of the diaphragmatico-hepatic (DH) view of the abdominal and thoracic focused assessment with sonography for triage (AFAST/TFAST) in detecting pericardial effusion (PE) in dogs.

Design: Retrospective case series from 2011 to 2012.

Setting: Private practice emergency and critical care hospital.

Animals: Twenty-four dogs with PE diagnosed by FAST.

Interventions: None.

Measurement and main results: Fifty-two medical records from October 1, 2011 through September 30, 2012 had the terms "PE" within the medical record. Twenty-four dogs were diagnosed with PE by FAST with entries for the DH view. Of the 24 dogs, 7 had abdominal FAST, 6 had thoracic FAST (TFAST), and 11 had both exams performed. PE was noted on the DH view in 20 of 24 (83%) cases. Subjective PE volume assessment ranged from trivial (<5 mm) to severe. Of the 4 cases in which PE was absent via the DH view, PE was seen during the same exam at the TFAST pericardial views (n = 2) or detected on serial exam at the DH view (n = 2). The PE volume that was missed via the DH view was characterized as trivial (<5 mm; n = 1), mild (n = 1), and moderate (n = 2).

Conclusions: The DH view of FAST was found to be clinically helpful for the detection of PE. Veterinarians should make it routine practice and part of FAST training to look into the thorax via the DH view during both abdominal FAST and TFAST exams.

Objectives: To characterize the utility and safety of IV insulin aspart in the treatment of diabetes ketoacidosis (DKA) in dogs and to determine the times to resolution of hyperglycemia, ketonemia, and acidemia in dogs treated with IV insulin aspart.

Design: Prospective noncontrolled single arm study of dogs with DKA between February 2010 and March 2011.

Setting: University teaching hospital.

Animals: Six dogs with spontaneous DKA and blood glucose (BG) concentration >13.8 mmol/L (250 mg/dL), pH between 7.0 and 7.35, and blood beta-hydroxybutyrate >2.0 mmol/L were treated with an IV continuous rate infusion (CRI) of aspart insulin. The time to biochemical resolution of DKA was defined as the time interval from when the IV CRI of aspart insulin began until marked hyperglycemia (BG concentration >13.8 mmol/L [250 mg/dL]), acidemia (venous pH <7.35), and ketonemia (beta-hydroxybutyrate concentration >2.0 mmol/L) resolved. Aspart insulin was administered as an IV CRI at an initial dose of 0.09 U/kg/h. The dose was adjusted according to a previously published protocol.

Measurements and main results: The median time to biochemical resolution of DKA in dogs treated with insulin aspart was 28 hours (range, 20-116 h). Mean BG concentration decreased significantly from the time IV fluid resuscitation began (32.0 mmol/L [576 mg/dL]; range, 14.9-38.9 mmol/L [268-700 mg/dL]) until 6 hours later when IV aspart insulin CRI began (20.1 mmol/L [363 mg/dL]; range, 9.4-26.1 mmol/L [169-470 mg/dL], P = 0.03). No adverse effects were observed in association with IV insulin aspart administration. Median cost of hospitalization was US$3,477 (range, US$1,483-10,469). Median total units per kilogram of administered IV insulin aspart was 2.97 U/kg (range, 2.04-10.52 U/kg).

Conclusions: Intravenous CRI of insulin aspart is a safe and effective treatment for DKA in dogs. IV fluid resuscitation is recommended prior to insulin administration.

Objective: To evaluate the use of abdominal- and thoracic-focused assessment with sonography for trauma (AFAST and TFAST) in nontraumatized dogs and cats in the emergency and critical care setting and to compare prevalence of free fluid identified via these techniques between stable and unstable patients.

Design: Prospective observational study.

Setting: University Distributed Veterinary Learning Community.

Animals: One hundred client-owned dogs and cats presenting to an emergency service with no evidence of trauma.

Interventions: AFAST and TFAST performed within 12 hours of presentation.

Measurement and main results: Free fluid was identified on AFAST or TFAST in 33% of dogs and cats in this study. Free fluid was identified in 27 of 36 (75%) cardiovascularly unstable or dyspneic patients, compared to 6 of 64 (9%) stable patients. A significantly greater proportion of unstable patients had free fluid compared to stable patients (P < 0.0001).

