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Wallace ML. Surgical management of brachycephalic obstructive airway syndrome: An update on options and outcomes. Vet Surg 2024. [PMID: 38952039 DOI: 10.1111/vsu.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/22/2024] [Accepted: 06/08/2024] [Indexed: 07/03/2024]
Abstract
Dogs with a brachycephalic conformation often experience a collection of abnormalities related to their craniofacial conformation, which can lead to a variety of clinical signs such as stertor, exercise intolerance, respiratory distress, and gastrointestinal signs such as regurgitation, among others. This collection of abnormalities is termed brachycephalic obstructive airway syndrome (BOAS). With the rise in popularity of several brachycephalic breeds, veterinarians and veterinary surgery specialists are seeing these dogs with increasing frequency for surgical and medical treatment of these clinical signs, leading to an increased interest in developing surgical techniques for dogs with BOAS and evaluating objective methods of determining outcome after surgery. Advances in anesthetic management including standardized protocols and use of local nerve blocks to decrease opiate use may decrease postoperative complications. A variety of new or modified surgical techniques to manage hyperplastic soft palate and stenotic nares, among other BOAS components, have been developed and studied in recent years. Newer studies have also focused on risk factors for development of major complications in the postoperative period and on objective measurements that may help determine which patients will receive the most benefit from BOAS surgery. In this review, the newest studies focused on updates in anesthetic management, surgical techniques, and postoperative care will be discussed. Additionally, updated information on complication rates and outcomes for dogs undergoing surgical management of BOAS will be included.
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Affiliation(s)
- Mandy L Wallace
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia, USA
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Dartencet C, Abunemeh M, Junot S, Nectoux A, Allaouchiche B, Krafft E, Pouzot-Nevoret C. High flow oxygen therapy versus conventional oxygen therapy in dogs and cats undergoing bronchoscopy and bronchoalveolar lavage: a pilot study. Front Vet Sci 2024; 11:1360017. [PMID: 38855409 PMCID: PMC11157099 DOI: 10.3389/fvets.2024.1360017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Objectives To evaluate the safety and feasibility of high flow oxygen therapy (HFOT), and to record SpO2 and desaturation episodes in dogs and cats receiving HFOT or conventional oxygen therapy (COT) during bronchoscopy ± bronchoalveolar lavage (BAL). Materials and methods Dogs and cats undergoing bronchoscopy ± BAL between January and May 2023 were included in the study. Patients were randomly allocated to two groups: HFOT (HFOT group; two cats and four dogs) and COT (COT group; one cat and five dogs). HFOT and COT were started at the beginning of the bronchoscopy. HFOT was delivered with a gas flow rate of 1 L/kg/min at an FiO2 of 100% and a temperature of 34°C (pediatric mode) or 37°C (adult mode). COT was delivered through the working channel of the bronchoscope at a rate of 1.5 L/min. The safety and feasibility of HFOT were assessed, and peripheral oxygen saturation (SpO2) was measured by pulse oximetry every 30 s throughout the procedure. Measurements and main results HFOT was feasible and safe in both dogs and cats with no complications reported. While there was no significant difference in the number of desaturation episodes (SpO2 < 94%) between the two groups, none of the patients in the HFOT group experienced severe desaturation (SpO2 < 90%). In contrast, two patients in the COT group had an SpO2 < 90%. Mean SpO2 was significantly higher in the HFOT group compared to the COT group at T0 (98% ± 2% vs. 94 ± 2%), T0.5 (98% ± 2% vs. 94% ± 3%) and T1 (98% ± 2% vs. 94% ± 4%). Conclusion To the authors' knowledge, this is the largest study conducted to date using HFOT during bronchoscopy in dogs and cats. Our results suggest that HFOT is feasible and safe during bronchoscopy ± BAL. Furthermore, HFOT may reduce the risk of desaturation episodes in dogs and cats undergoing bronchoscopy and BAL.
