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Cagle LA, Hopper K, Epstein SE. Indications and outcome associated with positive-pressure ventilation in dogs and cats: 127 cases. J Vet Emerg Crit Care (San Antonio) 2022; 32:365-375. [PMID: 35043547 DOI: 10.1111/vec.13176] [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: 08/11/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the indications and outcomes of positive-pressure ventilation (PPV) and identify factors associated with successful weaning. DESIGN Retrospective study from October 2009 to September 2013. SETTING University teaching hospital. ANIMALS One hundred and eleven dogs and 16 cats. MEASUREMENTS AND MAIN RESULTS Medical records were retrospectively reviewed; signalment, indication for PPV, patient characteristics, blood gas, and ventilator variables during PPV, duration of PPV, and outcome were recorded. Dogs were most commonly ventilated for pneumonia (36/111; 32%) and cats for multiple pulmonary diseases (8/16; 50%). The median duration of PPV for all animals was 25.7 h (range, 0.1-957 h). Long-term PPV (≥24 h) was performed in 53% of cases. No differences were noted in successful weaning rates between cases ventilated for pulmonary etiologies (23/99; 23%) versus nonpulmonary etiologies (9/28; 32%). Overall, 32 of 127 (25%; 30 dogs, 2 cats) animals were successfully weaned from PPV and 28 of 127 (22%; 26 dogs, 2 cats) survived to hospital discharge. Long-term ventilation had a higher likelihood of successful weaning (26/67 [39%] vs 6/60 [10%], P = 0.0002) and higher rates of survival to discharge (23/67 [34%] vs 5/60 [8%], P = 0.0005) than short-term ventilation. Animals with higher Pao2 /Fio2 and Spo2 /Fio2 and lower APPLE and SOFA scores on day 1 of PPV were more likely to be weaned (P < 0.03). CONCLUSIONS The outcome of PPV appears to be most heavily determined by the underlying disease process and no clear improvement in outcome could be demonstrated in this study, despite advances in veterinary critical care and ventilator management strategies since previous studies. Dogs and cats receiving PPV for more than 24 h in this study had a higher likelihood of a positive outcome. Several indices of oxygenation and illness severity at the onset of PPV were predictive of outcome and maybe useful when considering prognosis of these cases.
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Affiliation(s)
- Laura A Cagle
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
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Hopper K, Rezende ML, Borchers A, Epstein SE. Efficacy of Manual Ventilation Techniques During Cardiopulmonary Resuscitation in Dogs. Front Vet Sci 2018; 5:239. [PMID: 30327772 PMCID: PMC6174302 DOI: 10.3389/fvets.2018.00239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/11/2018] [Indexed: 12/02/2022] Open
Abstract
The efficacy of ventilation of dogs during cardiopulmonary resuscitation (CPR) with a tight fitting face mask or mouth-to-nose rescue breathing has not been evaluated. Twenty-four purpose bred research dogs: Dogs were randomized to be ventilated by cuffed orotracheal tube, tight fitting face mask, mouth-to-nose breathing or compressions only during CPR (n = 6 in all groups). Orotracheal tube and face mask ventilation was performed on room air. Chest compressions were performed during the experimental procedure. Arterial blood gases were performed prior to euthanasia (baseline), at 3 min and at 6 min of CPR. PaO2 and PaCO2 were compared for each time point and each group. There was no difference in PaO2 or PaCO2 between groups at baseline. At 6 min all groups had a significantly higher PaCO2 (P ≤ 0.005) and the facemask and compression only groups had a significantly lower PaO2 (P < 0.02) when compared to the orotracheal tube group. There was no difference between the PaO2 of the mouth-to-nose group compared to the orotracheal tube group at 3 or 6 min. Gastric distension, regurgitation, gas leakage around the mouth, and ineffective breaths were all noted in both the face mask and mouth-to-nose group. The results of this study supports that orotracheal intubation is the preferred technique for ventilation during CPR in dogs. When orotracheal intubation is not possible, face mask ventilation or mouth-to-nose ventilation would be reasonable alternatives. When oxygen supplementation is available, face mask ventilation is likely to be superior. Appropriate training for both face mask and mouth-to-nose ventilation techniques is recommended.
