Objective—To document pulmonary function, ventilator
management, and outcome of dogs with thoracic
trauma that required mechanical ventilation because
of severe pulmonary contusions.
Animals—10 dogs that required mechanical ventilation
because of severe pulmonary contusions caused
by blunt thoracic trauma.
Procedure—Signalment, historical data, arterial blood
gas values, oxygen tension-based indices, ventilator
settings, peak inspiratory pressure, positive end-expiratory
pressure, tidal volume, and minute ventilation
values were retrieved from medical records.
Results—All 10 dogs required positive-pressure
ventilation because of dyspnea following trauma and
had severely abnormal pulmonary function. Survival
rate to discharge was 30%. Dogs were categorized
into 2 groups; group A included 5 dogs in which pulmonary
function improved during ventilation, whereas
group B included 5 dogs that were euthanatized
because of progressive lung dysfunction (n = 4) or
cardiac arrest (1). Mean ± SD body weight of group-
A dogs (30.9 ± 15.9 kg [68 ± 35 lb]) was significantly
greater than that of group-B dogs (7.6 ± 1.8 kg
[16.7 ± 4 lb]). Dogs with improved lung function had
peak inspiratory pressure that decreased progressively,
whereas lung compliance deteriorated in
dogs in group B.
Conclusions and Clinical Relevance—Dyspneic
dogs with severe pulmonary contusions may require
and benefit from positive-pressure ventilation
Prognosis is better for dogs that weigh > 25 kg (55 lb).
(J Am Vet Med Assoc 2000;217:1505–1509)
Objective—To identify breed disposition, postoperative
complications, and outcome in dogs with lung
Animals—22 client-owned dogs.
Procedure—Information on signalment; history; clinical
findings; results of clinicopathologic testing, diagnostic
imaging, and pleural fluid analysis; surgical
treatment; intra- and postoperative complications; histologic
findings; and outcome were obtained from
Results—All 22 dogs had pleural effusion; dyspnea
was the most common reason for examination.
Fifteen dogs were large deep-chested breeds; 5 were
toy breeds. Afghan Hounds were overrepresented,
compared with the hospital population. One dog was
euthanatized without treatment; the remaining dogs
underwent exploratory thoracotomy and lung lobectomy.
Eleven dogs recovered from surgery without
complications, but 3 of these later died of thoracic
disease. Four dogs survived to discharge but had clinically
important complications within 2 months,
including chylothorax, mediastinal mesothelioma,
gastric dilatation, and a second lung lobe torsion. Six
dogs died or were euthanatized within 2 weeks after
surgery because of acute respiratory distress syndrome,
pneumonia, septic shock, pneumothorax, or
chylothorax. Chylothorax was diagnosed in 8 of the 22
dogs, including 4 Afghan Hounds.
Conclusion and Clinical Relevance—Results suggest
that lung lobe torsion is rare in dogs and develops
most frequently in large deep-chested dogs, particularly
Afghan Hounds. Other predisposing causes
were not identified, but an association with chylothorax
was evident, especially in Afghan Hounds.
Prognosis for dogs with lung lobe torsion was fair to
guarded. (J Am Vet Med Assoc 2000;217:1041–1044)
Objective—To evaluate the relationship between Doppler blood pressure (DBP) and survival or response to treatment in critically ill cats.
Design—Retrospective case series.
Procedures—Medical records from cats admitted to the intensive care unit with at least 2 recorded DBP measurements were included in the study. Hypotension was defined as 1 or more DBP measurements d 90 mm Hg. Change in blood pressure, survival to hospital discharge, heart rate, rectal temperature, PCV, plasma pH, serum ionized calcium concentration, disease process, body weight, age, duration of hospitalization, and catecholamine treatment were also evaluated.
Results—39 cats were included in the hypotensive group, and 44 were consistently normotensive. Overall survival rate was 53% (44/83), with a significantly higher mortality rate in the hypotensive group (64% vs 32%). Among other variables, only low rectal temperature and low PCV were significantly associated with hypotension. Hypotensive cats with an increase in blood pressure of ≥ 20 mm Hg during hospitalization were more likely to survive to discharge (mortality rate, 69% vs 17%).
Conclusions and Clinical Relevance—Hypotensive cats had increased mortality rate with lower rectal temperatures and lower PCV, compared with normotensive critically ill cats. The implications of these findings with regard to treatment remain to be elucidated, but addressing these abnormalities may be appropriate.
Objective—To prospectively evaluate a survival prediction
index (SPI) in dogs admitted to intensive care
units (ICU) and to generate and test an improved SPI
Sample Population—Medical records of 624 critically
ill dogs admitted to an ICU.
Procedure—Data were collected from dogs within
24 hours after admission to an ICU. Variables recorded
reflected function of vital organ systems, severity
of underlying physiologic derangement, and extent of
physiologic reserve; outcome was defined as dogs
that survived or did not survive until 30 days after
admission to the ICU. Probabilities of survival were
calculated, using an established model (SPI). We then
performed another logistic regression analysis, thereby
reestimating the variables to create the new SPI2.
