1
|
Murphy KM, Rishniw M, Silverstein DC. Use of vasopressors for treatment of vasodilatory hypotension in dogs and cats by Diplomates of the American College of Veterinary Emergency and Critical Care. J Vet Emerg Crit Care (San Antonio) 2022; 32:714-722. [PMID: 35829666 DOI: 10.1111/vec.13230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/30/2021] [Accepted: 06/20/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To identify the most common practices of Diplomates of the American College of Veterinary Emergency and Critical Care (DACVECCs) as they relate to the recognition and treatment of hypotension in dogs and cats, particularly concerning the use of vasopressors in vasodilatory shock states. DESIGN A survey regarding vasopressor use was sent to all active DACVECCs using the Veterinary Information Network. Questions focused on respondent characteristics, method of recognition of hypotension, triggers for initiation of vasopressor therapy, first- and second-line vasopressor choice, and methods of determining response to therapy. SUBJECTS A total of 734 DACVECCs were invited to participate, and 203 Diplomates (27.7%) completed the survey. RESULTS For both dogs and cats, the most common first-line vasopressor was norepinephrine (87.9% in dogs and 83.1% in cats). The most common second-choice vasopressor was vasopressin (44.2% in dogs and 39.0% in cats). Cutoff values for initiating vasopressor therapy varied between species and modality used for blood pressure measurement. In general, most DACVECCs chose to initiate vasopressor therapy at a Doppler blood pressure <90 mm Hg or a mean arterial pressure of <60 or <65 mm Hg when using oscillometric or direct arterial blood pressure measurements in dogs and cats. CONCLUSIONS Most DACVECCs adhere to published human guidelines when choosing a first-line vasopressor. However, there is significant variability in blood pressure measurement technique, cutoffs for initiation of vasopressor use, and choice of second-line vasopressors.
Collapse
Affiliation(s)
- Kellyann M Murphy
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Mark Rishniw
- Veterinary Information Network, Davis, California, USA
| | - Deborah C Silverstein
- Department of Clinical Studies and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Trenholme HN, Tynan B, Jackson M, Kerl M. Comparison of point-of-care NOVA CCX blood gas analyzer to laboratory analyzer in a population of healthy adult cats. J Vet Emerg Crit Care (San Antonio) 2022; 32:173-180. [PMID: 35166436 DOI: 10.1111/vec.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 08/23/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the level of agreement of measurement of analytes (sodium, chloride, potassium, urea nitrogen [UN], creatinine, glucose) in a population of healthy adult cats between the point-of-care (POC) analyzer and laboratory analyzer. To establish reference intervals for the POC analyzer in healthy adult cats. DESIGN Prospective observational study. SETTING University teaching hospital. ANIMALS Fifty-five cats were screened. Seven cats were excluded due to aggression that prohibited phlebotomy, and 1 cat was excluded due to prolonged restraint; 47 cats were enrolled. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In this patient population, reference intervals for the POC analyzer were calculated: sodium 145-157 mmol/L; chloride 116-124 mmol/L; potassium 3.4-5.5 mmol/L; UN 5.71-13.9 mmol/L (16-39 mg/dl); creatinine 74.3-189.2 mmol/L (0.84-2.14 mg/dl); and glucose 4-11.8 mmol/L (72-213 mg/dl). Comparison between the POC analyzer and laboratory analyzer using the Bland-Altman method was performed. The bias for each analyte is as follows: sodium 1.55 mmol/L; chloride 0.99 mmol/L; potassium 0.21 mmol/L; UN -0.25 mmol/L (-0.7 mg/dl); creatinine 9.73 mmol/L (0.11 mg/dl); and glucose 0.5 mmol/L (9.79 mg/dl). CONCLUSIONS Reference intervals for each analyte were similar to other chemistry analyzers. There was no significant difference between the POC and laboratory analyzers in analysis of UN, with a statistically significant difference observed with sodium, potassium, chloride, creatinine, and glucose. However, the values are likely not sufficiently different to alter initial clinical decisions regarding patient care.