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Affiliation(s)
- Camille Dartencet
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Maha Abunemeh
- Department of Veterinary Anesthesia and Analgesia, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Stephane Junot
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
- Department of Veterinary Anesthesia and Analgesia, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Alexandra Nectoux
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Bernard Allaouchiche
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, Pierre-Bénite, France
| | - Emilie Krafft
- Small animal medicine, USC1233 RS2GP, INRAe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
| | - Celine Pouzot-Nevoret
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
- APCSe, Université de Lyon, VetAgro Sup, Marcy l'Étoile, France
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Duble E, Her J, Preteseille I, Lee J, Allaouchiche B, Pouzot-Nevoret C. The utility of the respiratory rate-oxygenation index as a predictor of treatment response in dogs receiving high-flow nasal cannula oxygen therapy. Front Vet Sci 2024; 11:1404195. [PMID: 38774907 PMCID: PMC11106722 DOI: 10.3389/fvets.2024.1404195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/18/2024] [Indexed: 05/24/2024] Open
Abstract
Objective This study aims to evaluate the respiratory rate-oxygenation index (ROX) and the ratio of pulse oximetry saturation (SpO2) to the fraction of inspired oxygen (FiO2) (SpO2/FiO2, [SF]) to determine whether these indices are predictive of outcome in dogs receiving high-flow nasal cannula oxygen therapy (HFNOT). Design This is a prospective observational study. Setting This study was carried out at two university teaching hospitals. Animals In total, 88 dogs treated with HFNOT for hypoxemic respiratory failure due to various pulmonary diseases were selected. Measurements and main results The ROX index was defined as the SF divided by the respiratory rate (RR). ROX and SF were calculated at baseline and for each hour of HFNOT. The overall success rate of HFNOT was 38% (N = 33/88). Variables predicting HFNOT success were determined using logistic regression, and the predictive power of each variable was assessed using the area under the receiver operating curve (AUC). ROX and SF were adequately predictive of HFNOT success when averaged over 0-16 h of treatment, with similar AUCs of 0.72 (95% confidence interval [CI] 0.60-0.83) and 0.77 (95% CI 0.66-0.87), respectively (p < 0.05). SF showed acceptable discriminatory power in predicting HFNOT outcome at 7 h, with an AUC of 0.77 (95% CI 0.61-0.93, p = 0.013), and the optimal cutoff for predicting HFNC failure at 7 h was SF ≤ 191 (sensitivity 83% and specificity 76%). Conclusion These indices were easily obtained in dogs undergoing HFNOT. The results suggest that ROX and SF may have clinical utility in predicting the outcomes of dogs on HFNOT. Future studies are warranted to confirm these findings in a larger number of dogs in specific disease populations.
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Affiliation(s)
- Erin Duble
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Jiwoong Her
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Ingrid Preteseille
- Intensive Care Unit (SIAMU), VetAgro Sup, Université de Lyon, Marcy-l'Étoile, France
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Jeongmin Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Bernard Allaouchiche
- Intensive Care Unit (SIAMU), VetAgro Sup, Université de Lyon, Marcy-l'Étoile, France
- VetAgro Sup, Université de Lyon, Marcy-l'Étoile, France
- Hospices Civils de Lyon, Service de Réanimation, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Céline Pouzot-Nevoret
- Intensive Care Unit (SIAMU), VetAgro Sup, Université de Lyon, Marcy-l'Étoile, France
- VetAgro Sup, Université de Lyon, Marcy-l'Étoile, France
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Filipas MC, Owen L, Adami C. A retrospective observational cohort study on the postoperative respiratory complications and their risk factors in brachycephalic dogs undergoing BOAS surgery: 199 cases (2019-2021). J Small Anim Pract 2024; 65:329-337. [PMID: 38413137 DOI: 10.1111/jsap.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES To observe the occurrence of postanaesthetic respiratory complications and to determine their prevalence and risk factors in dogs undergoing brachycephalic obstructive airway syndrome surgery. MATERIALS AND METHODS Data from 199 clinical records were retrospectively analysed. Univariable logistic regression followed by multivariable logistic regression was used to identify associations between the dependent variables (set as the postoperative respiratory complications observed in the study dogs) and various independent covariates. The quality of model-fit was assessed using the likelihood ratio test. P≤0.05 was considered statistically significant. RESULTS Four postoperative respiratory complications were observed: hypoxaemia (n=10/199; 5%), dyspnoea requiring tracheal re-intubation (n=13/199, 7%), dyspnoea requiring tracheostomy (n=10/199, 5%) and aspiration pneumonia (n=12/199, 6%). Univariable logistic regression showed an association between postoperative aspiration pneumonia and increasing body condition score and American Society of Anaesthesiology classification; however, when these covariates were evaluated in the multivariable model significance was not maintained. Risk factors for tracheostomy were preoperative and postoperative aspiration pneumonia (odds ratio: 9.52, 95% confidence interval: 1.56 to 57.93) and increasing brachycephalic obstructive airway syndrome grade (odds ratio: 4.65, 95% confidence interval: 0.79 to 27.50). CLINICAL SIGNIFICANCE High brachycephalic obstructive airway syndrome grade and aspiration pneumonia, either developing peri-operatively or as pre-existing condition, may represent risk factors for postoperative tracheostomy. Preoperative diagnosis of aspiration pneumonia may further increase the risk of postoperative complications.