Cross-validation of the models obtained was performed
by randomly assigning the total sample of 624
dogs into an estimation group of 499 dogs and validation
group of 125 dogs.
Results—Testing of SPI resulted in an area under the
curve (AUC) of 0.723. Testing of SPI2 revealed an
AUC of 0.773. A backwards-elimination procedure
was used to create a model containing fewer variables,
and variables were sequentially eliminated. The
AUC for the reduced model of SPI2 was 0.76, indicating
little loss in predictive accuracy.
Conclusions and Clinical Relevance—The new
SPI2 objectively stratified clinical patients into groups
according to severity of disease. This index could provide
an important tool for clinical research. ( Am J Vet
Objective—To determine the incidence of and risk
factors for ventilatory failure in dogs undergoing
surgery for treatment of cervical spinal disorders and
to document ventilator management, clinical course,
and long-term outcome of dogs that experienced ventilatory
failure in association with cervical spinal disorders
or their management.
Procedure—Dogs with cervical spinal disorders that
required positive-pressure ventilation (PPV) were
identified, and signalment, concurrent diseases, neurologic
status at initial examination, clinical course,
pulmonary function before, during, and after PPV,
management techniques, complications, and outcome
were recorded. Dogs that underwent surgery
and required PPV were compared with dogs that
underwent cervical spinal surgery during the same
period that did not require PPV.
Results—14 dogs with cervical spinal disorders
required PPV to treat hypoventilation, including 13 of
263 (4.9%) dogs that underwent surgery for cervical
spinal disorders. Lesions between the second and
fourth cervical vertebrae and treatment by means of a
dorsal decompressive laminectomy were associated
with a significantly increased risk of perioperative
hypoventilation. Pulmonary gas exchange function was
normal or nearly normal throughout the course of PPV
in dogs that survived. Ten dogs survived, and 9 of the 10
regained neurologic function. All 9 dogs that regained
neurologic function had deep pain perception on initial
examination at the veterinary teaching hospital.
Conclusions and Clinical Relevance—Results suggest
that a small percentage of dogs with cervical
spinal disorders may require perioperative ventilatory
support. With prolonged PPV and aggressive management,
a good outcome may be achieved in dogs
similar to those described in the present study. (J Am
Vet Med Assoc 2001;218:1598–1602).
Objective—To identify causative organisms, treatment, outcome, and prognosis for dogs < 1 year old with community-acquired infectious pneumonia.
Design—Retrospective case series.
Procedures—Dogs were considered to have community-acquired infectious pneumonia if they had clinical signs of primary respiratory tract disease in conjunction with radiographic evidence of alveolar disease and positive results following bacterial culture of tracheal wash fluid.
Results—Most dogs were hypoxemic at the time of initial examination, with pulmonary function becoming worse during the first few days of hospitalization before improving; 57 (88%) dogs survived to discharge. Bordetella bronchiseptica was isolated from tracheal wash fluid from 32 (49%) dogs, and other organisms, predominantly gram-negative enteric bacteria, were isolated from the other 33 (51%). Dogs with Bordetella pneumonia were significantly younger (median, 14 vs 21 weeks), were significantly more likely to have been obtained from a pet store (19/31 vs 7/32), had been owned for a significantly shorter time prior to the onset of illness (median, 18 vs 90 days), had significantly higher PvCO2 values at initial examination (median, 48.7 vs 41.3 mm Hg), were significantly more likely to receive supplemental oxygen (25/32 vs 16/33), and had significantly longer hospitalization times (mean, 7.2 vs 4.9 days) than did dogs with pneumonia caused by any other organism.
Conclusions and Clinical Relevance—Results suggested that a type of community-acquired infectious pneumonia could be identified in dogs < 1 year old, with disease being more severe in dogs with Bordetella pneumonia than in dogs with pneumonia caused by other bacterial organisms.
Objective—To identify risk factors for development of sepsis in dogs treated with chemotherapeutics and to evaluate the impact of sepsis on outcome.
Animals—Client-owned dogs with various cancers undergoing standard chemotherapeutic treatment at the University of Pennsylvania veterinary hospital.
Procedures—39 dogs with sepsis (cases) were identified through a search of the medical record database. Controls (n = 77) were randomly selected from dogs admitted during the same time period. Variables analyzed included patient demographics, tumor type, stage, remission status, treatment phase, chemotherapeutics used, and outcome.
Results—Dogs that weighed less and dogs with lymphoma were significantly more likely to become septic, compared with larger dogs or dogs with solid tumors. Septic dogs were also significantly more likely to have received doxorubicin (odds ratio [OR], 12.5; 95% confidence interval [CI], 2.4 to 66.0) or vincristine (OR, 9.0; 95% CI, 1.6 to 52.0) than controls. Of the 39 cases, 28 (71.8%) were in the induction phase of their protocol, and 19 of 39 (48.7%) became septic after receiving the chemotherapeutic drug for the first time. Median survival time of the cases (253 days) was not significantly different from that of the controls (371 days).