Collapse
Affiliation(s)
- H Nicole Trenholme
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri, USA.,Department of Veterinary Clinical Medicine, University of Illinois, 1008 W Hazelwood Drive, Urbana, Illinois, 61802, USA
| | - Beth Tynan
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri, USA.,Charleston Veterinary Referral Center, Charleston, South Carolina, USA
| | - Mary Jackson
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri, USA.,Animal Emergency and Critical Care Center of Brevard, Melbourne, Florida, USA
| | - Marie Kerl
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri, USA.,VCA Inc., Los Angeles, California, USA
| |
Collapse
|
3
|
Venn EC, Barnes AJ, Hansen RJ, Boscan PL, Twedt DC, Sullivan LA. Serum D-lactate concentrations in dogs with parvoviral enteritis. J Vet Intern Med 2020; 34:691-699. [PMID: 31919893 PMCID: PMC7096611 DOI: 10.1111/jvim.15688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 12/11/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Dogs infected with canine parvovirus (CPV) have compromised intestinal epithelial barrier integrity. Production of D-lactate by enteric bacteria may directly reflect disease severity or contribute to metabolic acid-base status in these dogs. HYPOTHESIS Serum D-lactate concentration will be increased in CPV dogs compared to healthy controls and correlate with markers of disease severity and acid-base status. ANIMALS Dogs with CPV undergoing treatment (n = 40) and healthy control dogs (n = 9). METHODS Prospective observational study. Dogs with CPV had a baseline and daily CBC, venous blood gas with serum electrolyte concentrations, composite clinical severity score, and serum D-lactate concentration performed. A single serum D-lactate measurement was obtained from healthy control dogs. RESULTS The CPV dogs had a higher D-lactate concentration (mean ± SD) of 469 ± 173 μM compared to controls, 306 ± 45 μM (P < .001). There was no difference in baseline D-lactate concentrations for CPV survivors (474 ± 28 μM), versus nonsurvivors (424 ± 116 μM; P = .70). D-lactate concentration decreased over the first 4 days of treatment (-9.6 μM/d; P = .46). Dogs hospitalized for <4 days had lower baseline D-lactate concentrations compared to those hospitalized ≥4 days (400 ± 178 μM versus 520 ± 152 μM; P = .03). No sustained correlation over time between serum D-lactate concentration and clinical severity score or recorded acid-base results. CONCLUSIONS AND CLINICAL IMPORTANCE Serum D-lactate concentrations are higher in dogs with CPV compared to healthy controls but do not appear to be clinically relevant. No relationship identified between serum D-lactate concentrations and markers of CPV disease severity, acid-base status, or outcome.
Collapse
Affiliation(s)
- Emilee C Venn
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Alex J Barnes
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Ryan J Hansen
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Pedro L Boscan
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - David C Twedt
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Lauren A Sullivan
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| |
Collapse
|
4
|
Teixeira LG, Martins LR, Schimites PI, de Oliveira RB, Bonella J, Campos RV, Mangini LT, Gasparotto JC, Soares AV. Peripheral perfusion index does not accurately reflect hypoperfusion in healthy dogs undergoing elective ovariohysterectomy. Vet J 2018; 240:27-30. [PMID: 30268329 DOI: 10.1016/j.tvjl.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/28/2018] [Accepted: 09/02/2018] [Indexed: 11/18/2022]
Abstract
This study evaluated the variability of the peripheral perfusion index (PI) in 22 anaesthetised female dogs undergoing elective ovariohysterectomy and examined the relationship between peripheral PI and heart rate, blood pressure, blood pH, end tidal CO2 (EtCO2), O2 saturation (SpO2), core-peripheral temperature gradient (ΔTc-p), partial pressure of CO2 (PCO2), and concentrations of glucose, cortisol, lactate and bicarbonate (HCO3-). Blood pH, lactate and glucose concentrations were determined 15, 30, 45min into the ovariohysterectomy procedure and after extubation. Cortisol concentrations were assessed before anaesthesia and after extubation. Other variables were recorded at every 5min throughout the ovariohysterectomy procedure. Hyperglycaemia was observed in 59% of bitches during surgery, but serum cortisol concentrations remained unchanged. Most measures of perfusion (ΔTc-p, pH, PCO2, EtCO2, SpO2) and heart rate remained unchanged throughout anaesthesia and did not correlate with peripheral PI. Mean arterial pressure increased during the ovariohysterectomy procedure, while peripheral PI decreased, resulting in negative correlations between these variables at 30 and 45min. Lactate concentrations decreased from baseline to the time of measurement post-extubation. Peripheral PI gradually decreased during the ovariohysterectomy procedure, probably reflecting vasoconstriction induced by nociceptive stimuli. Using lactate concentrations as the reference standard for peripheral perfusion, low peripheral PI in healthy bitches undergoing ovariohysterectomy might not represent peripheral hypoperfusion.