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Affiliation(s)
- M C Filipas
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
| | - L Owen
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
| | - C Adami
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
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Vicenti C, Otero PE, Briganti A, Rondelli V, Stabile M, Piemontese C, Crovace A, Lacitignola L, Staffieri F. Respiratory Effects of Continuous Positive Airway Pressure Administered during Recovery from General Anesthesia in Brachycephalic Dogs. Vet Sci 2024; 11:75. [PMID: 38393093 PMCID: PMC10893332 DOI: 10.3390/vetsci11020075] [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: 12/14/2023] [Revised: 01/20/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to evaluate the benefits of applying 5 cmH2O of CPAP using a pediatric helmet during the recovery phase from general anesthesia in brachycephalic dogs. Brachycephalic dogs undergoing various surgical procedures were included in this study, and a total of 64 subjects were randomly assigned to receive either standard oxygen supplementation (NO-CPAP group) or oxygen supplementation combined with CPAP (CPAP group). This study evaluated arterial blood pH, blood gas partial pressures of O2 and CO2, arterial blood O2 saturation, and related parameters during recovery. The dogs were monitored, and helmet tolerance was assessed using predefined criteria. Of the initially assessed 69 dogs, 64 were enrolled: 32 in the CPAP group and 32 in the NO-CPAP group. Fifteen dogs in the NO-CPAP group were excluded based on predetermined criteria. The CPAP group showed significant improvements in PaO2, PaO2/FiO2, P(A-a)O2, F-Shunt, and respiratory rate compared with the NO-CPAP group (p < 0.001). The incidence of reintubation and helmet intolerance was higher in the NO-CPAP group (18% and 15.6%, respectively) than in the CPAP group (0%). This study highlights the potential benefits of incorporating CPAP, delivered through a pediatric helmet, in the perioperative management of brachycephalic dogs.
