Comparison of 4 point-of-care techniques to detect correct positioning of nasogastric tubes in dogs (2020-2021).

OBJECTIVE: To compare 4 point-of-care (POC) techniques to assess nasogastric (NG) tube placement versus radiographs as a reference standard. POC methods included air inflation with auscultation, fluid aspiration with pH measurement, ultrasonography, and capnography. DESIGN: Prospective observational study in hospitalized dogs between 2020 and 2021. SETTING: University teaching hospital. ANIMALS: Fifty-one dogs requiring NG tube placement as part of their normal care. INTERVENTIONS: After standard blind NG tube placement, each POC method was performed following standardized instructions. All POC methods were scored as to whether the investigator believed the tube to be in the gastrointestinal tract (as indicated by positive auscultation of borborygmus during insufflation, positive fluid aspiration with pH ≤5, presence of hyperechoic shadow in the esophagus, or absence of capnographic waveform). Subsequently, radiographs were taken to determine NG tube position as a gold standard. The sensitivity, specificity, and accuracy of each test as compared to 2-view thoracic radiographs were determined. MEASUREMENTS AND MAIN RESULTS: Sensitivity, specificity, and accuracy for each POC technique were as follows: air auscultation (84.4%, 50.5%, and 80.4%, respectively), neck ultrasound (95.6%, 83.3%, and 94.1%, respectively), capnography (91.1%, 33.3%, and 84.3%, respectively), and fluid aspiration with pH measurement (22.2%, 100%, and 31.4%, respectively). CONCLUSIONS: Among the 4 techniques evaluated, neck ultrasound had the best overall performance for assessing NG tube placement. Fluid aspiration with pH measurement might also have potential due to perfect specificity, but its clinical utility may be limited by low sensitivity and accuracy. Nonetheless, 2-view thoracic radiography should still be considered the standard method for confirmation of NG tube placement as none of the 4 POC techniques investigated showed both high sensitivity and perfect specificity.

Conventional versus high-flow oxygen therapy in dogs with lower airway injury.

Dogs with lower airway pathology that present in respiratory distress often receive oxygen therapy as the first line of treatment regardless of the underlying cause. Conventional "low-flow" systems deliver oxygen with a maximum flow rate of 15 L/minute. Traditionally, when an animal's respiratory status does not improve with conventional oxygen therapy and treatments for underlying disease, options might be limited to either intubation and mechanical ventilation or humane euthanasia. High-flow oxygen therapy (HFOT) has been gaining popularity in veterinary medicine as an alternative route of oxygen supplementation for animals that require support beyond conventional therapy. High-flow oxygen therapy can supply a mixture of air and oxygen via a heated and humidified circuit. It is user friendly and can be used in an environment in which mechanical ventilation is unavailable. This review article is written for emergency doctors and general practitioners who lack access to mechanical ventilation. This article briefly reviews pertinent respiratory physiology, traditional oxygen supplementation techniques, the physiology of HFOT, and the limited evidence available in veterinary medicine regarding the use of HFOT, its applications, and limitations. Guidelines for the use of HFOT are suggested and HFOT is compared to conventional therapy.

Les chiens avec une pathologie des voies respiratoires inférieures qui présentent une détresse respiratoire reçoivent souvent une oxygénothérapie en première intention, quelle que soit la cause sous-jacente. Les systèmes conventionnels à « faible débit ¼ fournissent de l'oxygène avec un débit maximum de 15 L/minute. Traditionnellement, lorsque l'état respiratoire d'un animal ne s'améliore pas avec l'oxygénothérapie conventionnelle et les traitements de la maladie sous-jacente, les options peuvent se limiter à l'intubation et à la ventilation mécanique ou à l'euthanasie. L'oxygénothérapie à haut débit (HFOT) gagne en popularité en médecine vétérinaire en tant que voie alternative de supplémentation en oxygène pour les animaux qui nécessitent un soutien au-delà de la thérapie conventionnelle. L'oxygénothérapie à haut débit peut fournir un mélange d'air et d'oxygène via un circuit chauffé et humidifié. Il est convivial et peut être utilisé dans un environnement où la ventilation mécanique n'est pas disponible.Cet article de revue est écrit pour les médecins urgentistes et les médecins généralistes qui n'ont pas accès à la ventilation mécanique. L'article passe brièvement en revue la physiologie respiratoire pertinente, les techniques traditionnelles de supplémentation en oxygène, la physiologie de la HFOT et les preuves limitées disponibles en médecine vétérinaire concernant l'utilisation de la HFOT, ses applications et ses limites. Des lignes directrices pour l'utilisation de la HFOT sont suggérées et la HFOT est comparée au traitement conventionnel.(Traduit par Docteur Serge Messier).

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994-2004.

OBJECTIVES: The Alaska Native Medical Center diabetes program analysed Diabetes Care and Outcomes Audit data from 1994-2004 to evaluate the impact of the Special Diabetes Program for Indians (SDPI) funding on process and intermediate outcomes. STUDY DESIGN: We conducted a retrospective analysis of data from standardized medical records reviews conducted between 1994 and 2004 from regional sites in Alaska. METHODS: We analysed 7,735 randomly selected records for trends over three time periods (pre-SDPI, transition and SDPI). RESULTS: Hemoglobin A1c, total and LDL cholesterol, triglycerides and blood pressure significantly improved from the pre-SDPI to the SDPI period. However, as the number of people with diabetes increased, the percentage of patients receiving foot, eye and dental exams decreased, as did the percentage receiving nutrition, exercise and diabetes education. CONCLUSIONS: SDPI funding provided resources for interventions necessary to improve the effectiveness of diabetes care. This was associated with improved intermediate outcomes in American Indian/Alaska Native patients with diabetes. Further observations are needed to evaluate whether or not intermediate outcomes result in decreased cardiovascular disease, amputations, dialysis and retinopathy.