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Summary

Medical records of 21 dogs and 2 cats treated for septic peritonitis were reviewed. Animals were between 1 and 12 years old, (mean, 6.5 years) and weighed between 6 and 51.4 kg (mean, 22.7 kg). Overall, 13 animals survived and were discharged from the hospital. Immediately after surgical correction of the underlying cause of peritonitis, most animals were tachycardic (mean heart rate, 148 beats/min; range, 80 to 204 beats/min), and many were hypotensive (mean arterial pressure, 84.4 mm of Hg; range, 44 to 156 mm of Hg). Hypotension was attributed to sepsis and hypovolemia secondary to extensive loss of fluid into the peritoneal cavity. Survivors did not differ from nonsurvivors with regard to mean arterial pressure immediately after surgery, and in most animals, hypotension could be corrected by iv administration of fluids. Three animals died after failing to respond to fluid treatment, despite concurrent administration of inotropic or pressor agents. Mean rate for crystalloid fluid administration was 12.8 ml/kg of body weight/h (range, 5 to 23.5 ml/kg/h) during the first 24 hours after surgery. Six of 23 animals had low urine output for a short time after surgery, but urine output increased when fluids were administered. Hypoalbuminemia developed in all animals (mean serum albumin concentration, 1.17 g/dl; range, 0.6 to 2.3 g/dl), and peripheral edema developed in 13. Neither lowest mean serum albumin concentration nor fluid administration rate was significantly different between animals that developed peripheral edema and those that did not. Fluid administration rates were significantly higher in nonsurvivors (15 ml/kg/h; range, 5.5 to 23.5 ml/kg/h) than in survivors (11 ml/kg/h; range, 5 to 17.5 ml/kg/h). Thirteen animals had evidence of pulmonary alveolar consolidation, and 9 had pleural effusions; however, fluid administration rates were not significantly different between animals that did and those that did not develop clinical respiratory disease. Eleven animals had pancreatitis at the time of surgery, or developed pancreatitis subsequently. Four animals developed disseminated intravascular coagulation, and only 1 survived. Indicators of a poor prognosis included refractory hypotension, cardiovascular collapse, and development of respiratory disease or disseminated intravascular coagulation. Development of pancreatitis, high serum concentrations of hepatic enzymes, high or low wbc count, hypo- or hyperglycemia, signs of abdominal pain, and abdominal effusion were not associated with outcome.

Free access
in Journal of the American Veterinary Medical Association

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)

Full access
in Journal of the American Veterinary Medical Association
in Journal of the American Veterinary Medical Association

Abstract

Intermittent positive-pressure ventilation (ppv) is an invasive means of respiratory support that is indicated in animals with central and peripheral neuromuscular disease, as well as in those with primary disorders of the lung parenchyma. We reviewed the medical records of 34 dogs and 7 cats treated with ppv. The animals could be allotted to 2 groups; group 1 (21/41) had primary failure of ventilation attributable to neuromuscular disease or airway obstruction, and group 2 (20/41) had primary pulmonary parenchymal disease.

Mean inspiratory time was 1.02 ± 0.2 seconds (range, 0.6 to 1.5 seconds). Mean inspiratory flow was 26.9 ± 18.5 L/min (range, 7 to 87 L/min), and was positively correlated with body weight (R = 0.57). Mean set respiratory rate was 19.6 ± 10 breaths/min (range, 5 to 60 breaths/min), with mean tidal volume of 15.5 ± 6.2 ml/kg of body weight. Positive end-expiratory pressure (peep) was required in 14 of 20 dogs in group 2. Mean peak airway pressure in group 1 was 21.6 ± 6.3 cm of H2O, whereas in group 2 it was 32.9 ± 12.5 cm of H2O. The higher peak airway pressure in group-2 dogs reflected poor lung compliance and the use of peep in dogs with parenchymal lung disease. Mean duration of ppv was 28.2 ± 29.4 hours (range, 2 to 137 hours).

The overall survival rate was 39% (16/41). Factors that appeared to correlate with survival included age, with higher mortality in animals < 1 year old or > 11 years old (P < 0.01); body weight, with mortality highest in animals < 10 kg (P < 0.05); reason for ventilation, with survival in group 1 being 57%, and in group 2, 20%; and development of complications, with 28% of animals that developed major complications surviving, compared with 48% of those that did not develop major complications. Two major complications of ppv were documented: pneumothorax and pneumonia. Twelve of 41 animals developed pneumothorax and had been ventilated by use of peak airway pressures > 25 cm of H2O, or peep. An additional 6 animals developed subclinical pneumonia during treatment with ppv.

Free access
in Journal of the American Veterinary Medical Association

Objective

To characterize naturally developing glucocorticoid deficiency in dogs.

Design

Retrospective case series.

Animals

18 dogs with glucocorticoid deficiency defined by an inadequate response to stimulation with adrenocorticotropic hormone (ACTH), a normal Na:K ratio (> 27), and no history of receiving corticosteroids for at least 6 weeks.

Procedure

Information including signalment, body weight, clinical signs on admission, historical findings, physical examination findings, results of CBC and serum biochemical analyses, results of ACTH stimulation tests and other ancillary endocrine tests, diagnostic imaging findings, findings from other procedures such as endoscopy and surgery, and information on concurrent diseases, management, and outcome were retrieved from the medical records of dogs with glucocorticoid deficiency treated between 1986 and 1995 at the University of Pennsylvania’s School of Veterinary Medicine and 2 dogs from private practices.