Collapse
Affiliation(s)
- L G Teixeira
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil.
| | - L R Martins
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - P I Schimites
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - R B de Oliveira
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - J Bonella
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - R V Campos
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - L T Mangini
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - J C Gasparotto
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - A V Soares
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil; Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| |
Collapse
|
5
|
Noel-Morgan J, Muir WW. Anesthesia-Associated Relative Hypovolemia: Mechanisms, Monitoring, and Treatment Considerations. Front Vet Sci 2018; 5:53. [PMID: 29616230 PMCID: PMC5864866 DOI: 10.3389/fvets.2018.00053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/02/2018] [Indexed: 12/14/2022] Open
Abstract
Although the utility and benefits of anesthesia and analgesia are irrefutable, their practice is not void of risks. Almost all drugs that produce anesthesia endanger cardiovascular stability by producing dose-dependent impairment of cardiac function, vascular reactivity, and compensatory autoregulatory responses. Whereas anesthesia-related depression of cardiac performance and arterial vasodilation are well recognized adverse effects contributing to anesthetic risk, far less emphasis has been placed on effects impacting venous physiology and venous return. The venous circulation, containing about 65–70% of the total blood volume, is a pivotal contributor to stroke volume and cardiac output. Vasodilation, particularly venodilation, is the primary cause of relative hypovolemia produced by anesthetic drugs and is often associated with increased venous compliance, decreased venous return, and reduced response to vasoactive substances. Depending on factors such as patient status and monitoring, a state of relative hypovolemia may remain clinically undetected, with impending consequences owing to impaired oxygen delivery and tissue perfusion. Concurrent processes related to comorbidities, hypothermia, inflammation, trauma, sepsis, or other causes of hemodynamic or metabolic compromise, may further exacerbate the condition. Despite scientific and technological advances, clinical monitoring and treatment of relative hypovolemia still pose relevant challenges to the anesthesiologist. This short perspective seeks to define relative hypovolemia, describe the venous system’s role in supporting normal cardiovascular function, characterize effects of anesthetic drugs on venous physiology, and address current considerations and challenges for monitoring and treatment of relative hypovolemia, with focus on insights for future therapies.
Collapse
Affiliation(s)
- Jessica Noel-Morgan
- Center for Cardiovascular & Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - William W Muir
- QTest Labs, Columbus, OH, United States.,College of Veterinary Medicine, Lincoln Memorial University, Harrogate, TN, United States
| |
Collapse
|
6
|
Naseri A, Turgut K, Sen I, Ider M, Akar A. Myocardial depression in a calf with septic shock. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2017-000513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Amir Naseri
- Department of Veterinary Internal MedicineSelcuk UniversityKonyaTurkey
| | - Kursad Turgut
- Department of Veterinary Internal MedicineSelcuk UniversityKonyaTurkey
- Department of Veterinary Internal MedicineNear East UniversityNicosiaNorthern Cyprus
| | - Ismail Sen
- Department of Veterinary Internal MedicineSelcuk UniversityKonyaTurkey
- Department of Veterinary Internal MedicineNear East UniversityNicosiaNorthern Cyprus
| | - Merve Ider
- Department of Veterinary Internal MedicineSelcuk UniversityKonyaTurkey
| | - Aybars Akar
- Department of Veterinary Internal MedicineSelcuk UniversityKonyaTurkey
| |
Collapse
|
7
|
Arias MVB, Padilha FN, Perugini MR. Deep tissue culture and hemoculture in dogs with wounds and sepsis. PESQUISA VETERINÁRIA BRASILEIRA 2017. [DOI: 10.1590/s0100-736x2017001200020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT: Contaminated and infected wounds occur very frequently in veterinary medicine and can cause systemic inflammatory response syndrome, sepsis, and death. This study aimed to test the feasibility of collecting wound material by deep-tissue or punch biopsy for microbial culture, determine the frequency of bacteria in the wound(s) and blood cultures and the susceptibility of these microbes to antimicrobials, and evaluate clinical parameters that could be related to prognosis. Thirty dogs with wounds and signs of SIRS/sepsis were included in this study. Bacteria were isolated from all wounds and 41 bacterial isolates could be identified based on culture of the materials collected by punch biopsy; 53.66% of the isolates were gram-negative, mainly involving Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus spp., and 46.34% were gram-positive bacteria such as Streptococcus spp., Enterococcus spp., and Staphylococcus spp. The survival rate was 66.67%. Based on blood culture analysis, we identified bacteremia in seven patients, predominantly of gram-negative bacteria, which negatively affected patient survival, as six dogs died. Hypoglycemia (≤60mg/dL) and severe hyperglycemia (≥180mg/dL) also negatively affected survival as 23.33% of the hypo/hyperglycemic dogs died. Factors such as blood lactate level at admission and hematocrit levels, and mean arterial pressure were not significantly correlated with death or survival of the dogs.