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Affiliation(s)
- Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Marlis L Rezende
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Angela Borchers
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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Hodgson MM, Bevan JM, Evans RB, Johnson TI. Influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation. Vet Surg 2017; 46:566-573. [PMID: 28233909 DOI: 10.1111/vsu.12635] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the influence of in-house rehabilitation on the postoperative outcome of dogs with intervertebral disk herniation (IVDH). DESIGN Retrospective cohort study. ANIMALS Dogs (n = 248) under 20 kg of weight, with single site, thoracolumbar, Hansen Type I IVDH. PROCEDURES Medical records of non-ambulatory dogs with IVDH treated via hemilaminectomy were reviewed. Dogs were classified in 2 groups depending on whether their postoperative management included an in-house rehabilitation program. Preoperative and sequential postoperative modified Frankel scores (MFSs) were recorded. Time to ambulation, time to normal conscious proprioception, final MFS, and complications were compared between the groups. RESULTS More dogs returned to full neurologic function (final MFS of Grade 5) when in-house rehabilitation was included in the postoperative management (33% compared to 9%). Normal conscious proprioception and ambulation returned earlier in the control group (42 days and 14 days, respectively) compared to the group with rehabilitation (49 days and 28 days, respectively). The complication rate was higher in the control group (29%) compared with the group with rehabilitation (16%). CONCLUSIONS AND CLINICAL RELEVANCE In-house rehabilitation should be included in the postoperative management in dogs after surgical treatment of IVDH to improve neurologic function and reduce postoperative complications.
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Affiliation(s)
| | - John M Bevan
- Central Texas Veterinary Specialty Hospital, Austin, Texas
| | | | - Thai I Johnson
- Central Texas Veterinary Specialty Hospital, Austin, Texas
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Arnemo JM. Comments on mouth-to-snout ventilation in veterinary cardiopulmonary resuscitation. J Vet Emerg Crit Care (San Antonio) 2015; 25:594. [PMID: 26394379 DOI: 10.1111/vec.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jon M Arnemo
- Department of Forestry and Wildlife Management, Hedmark University College, Campus Evenstad, NO-2480, Koppang, Norway
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Granger N, Carwardine D. Acute spinal cord injury: tetraplegia and paraplegia in small animals. Vet Clin North Am Small Anim Pract 2014; 44:1131-56. [PMID: 25441629 DOI: 10.1016/j.cvsm.2014.07.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Spinal cord injury (SCI) is a common problem in animals for which definitive treatment is lacking, and information gained from its study has benefit for both companion animals and humans in developing new therapeutic approaches. This review provides an overview of the main concepts that are useful for clinicians in assessing companion animals with severe acute SCI. Current available advanced ancillary tests and those in development are reviewed. In addition, the current standard of care for companion animals following SCI and recent advances in the development of new therapies are presented, and new predictors of recovery discussed.
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Affiliation(s)
- Nicolas Granger
- The School of Veterinary Sciences, University of Bristol, Langford House, Langford, North Somerset BS40 5HU, UK.
| | - Darren Carwardine
- The School of Veterinary Sciences, University of Bristol, Langford House, Langford, North Somerset BS40 5HU, UK
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Caudle KL, Atkinson DA, Brown EH, Donaldson K, Seibt E, Chea T, Smith E, Chung K, Shum-Siu A, Cron CC, Magnuson DSK. Hindlimb stretching alters locomotor function after spinal cord injury in the adult rat. Neurorehabil Neural Repair 2014; 29:268-77. [PMID: 25106555 DOI: 10.1177/1545968314543500] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stretching is a widely accepted standard-of-care therapy following spinal cord injury (SCI) that has not been systematically studied in animal models. OBJECTIVE To investigate the influence of a daily stretch-based physical therapy program on locomotor recovery in adult rats with moderate T9 contusive SCI. METHODS A randomized treatment and control study of stretching in an animal model of acute SCI. Moderate SCIs were delivered with the NYU Impactor. Daily stretching (30 min/day, 5 days/wk for 8 weeks) was provided by a team of animal handlers. Hindlimb function was assessed using the BBB Open Field Locomotor Scale and kinematically. Passive range-of-motion for each joint was determined weekly using a goniometer. RESULTS Declines in hindlimb function during overground stepping were observed for the first 4 weeks for stretched animals. BBB scores improved weeks 5 to 10 but remained below the control group. Stretched animals had significant deficits in knee passive range of motion starting at week 4 and for the duration of the study. Kinematic assessment showed decreased joint excursion during stepping that partially recovered beginning at week 5. CONCLUSION Stretch-based therapy significantly impaired functional recovery in adult rats with a moderate contusive SCI at T10. The negative impact on function was greatest acutely but persisted even after the stretching ceased at 8 weeks postinjury.