Conclusions: Results of this study support the use of AFAST and TFAST to detect free fluid in nontraumatized dogs and cats in the emergency and critical care setting, particularly patients that are unstable on presentation.

Objective: To relate coagulation and fibrinolysis derangements to shock severity as reflected by plasma lactate concentrations in dogs with spontaneous hemoperitoneum (SHP) and determine the impact on transfusions.

Design: Prospective, observational, case-control study.

Setting: Three veterinary teaching hospitals.

Animals: Twenty-eight client-owned dogs with SHP and 28 breed- and age-matched control dogs.

Interventions: None.

Measurements and main results: Blood samples for platelet counts, coagulation, and anticoagulant assays (prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin, and protein C, thromboelastography [TEG]), fibrinolysis testing (d-dimer and TEG lysis parameters with and without the addition of 50 U/mL of tissue plasminogen activator [TEG LY30 measured with the addition of 50 U/mL of tPA to the blood sample, LY3050 and TEG LY60 measured with the addition of 50 U/mL of tPA to the blood sample, LY6050 ; LY30 and LY60]), and plasma lactate as an indicator of severity of shock were collected from SHP dogs at the time of diagnosis. SHP dogs were hypocoagulable (prolonged prothrombin time and activated partial thromboplastin time, decreased TEG maximum amplitude) and hyperfibrinolytic (increased LY3050 and TEG LY6050 ) compared to controls. The severity of hypocoagulability was related to protein C activity, while the severity of hyperfibrinolysis was related to plasma lactate concentration. Among the 18 dogs discharged from the hospital, LY3050 was significantly associated with the dose of fresh frozen plasma administered, but none of the parameters were associated with the dose of red blood cells administered.

Conclusions: Dogs with SHP have evidence of hypocoagulability, protein C deficiency, and hyperfibrinolysis. Parameters of hyperfibrinolysis were related to plasma lactate concentrations and volume of plasma transfused during hospitalization. These derangements resemble those found in people with acute coagulopathy of trauma and shock, and activation of protein C may be a common feature to both syndromes.

Objective: To evaluate the use of a combined protocol of prednisone and mycophenolate mofetil (MMF) for the treatment of meningoencephalomyelitis of unknown etiology (MUE) and to describe response, adverse effects, and outcome.

Design: Retrospective study (2005-2011).

Setting: University teaching hospital.

Animals: Twenty-five client-owned dogs with clinical signs, neuroimaging, and cerebrospinal abnormalities consistent with MUE. Five dogs whose MMF treatment was discontinued after 7-14 days due to gastrointestinal clinical signs were evaluated only for adverse effects.

Interventions: Dogs were initially treated with prednisone 2 mg/kg PO every 12 hours and with MMF 20 mg/kg PO or IV every 12 hours. Prednisone was tapered after 4 days to 1 mg/kg every 12 hours for 14 days, then to every 24 hours for 30 days, and again reduced by half every 2-4 months thereafter. When prednisone was tapered completely or to 0.5 mg/kg every 24-48 hours without clinical relapse, MMF was tapered in a similar manner.

Measurements and main results: Partial or complete clinical response was achieved in 95% (19/20) of the dogs. Median survival time by the end of the study was 250 days (range 6 to >1,679) with 40% (8/20) of the dogs still alive (336-1,679 days after diagnosis). All Pug dogs (4/20) included in the study died with a median survival time of 14 days. Adverse effects attributed to MMF, which included hemorrhagic diarrhea within the first 2 weeks of treatment, were recorded in 20% (5/25) of the dogs.

Conclusions: MMF can be used as an adjunctive treatment for dogs with MUE. This protocol enables reduction of prednisone treatment or, in some cases, its complete withdrawal. The possibility of intravenous administration is advantageous in cases with severe neurological abnormalities and mentation changes, often seen in MUE. Attention is warranted for gastrointestinal adverse effects, especially in the first 2 weeks of treatment.