Collapse
|
8
|
LeBlanc NL, Scollan KF, Stieger-Vanegas SM. Cardiac output measured by use of electrocardiogram-gated 64-slice multidector computed tomography, echocardiography, and thermodilution in healthy dogs. Am J Vet Res 2017. [DOI: 10.2460/ajvr.78.7.818] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Di Mauro FM, Schoeffler GL. Point of Care Measurement of Lactate. Top Companion Anim Med 2016; 31:35-43. [PMID: 27451047 DOI: 10.1053/j.tcam.2016.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/19/2016] [Indexed: 01/25/2023]
Abstract
Lactate is generated as a consequence of anaerobic glycolysis by all tissues of the body. Increased l-lactate, the isoform produced by most mammals, reflects increased anaerobic metabolism secondary to tissue hypoperfusion or tissue hypoxia in most clinical situations, and is called type A lactic acidosis. The utility of lactate measurement and serial lactate monitoring in veterinary patients has been demonstrated in multiple studies. Blood lactate concentration is significantly elevated in many disease processes including septic peritonitis, immune-mediated hemolytic anemia, Babesiosis, trauma, gastric dilation and volvulus, and intracranial disease. Lactate clearance can be used to assess response to fluid therapy, cardiovascular therapeutics, and blood product transfusion in patients affected by type A lactic acidosis. Lactate concentration in peritoneal, pericardial, and synovial fluid can also be used as a diagnostic tool. Point of care analyzers such as the Lactate Pro, Lactate Scout, Accutrend, iSTAT, and Lactate Plus have been shown to be accurate lactate measurement instruments in small animal patients.
Collapse
Affiliation(s)
| | - Gretchen Lee Schoeffler
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
| |
Collapse
|
10
|
Adamik KN, Yozova ID, Regenscheit N. Controversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care. J Vet Emerg Crit Care (San Antonio) 2016; 25:20-47. [PMID: 25655725 DOI: 10.1111/vec.12283] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/14/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To (1) review the development and medical applications of hydroxyethyl starch (HES) solutions with particular emphasis on its physiochemical properties; (2) critically appraise the available evidence in human and veterinary medicine, and (3) evaluate the potential risks and benefits associated with their use in critically ill small animals. DATA SOURCES Human and veterinary original research articles, scientific reviews, and textbook sources from 1950 to the present. HUMAN DATA SYNTHESIS HES solutions have been used extensively in people for over 30 years and ever since its introduction there has been a great deal of debate over its safety and efficacy. Recently, results of seminal trials and meta-analyses showing increased risks related to kidney dysfunction and mortality in septic and critically ill patients, have led to the restriction of HES use in these patient populations by European regulatory authorities. Although the initial ban on the use of HES in Europe has been eased, proof regarding the benefits and safety profile of HES in trauma and surgical patient populations has been requested by these same European regulatory authorities. VETERINARY DATA SYNTHESIS The veterinary literature is limited mostly to experimental studies and clinical investigations with small populations of patients with short-term end points and there is insufficient evidence to generate recommendations. CONCLUSIONS Currently, there are no consensus recommendations regarding the use of HES in veterinary medicine. Veterinarians and institutions affected by the HES restrictions have had to critically reassess the risks and benefits related to HES usage based on the available information and sometimes adapt their procedures and policies based on their reassessment. Meanwhile, large, prospective, randomized veterinary studies evaluating HES use are needed to achieve relevant levels of evidence to enable formulation of specific veterinary guidelines.