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Affiliation(s)
- Caterina Vicenti
- Section of Veterinary Clinics and Animal Production, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, 70010 Valenzano, Italy
| | - Pablo E Otero
- Section of Veterinary Clinics and Animal Production, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, 70010 Valenzano, Italy
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires C1427CWN, Argentina
| | - Angela Briganti
- Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, 56122 Pisa, Italy
| | | | - Marzia Stabile
- Section of Veterinary Clinics and Animal Production, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, 70010 Valenzano, Italy
| | - Claudia Piemontese
- Section of Veterinary Clinics and Animal Production, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, 70010 Valenzano, Italy
| | - Antonio Crovace
- Section of Veterinary Clinics and Animal Production, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, 70010 Valenzano, Italy
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, 70010 Valenzano, Italy
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari, 70010 Valenzano, Italy
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Guieu L, Pouzot-Nevoret C, Bersenas AM. Editorial: Reviews in invasive & non-invasive ventilation in veterinary medicine. Front Vet Sci 2024; 10:1341630. [PMID: 38239741 PMCID: PMC10794442 DOI: 10.3389/fvets.2023.1341630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Liz Guieu
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Céline Pouzot-Nevoret
- Université de Lyon, VetAgro Sup, Intensive Care Unit (SIAMU), APCSe, Marcy l'Etoile, France
| | - Alexa Maria Bersenas
- Department of Clinical Studie, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Poirier M, Walton RAL. The successful use of a subcutaneous catheter in the management of severe subcutaneous emphysema in a dog with laryngeal crush injury and tracheostomy tube placement. J Vet Emerg Crit Care (San Antonio) 2023; 33:710-714. [PMID: 37793056 DOI: 10.1111/vec.13322] [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: 12/09/2021] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To describe the placement of a subcutaneous catheter in a dog for the management of severe subcutaneous emphysema secondary to severe laryngeal crushing injury and temporary tracheostomy tube placement. CASE SUMMARY A 6-year-old male neutered Kelpie suffered a severe laryngeal crushing injury following a dog attack. Case management included the placement of a temporary tracheostomy tube due to severe respiratory compromise and inspiratory dyspnea associated with the crush injury. During hospitalization, the patient developed severe subcutaneous emphysema, pneumomediastinum, and a pneumothorax as a complication of the laryngeal crushing injury and temporary tracheostomy. A subcutaneous catheter was placed to manage the recurrent subcutaneous emphysema while the tracheostomy stoma healed. Five months posttrauma, the dog returned to normal with mild stridor during excitement and while panting. NEW OR UNIQUE INFORMATION PROVIDED This is the first report in veterinary medicine describing the use of a subcutaneous catheter for the management of subcutaneous emphysema secondary to laryngeal crush injury and temporary tracheostomy tube placement.
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Affiliation(s)
- Maude Poirier
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca A L Walton
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
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Teppo AM, Rossi H, Rajamäki MM, Hyytiäinen HK. Proposed protocol for utilising high-flow nasal oxygen therapy in treatment of dogs hospitalised due to pneumonia. BMC Vet Res 2023; 19:167. [PMID: 37735404 PMCID: PMC10512590 DOI: 10.1186/s12917-023-03737-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND High-flow nasal oxygen (HFNO) therapy is a non-invasive respiratory support method that provides oxygen-enriched, warmed, and humidified air to respiratory-compromised patients. It is widely used in human medical care, but in veterinary medicine it is still a relatively new method. No practical guidelines exist for its use in canine pneumonia patients, although they could potentially benefit from HFNO therapy. This study aims to provide a new, safe, non-invasive, and effective treatment protocol for oxygen supplementation of non-sedated dogs with pneumonia. METHODS Twenty privately owned dogs with pneumonia will receive HFNO therapy at a flow rate of 1-2 L/kg, and the fraction of inspired oxygen will be determined individually (ranging from 21% to 100%). HFNO therapy will continue as long as oxygen support is needed based on clinical evaluation. Patients will be assessed thrice daily during their hospitalisation, with measured primary outcomes including partial pressure of oxygen, oxygen saturation, respiratory rate and type, days in hospital, and survival to discharge. DISCUSSION The proposed protocol aims to provide a practical guideline for applying HFNO to dogs hospitalised due to pneumonia. The protocol could enable more efficient and well-tolerated oxygenation than traditional methods, thus hastening recovery and improving survival of pneumonia patients.
