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Abstract

Objective—To document the existence and incidence of acute lung injury (ie, veterinary acute lung injury [VetALI] per the 2007 consensus definition) in a population of client-owned dogs receiving transfusions for various clinical reasons.

Design—Prospective observational study.

Animals—54 client-owned dogs.

Procedures—Arterial blood gas analysis was performed for dogs receiving a transfusion (blood and plasma products) at 0 to 12 hours before and 24 to 48 hours after transfusion; dogs also underwent thoracic radiography 0 to 24 hours before and 24 to 48 hours after transfusion. The ratio of Pao 2 to fraction of inspired oxygen (Fio 2) was calculated. Dogs with posttransfusion radiographic signs of pulmonary infiltrates, a Pao 2:Fio 2 ratio < 300, or clinical signs of respiratory compromise were suspected of having VetALI and underwent echocardiography to exclude left-sided heart failure. The incidence of VetALI was calculated, and χ2 tests were used to compare the incidence in study dogs with the historical reported incidence of acute respiratory distress syndrome (ARDS) in ill dogs (not receiving transfusions) and transfusion-related acute lung injury (TRALI) in humans.

Results—The incidence of VetALI (2/54 [3.7%]; 95% confidence interval, 0% to 8.73%) in study dogs was significantly less than the reported incidence of TRALI in humans (25%) and not significantly different from the reported incidence of ARDS in ill dogs (10%).

Conclusions and Clinical Relevance—VetALI occurred in dogs that received transfusions at a frequency similar to that previously reported for ARDS in ill dogs that did not receive transfusions.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To provide a video tutorial detailing how to perform continuous noninvasive blood pressure monitoring in dogs and cats.

ANIMALS

Any size dog or cat.

METHODS

To measure blood pressure noninvasively, a blood pressure cuff is selected on the basis of the circumference of the limb and placed at the level of the right atrium. For oscillometric blood pressure measurement, the cuff is connected to an oscillometric unit that will automatically inflate and deflate the cuff in order to measure the patient’s blood pressure using an internal algorithm. For Doppler blood pressure measurement, a sphygmomanometer is used to manually inflate the pressure cuff 30 to 40 mm Hg above the point where the audible arterial sounds disappear. Then, the cuff is gradually deflated until the audible arterial sounds return; the pressure at the first sound is recorded as the blood pressure. To generate continuous readings, the oscillometric machine is set to measure blood pressure as often as every minute. Alternatively, the Doppler crystal is taped to the patient’s leg to facilitate repeated cuff inflation/deflation and collection of blood pressure values as often as every minute.

RESULTS

Continuous blood pressure readings can be obtained by both the oscillometric and Doppler techniques.

CLINICAL RELEVANCE

Continuous blood pressure readings identify trends in a patient’s cardiovascular status. The most reliable oscillometric blood pressure reading is the mean arterial pressure. Doppler blood pressure values are considered systolic in dogs. Doppler values in cats underestimate systolic and overestimate mean blood pressure.

Open access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To provide a video tutorial detailing how to perform “blind” and ultrasound-guided abdominocentesis for diagnostic and therapeutic guidance, and to provide a brief demonstration of intra-abdominal pressure measurement (IAP).

ANIMALS

Any cat or dog with suspicion of free abdominal effusion or patients requiring measurement of IAP.

METHODS

Abdominocentesis should be performed when there is high suspicion for peritoneal effusion based on physical exam and/or diagnostic imaging. The 4-quadrant tap uses 20-gauge or larger needles placed blindly in ≥ 1 of the 4 quadrants of the abdomen to collect abdominal fluid. In contrast, ultrasound allows visualization of fluid in the abdomen prior to percutaneous insertion of a needle and syringe to collect fluid. Regardless of collection technique, fluid should have immediate cytologic analysis and later can be submitted for biochemical parameters, additional cellular analysis by a pathologist, and culture and sensitivity (in rare cases if indicated). Intravesicular bladder pressure measurement using a manometer–urinary catheter system approximates the IAP when there is concern for organ hypoperfusion and compartment syndrome.

RESULTS

Abdominocentesis can be performed with and without the use of ultrasound guidance. Intravesicular bladder pressure measurement is used to diagnose and trend IAP values before and after treatments are performed.

CLINICAL RELEVANCE

Abdominocentesis is a simple and safe technique that all small animal clinicians should be comfortable performing. Effusion sampling can guide further diagnostics and treatments. Measurement of IAP is simple and requires no specialized equipment.

Open access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To provide a video tutorial describing intraperitoneal (IP) and intracoelomic (IC) therapeutics (IP/IC fluid therapy, euthanasia, direct peritoneal resuscitation).

ANIMALS

Dogs, cats, and exotic pets.

METHODS

Peritoneal and coelomic centesis allows for delivery of fluids or to perform euthanasia. The peritoneal and coelomic membranes contain a vast network of capillaries and lymphatics that allow absorption of fluids and blood products. Needles are inserted aseptically IP or IC at species-specific locations to avoid iatrogenic damage. In mammals, the needle is inserted in a periumbilical location at a 1- to 2-cm radius from the umbilicus, while the needle is inserted into the ventral inguinal fossa in chelonians and lateroventrally in lizards and snakes. Direct peritoneal resuscitation is a human technique in which a dextrose/electrolyte solution infused IP reduces ischemia-reperfusion injury, edema, and tissue necrosis to improve mortality in patients with diseases like shock and sepsis or who require acute abdominal surgery.

