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  • Author or Editor: Lesley G. King x
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Abstract

Objective—To document pulmonary function, ventilator management, and outcome of dogs with thoracic trauma that required mechanical ventilation because of severe pulmonary contusions.

Design—Retrospective study.

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)

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To identify breed disposition, postoperative complications, and outcome in dogs with lung lobe torsion.

Design—Retrospective study.

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 medical records.

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)

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To evaluate the relationship between Doppler blood pressure (DBP) and survival or response to treatment in critically ill cats.

Design—Retrospective case series.

Animals—83 cats.

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.

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in Journal of the American Veterinary Medical Association

Abstract

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 (ie, SPI2).

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 Res 2001;62:948–954)

Full access
in American Journal of Veterinary Research

Abstract

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.

Design—Retrospective study.

Animals—14 dogs.

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).

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To identify causative organisms, treatment, outcome, and prognosis for dogs < 1 year old with community-acquired infectious pneumonia.

Design—Retrospective case series.

Animals—65 dogs.

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.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To identify risk factors for development of sepsis in dogs treated with chemotherapeutics and to evaluate the impact of sepsis on outcome.

Design—Case-control study.

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.

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in Journal of the American Veterinary Medical Association

Abstract

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 in cats.

Design—Retrospective study.

Animals—29 cats confirmed to have severe sepsis at necropsy.

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)

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in Journal of the American Veterinary Medical Association

Abstract

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.

Design—Retrospective study.

Animals—51 cats with septic peritonitis.

Procedure—Medical records were reviewed for clinical findings; results of clinicopathologic testing, microbial culture, and radiography; diagnosis; treatment; and outcome.

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)

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in Journal of the American Veterinary Medical Association

Abstract

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)

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in Journal of the American Veterinary Medical Association