Conclusions and Clinical Relevance—Dogs that weighed less were at increased risk for chemotherapy-induced sepsis. Tumor type and chemotherapeutic drug used were also important risk factors. These results may lead to the implementation of prophylactic measures, especially when doxorubicin or vincristine is used in the induction phase in small dogs with lymphoma.
Objective—To document the clinical, clinicopathologic,
and pathologic findings in cats with severe sepsis,
identify abnormalities unique to this species, and
identify criteria that could be used antemortem to
diagnose the systemic inflammatory response syndrome
Animals—29 cats confirmed to have severe sepsis at
Procedure—Pertinent history, physical examination
findings, and results of hematologic and biochemical
testing were extracted from medical records.
Results—Clinical diagnoses included pyothorax, septic
peritonitis, bacteremia secondary to gastrointestinal
tract disease, pneumonia, endocarditis,
pyelonephritis, osteomyelitis, pyometra, and bite
wounds. Physical examination findings included
lethargy, pale mucous membranes, poor pulse quality,
tachypnea, hypo- or hyperthermia, signs of diffuse
pain on abdominal palpation, bradycardia, and icterus.
Clinicopathologic abnormalities included anemia,
thrombocytopenia, band neutrophilia, hypoalbuminemia,
low serum alkaline phosphatase activity, and
hyperbilirubinemia. Necropsy findings included multiorgan
necrosis or inflammation with intralesional bacteria.
Conclusions and Clinical Relevance—Results suggest
that severe sepsis in cats is characterized by
lethargy, pale mucous membranes, signs of diffuse
abdominal pain, tachypnea, bradycardia, weak pulses,
anemia, hypoalbuminemia, hypothermia, and icterus.
Recognition of this combination of clinical findings
should facilitate the diagnosis of severe sepsis in
cats. (J Am Vet Med Assoc 2000;217:531–535)
Objective—To determine the underlying cause,
pathophysiologic abnormalities, and response to
treatment in cats with septic peritonitis and identify
differences between cats that survived following
treatment and cats that did not survive despite treatment.
Animals—51 cats with septic peritonitis.
Procedure—Medical records were reviewed for clinical
findings; results of clinicopathologic testing,
microbial culture, and radiography; diagnosis; treatment;
Results—Signs of pain during palpation of the
abdomen were reported for only 29 of 47 (62%) cats.
Eight (16%) cats had relative bradycardia (heart rate
< 140 beats/min). The most commonly isolated organisms
included Escherichia coli, Enterococcus spp, and
Clostridium spp. The most common cause of peritonitis
was gastrointestinal tract leakage (24 cats). No
definitive source could be identified in 7 cats.
Treatment, including exploratory surgery, was pursued
in 23 cats, of which 16 (70%) survived and were
discharged. There were no significant differences
between survivors and nonsurvivors in regard to
heart rate, age, rectal temperature, serum lactate
concentration, WBC count, PCV, blood glucose concentration,
or serum albumin concentration.
Conclusions and Clinical Relevance—Results suggest
that clinicopathologic abnormalities and outcome
in cats with septic peritonitis are similar to
those reported for dogs. However, certain features
may be unique, including an absence of signs of pain
during abdominal palpation, relative bradycardia, and
apparent spontaneous peritonitis in some cats. (J Am
Vet Med Assoc 2004;225:897–902)
Objective— To determine indications for and outcomes of positive-pressure ventilation (PPV) in cats, document ventilator management, and identify factors
associated with outcome.
Design— Retrospective study.
Animals— 53 cats that underwent PPV.
Procedure— Information on signalment, history, concurrent diseases, clinical findings, results of venous blood gas analyses and clinicopathologic testing, treatment, ventilator settings, and outcome was retrieved from the medical records. Data for cats that survived were compared with data for cats that died or were euthanatized while undergoing PPV.
Results—PPV was initiated for management of respiratory failure (36 cats [68%]), cardiac arrest (9 [17%]), neurologic impairment (6 [11%]), and nonresponsive hypotension (2 [4%]). Eight cats (15%) survived, 19 (36%) died, and 26 (49%) were euthanatized while undergoing PPV. Cats that survived had a longer duration of ventilation than did those that died or were euthanatized and had a significantly higher incidence of ventilator-associated pneumonia. Signalment and ventilator settings were not associated with outcome. Cats that had no clinical evidence of pulmonary disease but
required PPV because of primary neurologic disease had a higher survival rate (2/6) than did cats that
required PPV because of respiratory failure (5/36), cardiac arrest (1/9), or nonresponsive hypotension (0/2).
Conclusions and Clinical Relevance—Results suggest that the survival rate for cats requiring PPV may be lower than reported survival rates for dogs. Death was attributable to progressive respiratory failure, nonresponsive hypotension, kidney failure, or neurologic
impairment. (J Am Vet Med Assoc 2005;226:924–931)