Collapse
Affiliation(s)
- Katja N Adamik
- Department of Veterinary Clinical Medicine, Division of Small Animal Emergency and Critical Care, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | | |
Collapse
|
11
|
Salcedo MC, Tart K, Hall K. A systematic review of human and veterinary applications of noninvasive tissue oxygen monitoring. J Vet Emerg Crit Care (San Antonio) 2016; 26:323-32. [PMID: 27062438 DOI: 10.1111/vec.12465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 08/27/2014] [Accepted: 09/15/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe the methodology for and utilization of tissue oxygen monitoring by near infrared spectroscopy, and to review the current literature on the use of this monitoring modality in human and veterinary settings. DATA SOURCES Scientific reviews and original research found using the PubMed and CAB Abstract search engines with the following keywords: "tissue oxygen monitoring," "near-infrared tissue spectroscopy," and "tissue oxygen saturation (StO2 )." HUMAN DATA SYNTHESIS Tissue oxygen monitors have been evaluated in a wide variety of human clinical applications including trauma and triage, surgery, sepsis, and septic shock, and early goal-directed therapy. StO2 more rapidly identifies occult shock in human patients compared to traditional methods, which can lead to earlier intervention in these patients. VETERINARY DATA SYNTHESIS Veterinary studies involving tissue oxygen monitoring are limited, but the technology may have utility for identification of hemorrhagic shock earlier than changes in base excess, blood lactate concentration, or other traditional perfusion parameters. CONCLUSION Tissue oxygen monitoring is most commonly performed utilizing a noninvasive, portable monitor, which provides real-time, continuous, repeatable StO2 measurements. A decline in StO2 is an early indicator of shock in both human and veterinary patients. Low StO2 values in human patients are associated with increased morbidity, mortality, and length of hospitalization, as well as the development of multiple organ system dysfunction and surgical site infections.
Collapse
Affiliation(s)
- Mallory C Salcedo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108
| | - Kelly Tart
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108
| | - Kelly Hall
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108
| |
Collapse
|
12
|
Itami T, Endo Y, Hanazono K, Ishizuka T, Tamura J, Miyoshi K, Sano T, Yamashita K. Comparison of cardiac output measurements using transpulmonary thermodilution and conventional thermodilution techniques in anaesthetized dogs with fluid overload. Vet Anaesth Analg 2015; 43:388-96. [PMID: 26671761 DOI: 10.1111/vaa.12331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 10/26/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the agreement between cardiac output (CO) values obtained using a transpulmonary thermodilution technique (TPTDCO) and conventional thermodilution technique (TDCO) in anaesthetized dogs with fluid overload. STUDY DESIGN Prospective experimental study. ANIMALS Six healthy Beagle dogs aged 7-8 years. METHODS Dogs were anaesthetized with sevoflurane in oxygen, and catheters were inserted for TPTDCO and TDCO measurement. After instrumentation, baseline CO was measured using each technique at a central venous pressure (CVP) of 3-7 mmHg. Dogs were subsequently administered lactated Ringer's solution and 6% hydroxyethyl starch to induce fluid overload. CO measurements were obtained using each technique at CVP values of 8-12 mmHg, 13-17 mmHg, 18-22 mmHg and 23-27 mmHg. Agreements between CO measurements obtained with the respective techniques were analysed using Dunnett's test, Pearson's correlation coefficient and Bland-Altman analysis. RESULTS Thirty pairs of CO values were obtained, ranging from 1.45 L minute(-1) to 4.69 L minute(-1) for TPTDCO and from 1.30 L minute(-1) to 4.61 L minute(-1) for TDCO. TPTDCO and TDCO values correlated strongly (r(2) = 0.915, p < 0.001). The bias and mean relative bias between TPTDCO and TDCO were 0.26 ± 0.30 L minute(-1) (limits of agreement - 0.29 to 0.81 L minute(-1) ) and 9.7%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE TPTDCO and TDCO measurements obtained in anaesthetized dogs during fluid overload exhibited good agreement. Accordingly, transpulmonary thermodilution provides an accurate measurement of CO in dogs with fluid overload.
