Defining sepsis in small animals

OBJECTIVE

To discuss the definitions of sepsis in human and veterinary medicine.

DESIGN

International, multicenter position statement on the need for consensus definitions of sepsis in veterinary medicine.

SETTING

Veterinary private practice and university teaching hospitals.

ANIMALS

Dogs and cats.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Sepsis is a life-threatening condition associated with the body's response to an infection. In human medicine, sepsis has been defined by consensus on 3 occasions, most recently in 2016. In veterinary medicine, there is little uniformity in how sepsis is defined and no consensus on how to identify it clinically. Most publications rely on modified criteria derived from the 1991 and 2001 human consensus definitions. There is a divergence between the human and veterinary descriptions of sepsis and no consensus on how to diagnose the syndrome. This impedes research, hampers the translation of pathophysiology insights to the clinic, and limits our abilities to optimize patient care. It may be time to formally define sepsis in veterinary medicine to help the field move forward. In this narrative review, we present a synopsis of prior attempts to define sepsis in human and veterinary medicine, discuss developments in our understanding, and highlight some criticisms and shortcomings of existing schemes.

CONCLUSIONS

This review is intended to serve as the foundation of current efforts to establish a consensus definition for sepsis in small animals and ultimately generate evidence-based criteria for its recognition in veterinary clinical practice.

Assessment of plasma lactate and core-peripheral temperature gradient in association with stages of naturally occurring myxomatous mitral valve disease in dogs

OBJECTIVE

To evaluate plasma lactate concentrations and core-peripheral temperature gradients as perfusion parameters in dogs with heart failure caused by myxomatous mitral valve disease (MMVD) and to determine whether the above perfusion parameters are correlated with disease stages.

DESIGN

Prospective observational study.

SETTING

University teaching hospital.

ANIMALS

After excluding 129 dogs because of exclusion criteria, 7 dogs with heart failure classified as stage B2 and 10 dogs classified as stage C according to the American Heart Association (AHA)/American College of Cardiology (ACC) were included in the study. Six dogs without MMVD were evaluated as the control group.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Among the evaluated parameters, the plasma lactate concentrations were increased in stage C (median 3.70 mmol/L [33.3 mg/dL], interquartile range (IQR) 0.72 mmol/L [6.5 mg/dL]) compared with those in the control (median 2.80 mmol/L [25.2 mg/dL], IQR 0.8 mmol/L [7.2 mg/dL]; P = 0.024) and stage B2 groups (median 2.70 mmol/L [24.3 mg/dL], IQR 1.8 mmol/L [16.2 mg/dL]; P = 0.045). Significant differences were not observed in the core-peripheral temperature gradients among the control, stage B2, and stage C dogs.

CONCLUSIONS

Dogs with structural heart disease as a result of MMVD may have occult tissue hypoperfusion in stage C that is demonstrated by hyperlactatemia.

Surgical correction of aortic disease using intraluminal, crimped bovine pericardial graft

We propose the use of a crimped bovine pericardial graft joined to a rigid and grooved ring for the treatment of aortic dissections and aneurysms. This device was developed to support common tubular vascular prostheses of any material, length, diameter, or form, transforming them into intraluminal ones during the surgical procedure. During March 1989 to May 1994, 74 patients underwent an operation on the aorta in which this intraluminal ring, prepared from a tubular prosthesis of bovine pericardium, was used. Twenty-seven patients had an acute type A aortic dissection, 6 had an acute type B aortic dissection, 10 had annuloaortic ectasia, 6 had a descending aortic aneurysm, 3 had a thoracoabdominal aneurysm, and 22 had an abdominal aneurysm. The global mortality rate of 10.8% in the immediate postoperative period cannot be related to the surgical technique or the type of prosthesis used. We conclude from our findings that this modification of the sutureless intraluminal graft, which allows it to be used to replace diseased segments of the aorta, affords the quickest and simplest means of repair and is attended by the least likelihood of anastomotic complications.