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Affiliation(s)
- Anna-Maija Teppo
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Heini Rossi
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
| | - Minna M Rajamäki
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Heli K Hyytiäinen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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de Jaureguizar Tesas MR, Matson H, Tappin S, Thomas E. The use of High-Flow Nasal Oxygen Therapy in 4 dogs undergoing bronchoscopy. Front Vet Sci 2023; 10:1088103. [PMID: 37065223 PMCID: PMC10101201 DOI: 10.3389/fvets.2023.1088103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionHigh-Flow Nasal Oxygen Therapy is a method to deliver warmed, humidified air-oxygen blended at high flow rates to patients through a nasal cannula using a specialized, commercially available machine. This is a well-tolerated, safe and effective method for oxygen delivery to healthy and hypoxemic dogs. Patients undergoing bronchoscopic procedures frequently develop hypoxemia. Human trials have shown a reduction in incidents of hypoxemic events and higher pulse oximeter oxygen saturation during bronchoscopies in patients on High-Flow Nasal Oxygen.Materials and methodsThis is a single-centre, prospective case series. All dogs weighing between 5 and 15 kg and undergoing bronchoscopy during the study period (03/07/2022-01/10/2022) were eligible.ResultsTwelve patients were eligible for inclusion of which four were enrolled. No clinically significant complications related to the use of High-Flow Nasal Oxygen Therapy were recorded. Two of the patients were re-intubated post bronchoscopy due to clinician preference for recovery. One of the patients had a self-limiting period of severe hypoxemia with a pulse oximeter oxygen saturation of 84% for < 1 min during bronchoalveolar lavage, and whilst undergoing High-Flow Nasal Oxygen administration. Another patient had a self-limiting episode of mild hypoxemia (SpO2 of 94% lasting < 1 min) 5 min after completion of bronchoalveolar lavage.ConclusionNo clinically relevant complications relating to High-Flow Nasal Oxygen Therapy were recorded in this case series, although further studies are required to confirm this conclusion. This initial data suggests that the use of High-Flow Nasal Oxygen therapy during bronchoscopy is feasible and potentially safe, although it may not prevent hypoxemia in these patients. The use of High-Flow Nasal Oxygen Therapy during bronchoscopy in small patients carries multiple potential benefits and further studies to compare its efficacy against other traditional oxygen delivery systems are warranted in this patient population.
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Affiliation(s)
- Maria Rosa de Jaureguizar Tesas
- Department of Emergency and Critical Care, Veterinary Teaching Hospital, Georgia University (UGA), Athens, GA, United States
| | - Hannah Matson
- Department of Emergency and Critical Care, Royal Veterinary College, London, United Kingdom
| | - Simon Tappin
- Department of Internal Medicine, Dick White Referrals (Part of Linnaeus Veterinary Limited), Newmarket, United Kingdom
| | - Emily Thomas
- Department of Emergency and Critical Care, Dick White Referrals (Part of Linnaeus Veterinary Limited), Newmarket, United Kingdom
- *Correspondence: Emily Thomas
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Whitney J, Keir I. Clinical review of high-flow nasal oxygen therapy in human and veterinary patients. Front Vet Sci 2023; 10:1070881. [PMID: 36950541 PMCID: PMC10027015 DOI: 10.3389/fvets.2023.1070881] [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: 10/15/2022] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Oxygen therapy is the first-line treatment for hypoxemic acute respiratory failure. In veterinary medicine this has traditionally been provided via mask, low-flow nasal oxygen cannulas, oxygen cages and invasive positive pressure ventilation. Traditional non-invasive modalities are limited by the maximum flow rate and fraction of inspired oxygen (FiO2) that can be delivered, variability in oxygen delivery and patient compliance. The invasive techniques are able to provide higher FiO2 in a more predictable manner but are limited by sedation/anesthesia requirements, potential complications and cost. High-flow nasal oxygen therapy (HFNOT) represents an alternative to conventional oxygen therapy. This modality delivers heated and humidified medical gas at adjustable flow rates, up to 60 L/min, and FiO2, up to 100%, via nasal cannulas. It has been proposed that HFNOT improves pulmonary mechanics and reduces respiratory fatigue via reduction of anatomical dead space, provision of low-level positive end-expiratory pressure (PEEP), provision of constant FiO2 at rates corresponding to patient requirements and through improved patient tolerance. Investigations into the use of HFNOT in veterinary patients have increased in frequency since its clinical use was first reported in dogs with acute respiratory failure in 2016. Current indications in dogs include acute respiratory failure associated with pulmonary parenchymal disease, upper airway obstruction and carbon monoxide intoxication. The use of HFNOT has also been advocated in certain conditions in cats and foals. HFNOT is also being used with increasing frequency in the treatment of a widening range of conditions in humans. Although there remains conflict regarding its use and efficacy in some patient groups, overall these reports indicate that HFNOT decreases breathing frequency and work of breathing and reduces the need for escalation of respiratory support. In addition, they provide insight into potential future veterinary applications. Complications of HFNOT have been rarely reported in humans and animals. These are usually self-limiting and typically result in lower morbidity and mortality than those associated with invasive ventilation techniques.