Collapse
Affiliation(s)
- Takaharu Itami
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yusuke Endo
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Kiwamu Hanazono
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomohito Ishizuka
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Jun Tamura
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Kenjiro Miyoshi
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Tadashi Sano
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Kazuto Yamashita
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| |
Collapse
|
13
|
Tynan B, Kerl ME, Jackson ML, Mann FA. Plasma lactate concentrations and comparison of two point-of-care lactate analyzers to a laboratory analyzer in a population of healthy cats. J Vet Emerg Crit Care (San Antonio) 2015; 25:521-7. [PMID: 26088563 DOI: 10.1111/vec.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/20/2013] [Accepted: 03/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To establish a reference interval for plasma lactate in a population of healthy adult cats on a laboratory analyzer (Nova Biomedical Critical Care Xpress [CCX]) and 2 commercially available point-of-care (POC) analyzers (Abbott i-STAT [i-STAT] and Nova Biomedical Lactate Plus [LP]), and to compare the level of agreement of lactate measurement between the laboratory analyzer and POC analyzers. DESIGN Prospective observational study. SETTING University veterinary teaching hospital. ANIMALS Forty-seven healthy adult cats. INTERVENTIONS Jugular phlebotomy. MEASUREMENTS AND MAIN RESULTS In this population, plasma lactate reference interval was 0.67-5.44 mmol/L for the CCX, 0.65-5.16 mmol/L for the i-STAT, and 0.68-4.39 mmol/L for the LP. Comparisons were made between lactate measurements on 2 point-of-care analyzers and the laboratory analyzer using the Bland-Altman method. For the comparison of CCX and i-STAT, the bias was -0.10 mmol/L; for the CCX and LP, the bias was -0.24 mmol/L. CONCLUSIONS Measurements of plasma lactate in cats using the i-STAT showed acceptable agreement with the CCX. The LP showed weaker agreement. However, both POC analyzers are suitable for measurement of lactate in cats, provided results from different POC analyzers are not directly compared. This study identified a larger reference interval for plasma lactate concentration in cats than what has been previously reported.
Collapse
Affiliation(s)
- Beth Tynan
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, 900 East Campus Drive, Columbia, MO, 65211
| | - Marie E Kerl
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, 900 East Campus Drive, Columbia, MO, 65211
| | - Mary L Jackson
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, 900 East Campus Drive, Columbia, MO, 65211
| | - F A Mann
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, 900 East Campus Drive, Columbia, MO, 65211
| |
Collapse
|
14
|
Boller E, Boller M. Assessment of Fluid Balance and the Approach to Fluid Therapy in the Perioperative Patient. Vet Clin North Am Small Anim Pract 2015; 45:895-915. [PMID: 26033443 DOI: 10.1016/j.cvsm.2015.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Perioperative patients can be highly dynamic and have various metabolic, physiologic, and organ system derangements that necessitate smart monitoring strategies and careful fluid therapy. The interplay between changing patient status, therapeutic interventions, and patient response makes effective monitoring crucial to successful treatment. Monitoring the perioperative patient and an approach to fluid therapy are discussed in this text.
Collapse
Affiliation(s)
- Elise Boller
- Emergency and Critical Care, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, 250 Princes Highway, Werribee, Melbourne, Victoria 3030, Australia.
| | - Manuel Boller
- Emergency and Critical Care, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, 250 Princes Highway, Werribee, Melbourne, Victoria 3030, Australia
| |
Collapse
|
15
|
Tamura J, Itami T, Ishizuka T, Fukui S, Miyoshi K, Sano T, Yamashita K. Central venous blood gas and acid-base status in conscious dogs and cats. J Vet Med Sci 2015; 77:865-9. [PMID: 25754649 PMCID: PMC4527512 DOI: 10.1292/jvms.14-0503] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
To determine the reference level of central venous oxygen saturation (ScvO2)
and clinical efficacy of central venous blood gas analysis, partial pressures of oxygen
and carbon dioxide, pH, oxygen saturation, base excess (B.E.) and HCO3
concentration were compared between simultaneously obtained central venous and arterial
blood samples from conscious healthy 6 dogs and 5 cats. Comparisons between arteriovenous
samples were performed by a paired t-test and Bland-Altman analysis.
Between arteriovenous samples, B.E. showed good agreement, but there were significant
differences in other parameters in the dogs, and no good agreement was detected in cats.
The ScvO2 in dogs and cats were 82.3 ± 3.5 and 62.4 ± 13.5%, respectively.
Central venous blood gas analysis is indispensable, especially in cats.