RESULTS

Isotonic crystalloids are given IP/IC at 10- to 20-mL/kg doses (smaller volumes in reptiles) and blood products at standard calculated doses. Sodium pentobarbital without phenytoin (3 mL/4.5 kg) is used for IP/IC euthanasia.

CLINICAL RELEVANCE

Being aware of multiple routes for fluid and blood product administration allows treatment in animals for which intravenous or intraosseous catheterization is undesirable or impossible. While intravenous or intraosseous routes are always preferred, especially for resuscitation, familiarity with locations for IP/IC fluid and euthanasia is useful. Techniques like direct peritoneal resuscitation are not currently used in animals but might be translated to veterinary cases in the future.

Open access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine whether lipid particle coalescence develops in veterinary parenteral nutrition (PN) admixture preparations that are kept at room temperature (23°C) for > 48 hours and whether that coalescence is prevented by admixture filtration, refrigeration, or agitation.

Sample Population—15 bags of veterinary PN solutions.

Procedures—Bags of a PN admixture preparation containing a lipid emulsion were suspended and maintained under different experimental conditions (3 bags/group) for 96 hours while admixtures were dispensed to simulate IV fluid administration (rate, 16 mL/h). Bags were kept static at 4°C (refrigeration); kept at 23°C (room temperature) and continuously agitated; kept at room temperature and agitated for 5 minutes every 4 hours; kept static at room temperature and filtered during delivery; or kept static at room temperature (control conditions). Admixture samples were collected at 0, 24, 48, 72, and 96 hours and examined via transmission electron microscopy to determine lipid particle diameters. At 96 hours, 2 samples were collected at a location distal to the filter from each bag in that group for bacterial culture.

Results—Distribution of lipid particle size in the control preparations and experimentally treated preparations did not differ significantly. A visible oil layer developed in continuously agitated preparations by 72 hours. Bacterial cultures of filtered samples yielded no growth.

Conclusions and Clinical Relevance—Data indicated that the veterinary PN admixtures kept static at 23°C are suitable for use for at least 48 hours. Manipulations of PN admixtures appear unnecessary to prolong lipid particle stability, and continuous agitation may hasten lipid breakdown.

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE

To evaluate physical compatibility of small animal (SAE) and large animal (LAE) injectable formulations of enrofloxacin with select IV fluids and drugs.

SAMPLE

162 admixtures containing SAE or LAE with saline (0.9% NaCl) solution, lactated Ringer solution (LRS), Plasma-Lyte A (PLA), 6% hydroxyethylstarch 130/0.4 (HES), metoclopramide, or ampicillin-sulbactam.

PROCEDURES

In the first of 2 simultaneously conducted experiments, admixtures containing enrofloxacin (10 mg/kg) and a volume of IV fluid that would be administered over a 20-minute period when dosed at the maintenance infusion rate (40 mL/kg/d for saline solution, LRS, and PLA and 20 mL/kg/d for HES) were created. In the second experiment, enrofloxacin (10 mg/kg) was admixed with saline solution (40 mL/kg/d) and metoclopramide (2 mg/kg/d) or ampicillin-sulbactam (30 mg/kg). In both experiments, admixture components were infused into a flask over 20 minutes assuming patient weights of 5, 10, and 20 kg. Admixtures were created by use of undiluted SAE and SAE diluted 1:1 with saline solution and undiluted LAE and LAE diluted 1:1 and 1:10 with saline solution. Admixtures were assessed for physical incompatibility at 0, 15, 30, and 60 minutes after completion of mixing. Physical incompatibility was defined as gross precipitation, cloudiness, Tyndall effect, or change in turbidity.

RESULTS

Admixtures containing undiluted SAE or LAE were physically incompatible with saline solution, PLA, LRS, and HES. Because saline solution was used to dilute SAE and LAE, all admixtures containing diluted SAE or LAE were also physically incompatible. Physical compatibility of enrofloxacin with metoclopramide or ampicillin-sulbactam could not be assessed because those admixtures also contained saline solution.

CONCLUSIONS AND CLINICAL RELEVANCE

Enrofloxacin was physically incompatible with all tested solutions.

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE

To compare the performance of an interstitial glucose monitor (IGM) versus a portable blood glucose monitor (PBGM) in sick juvenile dogs in a veterinary ICU.

ANIMALS

16 client-owned dogs admitted to the university teaching hospital under 1 year of age with systemic illness.

PROCEDURES

Paired interstitial and blood glucose samples were collected. A third glucose measurement with a reference method was obtained when IGM and PBGM values were clinically disparate. Analytical accuracy was measured by Pearson correlation and agreement statistics, including mean absolute relative difference (MARD), bias, and 95% limits of agreement. The Parkes consensus error grid analysis was performed to assess clinical accuracy.