Results

Most dogs were young (< 7 years) and represented larger breeds (> 20 kg). Clinical signs were nonspecific: lethargy, weight loss, and gastrointestinal disturbances including regurgitation with radiographic evidence of megaesophagus. Hypocholesterolemia, hypoalbuminemia, hypoglycemia, and a mild, nonregenerative anemia were common. Ten of the 18 dogs responded well to glucocorticoid supplementation alone, with only 2 dogs developing electrolyte abnormalities. Four (22%) of the dogs died, with death usually occurring as a result of secondary disease processes rather than hypoadrenocorticism.

Clinical Implications

An ACTH stimulation test should be considered as part of the diagnostic plan in dogs with signs of weight loss, inappetence, and interminent vomiting and diarrhea. Glucocorticoid-deficient dogs may not require supplemental mineralocorticoids. (J Am Vet Med Assoc 1996;209:2076–2081)

Free access
in Journal of the American Veterinary Medical Association

Objective

To investigate whether urinary urea nitrogen (UUN) content can be used to accurately estimate total urinary nitrogen content in hospitalized dogs.

Design

Prospective, cohort study.

Animals

24 client-owned dogs admitted to an intensive care unit of a veterinary teaching hospital.

Procedure

Indwelling urinary catheters and closed collection systems were placed for the purpose of monitoring urine output. Urine was collected during a 24-hour period from each dog. For each collection, the total volume was measured. Urine was analyzed for urea nitrogen content at an in-house laboratory, using standard methods for determination of BUN content. Total urinary nitrogen content was determined by another laboratory, using Kjeldahl's method. Correlation between UUN content and total urinary nitrogen content was evaluated by use of linear regression analysis.

Results

Total urinary nitrogen content adjusted for metabolic body weight ranged from 0.21 to 2.21 g/ kg0.75/d (mean ± SD, 0.81 ± 0.46 g/kg0.75/d). Adjusted UUN content ranged from 0.05 to 1.50 g/kg0.75/d (0.54 ± 0.38 g/kg0.75/d). Total urinary nitrogen content was highly correlated with UUN content (R 2, 0.88; P < 0.001).

Clinical Implications

Measurement of UUN content can be used to estimate total urinary nitrogen content in a clinical setting. Furthermore, critical illness in dogs is associated with substantial catabolism of endogenous proteins. (J Am Vet Med Assoc 1997; 210:356–359

Free access
in Journal of the American Veterinary Medical Association

SUMMARY

Thoracic compliance measurements by use of readily available equipment were determined to be practical and safe in dogs. Twenty healthy dogs (age 1 to 16 years, weight 2.3 to 49.5 kg) were anesthetized for routine procedures such as dentistry or neutering. The animals were first hyperventilated to reduce pulmonary atelectasis, to check for leakage at the endotracheal tube cuff, and to induce mild hypocarbia, thus minimizing voluntary respiratory efforts. Total thoracic compliance measurements were calculated as the difference between exhaled volumes at static inspiratory pressures of 15 and 20 cm of H2O, divided by the pressure difference, and expressed as a function of body weight. The procedure was easy, took 5 to 10 minutes, and caused no recognizable ill effects in any of the dogs studied. Mean total thoracic compliance was 42.25 ± 32 ml/cm of H2O. There was a significant correlation with weight, but no significant relationship was seen between compliance and age, or gender. The mean weight-adjusted total thoracic compliance was 1.85 ± 0.56 ml/cm of H2O/kg. In studies in a small group of dogs with documented respiratory tract disease, 4 of 7 had a mean compliance > 2 sd below the normal range. Thus, this test may become part of the routine workup of any animal being anesthetized for procedures such as bronchoscopy to evaluate respiratory tract disease. Routine monitoring of animals on ventilators could provide early warning of complications such as pneumonia, pleural effusion, or pulmonary edema.

Free access
in American Journal of Veterinary Research

Objective

To characterize cranial vena cava thrombosis in dogs with regard to signalment, clinical manifestation, potential inciting causes, treatment, and outcome.

Design

Retrospective study.

Animals

17 dogs with a cranial vena cava thrombus.

Procedure

Medical and necropsy records were reviewed for signalment, potential causes of thrombus formation, diagnosis, clinicopathologic findings, treatment, and outcome.

Results

A signalment predisposition was not found. Ten dogs had cranial vena cava syndrome, and 10 had a pleural effusion. Ten dogs were dyspneic, and 5 had palpable jugular thrombi. Predisposing conditions identified were presumed immune-mediated hematologic disease and corticosteroid administration (6 dogs), sepsis (6), protein-losing nephropathy (2), neoplasia (2), and cardiac disease (1). Central venous catheterization was implicated as a contributing cause. Thrombocytopenia was the most consistent clinicopathologic finding, and ultrasonography was helpful in confirming the diagnosis. Treatment varied, but 15 of the 17 dogs died or were euthanatized within 20 days of clinical manifestation of the thrombus. At necropsy, thrombi were found in other organs, mainly the right atrium, jugular veins, and pulmonary arteries.

Clinical Implications

Prognosis is poor for dogs with cranial vena cava thrombosis associated with clinical signs. Use of central venous catheters should be avoided in dogs with predisposing diseases such as immune-mediated disease, sepsis, protein-losing nephropathy, neoplasia, and cardiac disease. (J Am Vet Med Assoc 1998;213:220-224)

Free access
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.

Full access
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)

Full access
in Journal of the American Veterinary Medical Association