Collapse
Affiliation(s)
- Jun Tamura
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido 069-8501, Japan
| | | | | | | | | | | | | |
Collapse
|
16
|
Cortellini S, Seth M, Kellett-Gregory LM. Plasma lactate concentrations in septic peritonitis: A retrospective study of 83 dogs (2007-2012). J Vet Emerg Crit Care (San Antonio) 2014; 25:388-95. [PMID: 25212787 DOI: 10.1111/vec.12234] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 05/17/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if absolute plasma lactate concentration or lactate clearance in dogs with septic peritonitis is associated with morbidity or mortality. DESIGN Retrospective cohort study from 2007 to 2012. SETTING University teaching hospital. ANIMALS Eighty-three dogs with septic peritonitis were included. Patients had at least 1 plasma lactate measurement during the course of the hospitalization. RESULTS Sixty-four percent of the patients survived to discharge, 22% were euthanized, and 14% died during hospitalization. Plasma lactate concentration >2.5 mmol/L on admission (29% of the patients) was associated with mortality (P = 0.001). Median admission plasma lactate concentration (n = 81) was significantly different between nonsurvivors (2.5 mmol/L, range 0.5-8.4) and survivors (1.4 mmol/L, range 0.5-9.7; P = 0.007). Admission plasma lactate concentration >4 mmol/L yielded a sensitivity of 36% and a specificity of 92% for nonsurvival. The inability to normalize plasma lactate concentration within 6 hours of admission (n = 10/24) yielded a sensitivity of 76% and specificity of 100% for nonsurvival. Postoperative hyperlactatemia (plasma lactate concentration >2 mmol/L; n = 18/76) had a sensitivity of 46% and specificity of 88% for nonsurvival. Persistent postoperative hyperlactatemia (n = 11/18) had a sensitivity of 92% and a specificity of 100% for nonsurvival. Lactate clearance less than 21% at 6 hours (n = 20) had a sensitivity of 54% and specificity of 91% for nonsurvival. Lactate clearance less than 42% at 12 hours (n = 18) had a sensitivity of 82% and a specificity of 100% for nonsurvival. CONCLUSIONS Admission plasma lactate concentration and lactate clearance were good prognostic indicators in dogs with septic peritonitis.
Collapse
Affiliation(s)
- Stefano Cortellini
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, United Kingdom
| | - Mayank Seth
- Animal Health Trust, Small Animal Centre, Kentford, Newmarket, Suffolk, CB8 7UU, United Kingdom
| | - Lindsay M Kellett-Gregory
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, United Kingdom
| |
Collapse
|
17
|
Abstract
Aim: Detailed information regarding the causes and treatment of acute collapse in the cat can be difficult to locate in a single published source. This two-part review aims to provide a logical approach to the clinical assessment and stabilisation of the critically ill collapsed cat. Practical relevance: Cats are particularly challenging when presented as emergency patients, often in the later stages of an illness or with a vague history and non-specific signs. The nuances of the critically ill cat are considered, especially for shock and its management. Clinical challenges: Shocked cats do not present in the classic stages typically seen in dogs, and the signs are more subtle. Therefore, the clinician must consider whether physical parameters are appropriate for the state and environment of the patient; for example, a normal heart rate in a shocked cat would be considered inappropriate. Audience: This review is directed at any veterinarian working with feline patients, and particularly those dealing with emergencies on a regular basis. Evidence base: There is an extensive body of published literature, both original studies and textbook chapters, pertaining to the causes and treatment of collapse in the cat. In this article the authors draw on information from original publications, reviews and their clinical experience to provide practical guidance to assist in the emergency setting.
Collapse
Affiliation(s)
- Kate Murphy
- Bath Veterinary Referrals, Rosemary Lodge, Wellsway, Bath BA2 5RL, UK
| | - Angie Hibbert
- The Feline Centre, Langford Veterinary Services, Langford, Bristol BS40 5DU, UK
| |
Collapse
|
18
|
Abstract
This article discusses anesthesia for horses with colic from acute gastrointestinal disease. Emphasis is placed on new developments in pre-, intra-, and immediate postoperative management over the last decade, including early goal-directed therapy (EGDT) in the resuscitation of septic patients, the controversy over the optimal fluid type to administer, and the management of complications, such as cardiovascular depression, hypoventilation and hypoxemia, and decreased colloid oncotic pressure (COP). An update on analgesia is also provided; older drugs such as ketamine and lidocaine are increasingly being recognized both for their analgesic properties and other potentially beneficial effects in endotoxemic horses.
Collapse
Affiliation(s)
- Jordyn M Boesch
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY 14850, USA.
| |
Collapse
|