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Affiliation(s)
| | | | | | | | - Erik Seibt
- University of Louisville, Louisville KY, USA
| | - Tim Chea
- University of Louisville, Louisville KY, USA
| | - Erin Smith
- University of Louisville, Louisville KY, USA
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Fletcher DJ, Boller M, Brainard BM, Haskins SC, Hopper K, McMichael MA, Rozanski EA, Rush JE, Smarick SD. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S102-31. [PMID: 22676281 DOI: 10.1111/j.1476-4431.2012.00757.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present a series of evidence-based, consensus guidelines for veterinary CPR in dogs and cats. DESIGN Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Questions in five domains were examined: Preparedness and Prevention, Basic Life Support, Advanced Life Support, Monitoring, and Post-Cardiac Arrest Care. Standardized worksheet templates were used for each question, and the results reviewed by the domain members, by the RECOVER committee, and opened for comments by veterinary professionals for 4 weeks. Clinical guidelines were devised from these findings and again reviewed and commented on by the different entities within RECOVER as well as by veterinary professionals. SETTING Academia, referral practice and general practice. RESULTS A total of 74 worksheets were prepared to evaluate questions across the five domains. A series of 101 individual clinical guidelines were generated. In addition, a CPR algorithm, resuscitation drug-dosing scheme, and postcardiac arrest care algorithm were developed. CONCLUSIONS Although many knowledge gaps were identified, specific clinical guidelines for small animal veterinary CPR were generated from this evidence-based process. Future work is needed to objectively evaluate the effects of these new clinical guidelines on CPR outcome, and to address the knowledge gaps identified through this process.
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Affiliation(s)
- Daniel J Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
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Hopper K, Epstein SE, Fletcher DJ, Boller M. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 3: Basic life support. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S26-43. [DOI: 10.1111/j.1476-4431.2012.00753.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kate Hopper
- School of Veterinary Medicine; Department of Veterinary Surgical and Radiological Sciences; University of California at Davis; Davis; CA
| | - Steven E. Epstein
- School of Veterinary Medicine; Department of Veterinary Surgical and Radiological Sciences; University of California at Davis; Davis; CA
| | - Daniel J. Fletcher
- College of Veterinary Medicine; Department of Clinical Sciences; Cornell University; Ithaca; NY
| | - Manuel Boller
- Department of Clinical Studies; School of Veterinary Medicine; and the Department of Emergency Medicine; School of Medicine; Center for Resuscitation Science University of Pennsylvania; Philadelphia; PA
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Rutter CR, Rozanski EA, Sharp CR, Powell LL, Kent M. Outcome and medical management in dogs with lower motor neuron disease undergoing mechanical ventilation: 14 cases (2003-2009). J Vet Emerg Crit Care (San Antonio) 2011; 21:531-41. [DOI: 10.1111/j.1476-4431.2011.00669.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Accepted: 07/09/2011] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Claire R. Sharp
- College of Veterinary Medicine; University of Missouri; Columbia; MO
| | - Lisa L. Powell
- College of Veterinary Medicine; University of Minnesota; St Paul; MN
| | - Marc Kent
- Department of Small Animal Medicine and Surgery; College of Veterinary Medicine; University of Georgia; Athens; GA
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Caudle KL, Brown EH, Shum-Siu A, Burke DA, Magnuson TSG, Voor MJ, Magnuson DSK. Hindlimb immobilization in a wheelchair alters functional recovery following contusive spinal cord injury in the adult rat. Neurorehabil Neural Repair 2011; 25:729-39. [PMID: 21697451 DOI: 10.1177/1545968311407519] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Locomotor training of rats with thoracic contusion spinal cord injuries can induce task-specific changes in stepping but rarely results in improved overground locomotion, possibly due to a ceiling effect. Thus, the authors hypothesize that incompletely injured rats maximally retrain themselves while moving about in their cages over the first few weeks postinjury. OBJECTIVE To test the hypothesis using hindlimb immobilization after mild thoracic contusion spinal cord injury in adult female rats. A passive stretch protocol was included as an independent treatment. METHODS Wheelchairs were used to hold the hindlimbs stationary in an extended position leaving the forelimbs free. The wheelchairs were used for 15 to 18 hours per day, 5 days per week for 8 weeks, beginning at 4 days postinjury. A 20-minute passive hindlimb stretch therapy was applied to half of the animals. RESULTS Hindlimb locomotor function of the wheelchair group was not different from controls at 1 week postinjury but declined significantly over the next 4 weeks. Passive stretch had no influence on wheelchair animals but limited functional recovery of normally housed animals, preventing them from regaining forelimb-hindlimb coordination. Following 8 weeks of wheelchair immobilization and stretch therapy, only the wheelchair group displayed an improvement in function when returned to normal housing but retained significant deficits in stepping and coordination out to 16 weeks. CONCLUSION Hindlimb immobilization and passive stretch may hinder or conceal the normal course of functional recovery of spinal cord injured rats. These observations have implications for the management of acute clinical spinal cord injuries.
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