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Krawec P, Marshall K, Odunayo A. A Review of High Flow Nasal Cannula Oxygen Therapy in Human and Veterinary Medicine. Top Companion Anim Med 2021; 46:100596. [PMID: 34757156 DOI: 10.1016/j.tcam.2021.100596] [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: 09/01/2020] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
Respiratory distress is a common ailment in small animal medicine. Oxygen supplementation is a mainstay of initial therapy. High Flow Nasal Cannula Oxygen Therapy (HFNCOT) has become increasingly popular as a treatment modality in human medicine, and more recently in canine patients. These devices deliver high flow rates of heated and humidified oxygen at an adjustable fraction of inspired oxygen (FiO2). This article reviews current literature in human patients on HFNCOT as well as studies that have evaluated its use in veterinary patients. A discussion of the respiratory physiology that is associated with respiratory distress, in addition to an overview of currently available oxygen supplementation modalities is provided. The physiologic benefits of HFNCOT are explained, as are technical aspects associated with its use. Recommendations on initial settings, maintenance therapy, and weaning are also described.
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Affiliation(s)
- Philip Krawec
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville.
| | - Kristen Marshall
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida
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Harduin C, Allaouchiche B, Nègre J, Goy-Thollot I, Barthélemy A, Fougeray A, Baudin F, Bonnet-Garin JM, Pouzot-Nevoret C. Impact of flow and temperature on non-dyspnoeic dogs' tolerance undergoing high-flow oxygen therapy. J Small Anim Pract 2020; 62:265-271. [PMID: 33346390 DOI: 10.1111/jsap.13284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/06/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To prospectively describe the impact of gas flow rate and temperature on dog's tolerance of high-flow nasal oxygen therapy during recovery from anaesthesia, hypothesizing that higher flow rates and temperatures will decrease tolerance. MATERIALS AND METHODS Twelve non-dyspnoeic client-owned dogs recovering from general anaesthesia were included in this study. After extubation, a nasal cannula was positioned and high-flow nasal oxygen therapy was initiated. Two flow rates (two or four time the theoretical minute ventilation: HF2 and HF4), each of them combined with two temperatures (31 and 37°C: T31 and T37), were randomly applied (four conditions per dog). For each condition, cardiovascular and respiratory parameters (heart rate, respiratory rate, systolic arterial blood pressure and pulse oximeter oxygen saturation), sedation score and tolerance score were recorded at initiation (T0 ) and after 10 minutes of accommodation (T10 ). RESULTS Sedation scores were not significantly different between the four conditions. Cardiovascular and respiratory parameters were not significantly different between any condition at both T0 and T10 . Tolerance scores were good and not significantly different between any flow rate or temperature (HF2-T31: 4 (2-4), HF4-T31: 4 (2-4), HF2-T37: 4 (2-4), HF4-T37: 4 (1-4)). CLINICAL SIGNIFICANCE The gas flow rates and temperatures studied have no impact on tolerance during the recovery period of non-dyspnoeic dogs, and high-flow nasal cannula is well tolerated. Further studies are required to confirm these results in dyspnoeic dogs.
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Affiliation(s)
- C Harduin
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France.,Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France
| | - B Allaouchiche
- Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France.,Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, Pierre-Bénite, F-69310, France
| | - J Nègre
- Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France.,Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Réanimation, Pierre-Bénite, F-69310, France
| | - I Goy-Thollot
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France.,Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France
| | - A Barthélemy
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France.,Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France
| | - A Fougeray
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France
| | - F Baudin
- Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France.,Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service de Réanimation Pédiatrique, Bron, F- 69500, France
| | - J M Bonnet-Garin
- Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France
| | - C Pouzot-Nevoret
- Intensive Care Unit (SIAMU), Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France.,Université de Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, F-69280, France
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