RESULTS

159 paired glucose measurements were available for analysis. Comparison of IGM readings to PBGM measurements resulted in an MARD of 15.4% and bias of –2.6%, with the 95% limits of agreement ranging from –42.5% to 37.4%. Positive correlation between IGM and PBGM (Pearson r = 0.65) was found. On consensus error grid analysis, 100% of the pairs fell into clinically acceptable zones (74.2% in zone A, and 25.8% in zone B). When disparate IGM and PBGM readings were compared to a laboratory reference standard (n = 13), both methods resulted in high MARD and wide limits of agreement.

CLINICAL RELEVANCE

The IGM provides clinically acceptable glucose measurements compared to PBGM to monitor glucose levels in juvenile dogs in a clinical setting. Further clinical studies with a larger sample size, particularly in the hypoglycemic range, are needed to assess IGM performance in the lower glucose range.

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine the magnitude of the change in colloid oncotic pressure (COP) associated with general anesthesia in dogs undergoing a variety of elective procedures.

Design—Cohort study.

Animals—50 client-owned dogs.

Procedures—For each dog, preanesthetic and postanesthetic PCV, plasma total solids (TS) concentration, and COP were determined. The procedures requiring anesthesia, volume of crystalloid fluids administered IV, duration of anesthesia, age, weight, and sex were recorded.

Results—Postanesthetic PCV (mean ± SD, 41.8 ± 5.4%), TS concentration (6.3 ± 0.8 g/dL), and COP (19.4 ± 3.6 mm Hg) were significantly decreased, compared with preanesthetic values (48.8 ± 5.9%, 7.2 ± 0.7 g/dL, and 24.4 ± 4.2 mm Hg, respectively). None of the variables tested could be used to reliably predict changes in COP.

Conclusions and Clinical Relevance—Results suggested that COP in healthy dogs may decrease by 5 mm Hg on average after general anesthesia and that this decrease may not be reliably predicted by the volume of fluids administered IV during anesthesia or by the concurrent measured decrease in TS concentration.

Full access
in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE To evaluate the association between ultrasonographically measured optic nerve sheath diameter (ONSD) and acute increases in intracranial pressure (ICP) as measured by an epidural intracranial pressure monitoring system (EICPMS) in healthy dogs.

ANIMALS 6 young healthy dogs.

PROCEDURES An EICPMS connected to a pressure monitor was used to generate a continuous pressure waveform in each anesthetized dog. A 22-gauge IV catheter was inserted into the brain parenchyma through the contralateral parietal bone, and 0.5 to 2.0 mL of anticoagulated autologous blood was injected at predetermined intervals. At baseline (immediately after EICPMS placement) and following each injection, the ICP as indicated by EICPMS was recorded, and 3 ultrasonographic images of the optic nerve sheath of each eye were obtained. The ONSD was measured at maximum diameter and at 5 mm caudal to the optic disk.

RESULTS In linear models, the maximum ONSD was positively associated with increasing ICP. Specifically, the rate of maximum ONSD increase was greater for pressures ≤ 20 mm Hg above baseline (0.0534 mm/1 mm Hg ICP increase) than for pressures > 40 mm Hg above baseline (0.0087 mm/1 mm Hg ICP increase). The relationship of ICP to maximum ONSD was slightly nonlinear and best explained by comparison of fractional polynomial regression models.

CONCLUSIONS AND CLINICAL RELEVANCE ICP was positively and nonlinearly associated with increasing maximum ONSD, especially when ICP was ≤ 20 mm Hg above baseline, supporting the conclusion that ultrasonographic measurement of maximum ONSD may provide a noninvasive monitoring tool for evaluation of ICP in dogs. Further research is needed to assess the utility of these measurements in clinical patients.

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE To compare time to achieve vascular access (TTVA) between an ultrasound-guided technique (UST) and landmark-based technique (LMT) for central venous catheter (CVC) placement in healthy anesthetized dogs.

ANIMALS 39 purpose-bred hounds.

PROCEDURES Anesthetized dogs that were hemodynamically stable following completion of a terminal surgical exercise were enrolled in the study during 2 phases, with a 45-day intermission between phases. For each dog, a UST and LMT were used for CVC placement via each external jugular vein by 2 operators (criticalist and resident). The TTVA and number of venipuncture attempts and catheter redirections were recorded for each catheterization. Placement of the CVC was confirmed by contrast fluoroscopy. After euthanasia, a gross dissection was performed during which a hematoma score was assigned to the catheter insertion site. For each phase, nonlinear least squares estimation was used for learning curve analysis of the UST.

RESULTS Median TTVA, number of venipuncture attempts and catheter redirections, and hematoma score did not differ significantly between the 2 operators for either technique. Median TTVA for the UST (45 seconds) was significantly longer than that for the LMT (7 seconds). Learning curve analysis indicated that 8 and 7 UST catheterizations were required to achieve performance stability in phases 1 and 2, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the UST was comparable to the LMT for CVC placement in healthy dogs. The extra time required to perform the UST was not clinically relevant. Additional studies evaluating the UST for CVC placement in clinically ill dogs are warranted.

Full access
in American Journal of Veterinary Research