Pressor Therapy in Critically III Patients

Managing Reproduction Emergencies in the Field: Part 2: Parturient and Periparturient Conditions

Selected conditions affecting broodmares are discussed, including arterial rupture, dystocia, foal support with ex utero intrapartum treatment, uterine prolapse, postpartum colic, the metritis/sepsis/systemic inflammatory response syndrome complex, and retained fetal membranes. Postpartum colic beyond third-stage labor contractions should prompt comprehensive evaluation for direct injuries to the reproductive tract or indirect injury of the intestinal tract. Mares with perforation or rupture of the uterus are typically recognized 1 to 3 days after foaling, with depression, fever, and leukopenia; laminitis and progression to founder can be fulminant. The same concerns are relevant in mares with retention of fetal membranes.

Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome

OBJECTIVE

To evaluate the changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization in the ICU and their relation to outcome.

DESIGN

Prospective observational study.

SETTING

ICU of a veterinary university medical center.

ANIMALS

Thirty dogs with severe sepsis or septic shock caused by pyometra who underwent surgery and were admitted to the ICU.

MEASUREMENTS AND MAIN RESULTS

Severe sepsis was defined as the presence of sepsis and sepsis-induced dysfunction of one or more organs. Septic shock was defined as the presence of severe sepsis plus hypotension not reversed with fluid resuscitation. After the presumptive diagnosis of sepsis secondary to pyometra, blood samples were collected and clinical findings were recorded. Volume resuscitation with 0.9% saline solution and antimicrobial therapy were initiated. Following abdominal ultrasonography and confirmation of increased uterine volume, dogs underwent corrective surgery. After surgery, the animals were admitted to the ICU, where resuscitation was guided by the clinical parameters, central venous oxygen saturation (ScvO(2)), lactate, and base deficit. Between survivors and nonsurvivors it was observed that the ScvO(2), lactate, and base deficit on ICU admission were each related independently to death (P = 0.001, P = 0.030, and P < 0.001, respectively). ScvO(2) and base deficit were found to be the best discriminators between survivors and nonsurvivors as assessed via receiver operator characteristic curve analysis.

CONCLUSION

Our study suggests that ScvO(2) and base deficit are useful in predicting the prognosis of dogs with severe sepsis and septic shock; animals with a higher ScvO(2) and lower base deficit at admission to the ICU have a lower probability of death.

Goal-directed therapy in small animal critical illness

Monitoring critically ill patients can be a daunting task even for experienced clinicians. Goal-directed therapy is a technique involving intensive monitoring and aggressive management of hemodynamics in patients with high risk of morbidity and mortality. The aim of goal-directed therapy is to ensure adequate tissue oxygenation and survival. This article reviews commonly used diagnostics in critical care medicine and what the information gathered signifies and discusses clinical decision making on the basis of diagnostic test results. One example is early goal-directed therapy for severe sepsis and septic shock. The components and application of goals in early goal-directed therapy are discussed.

Economic burden of cardiovascular disease in the Russian Federation

Aim. To analyze the social and economic burden of cardiovascular disease (CVD) in the Russian Federation for the period of 2006-2009. Material and methods. The analysis of the economic CVD burden included direct spending and economic loss related to CVD. Direct spending included hospitalization, ambulance service use, out-patient visits, high medical technologies, and out-patient pharmaceutical treatment. Economic loss included the loss in gross domestic product (GDP) due to death or disability in working-age people, as well as the disability benefits. Results. Total economic burden of CVD for 2008-2009 exceeded 1 trillion RUB, or 3 % of GDP for the respective period. Only one-fifth (21,3 %) of total economic burden of CVD in 2009 was represented by direct costs of the healthcare system. As much as 78,7 % of the total economic burden of CVD was represented by such indirect costs as economic loss, mostly due to premature mortality in working-age men. Conclusion. Substantial economic burden of CVD in theRussian Federation requires increased funding of preventive programs, aimed at CVD risk reduction, and healthcare optimization programs. This increased funding should facilitate mortality risk reduction in the working-age population.