Retrospective evaluation of transportation and outcome of dogs on a mechanical ventilator: 9 cases.

OBJECTIVE: To describe the transportation and clinical outcome of 9 dogs transported to a referral hospital on mechanical ventilation (MV). DESIGN: Retrospective case series (2015-2020). SETTING: University teaching hospital. ANIMALS: Nine dogs transported to a referral center on MV. INTERVENTIONS: All dogs underwent MV during vehicular transport. MEASUREMENT AND MAIN RESULTS: The medical records of 9 dogs transported on a MV to a university teaching hospital were reviewed. Data collected included signalment, reason for MV, ventilator settings, sedation protocol, monitoring in transit, distance traveled, complications, clinical outcome, and cost. All dogs transported survived transport to the referral hospital and 8 of 9 were successfully weaned from the ventilator and discharged home. CONCLUSIONS: MV during transport in this setting was practical and safe. Dogs in this study had a high survival rate compared to previous studies of dogs undergoing MV, likely due to selection of cases assessed to have a correctable underlying disease.

Our quest for creating a space that is welcoming to all: A commentary from the American College of Veterinary Emergency and Critical Care Diversity, Equity, and Inclusion Committee.

Diversity, equity, and inclusion (DEI) are crucial elements of successful veterinary emergency and critical care practices across the world. Embracing the elements of DEI creates a work environment that is safe and welcoming for all the members of the team. The American College of Veterinary Emergency and Critical Care DEI committee was formed to enhance and support efforts to increase racial diversity in veterinary emergency and critical care, as well as provide resources that will generate DEI practices across the country. This article provides an overview of the vision of the committee and some of the steps that have been taken to create a welcoming space for all represented in veterinary emergency and critical care.

Indications and outcomes for puppies undergoing mechanical ventilation: 59 cases (2006 to 2020).

The medical records of 59 puppies from 6 hospitals undergoing mechanical ventilation (MV) between 2006 and 2020 were reviewed to describe the signalment, underlying disease, duration of ventilation, and outcome. The most common underlying diseases were pneumonia (n = 18), non-cardiogenic pulmonary edema (n = 16), and trauma (n = 8). Twenty-six (44%) puppies were weaned from the ventilator. The overall survival rate was 39% (23/59) including 19 non-brachycephalic dogs and 4 brachycephalics. Median duration of mechanical ventilation was 27 hours (range: 4 to 144 hours). Brachycephalic dogs were less likely to survive than nonbrachycephalic dogs (P = 0.032). English bulldogs were over-represented with pneumonia. No association between age and survival to discharge (P = 0.716) or outcome (P = 0.579) was detected. The survival rate, and underlying disease process and severity for mechanically ventilated puppies was similar to previous studies in adult dogs.

Indications et issues chez les chiots sous ventilation mécanique : 59 cas (2006 à 2020). Les dossiers médicaux de 59 chiots de six hôpitaux soumis à une ventilation mécanique (VM) entre 2006 et 2020 ont été examinés pour décrire le signalement, la maladie sous-jacente, la durée de la ventilation et le résultat. Les maladies sous-jacentes les plus courantes étaient la pneumonie (n = 18), l'oedème pulmonaire non cardiogénique (n = 16) et les traumatismes (n = 8). Vingt-six (44 %) chiots ont été sevrés du ventilateur. Le taux de survie global était de 39 % (23/59) dont 19 chiens non brachycéphales et quatre brachycéphales. La durée médiane de la ventilation mécanique était de 27 heures (intervalle : 4 à 144 heures). Les chiens brachycéphales étaient moins susceptibles de survivre que les chiens non brachycéphales (P = 0,032). Les bouledogues anglais étaient surreprésentés avec la pneumonie. Aucune association entre l'âge et la survie à la sortie (P = 0,716) ou le résultat (P = 0,579) n'a été détectée. Le taux de survie, ainsi que le processus et la gravité de la maladie sous-jacente chez les chiots ventilés mécaniquement étaient similaires à ceux des études précédentes chez les chiens adultes.(Traduit par Dr Serge Messier).

Therapeutic plasma exchange as adjunct therapy in 3 dogs with myasthenia gravis and myasthenia-like syndrome.

OBJECTIVE: To describe the use of therapeutic membrane-based plasma exchange (TPE) for treatment of clinical signs associated with suspected acquired myasthenia gravis (MG) in 3 dogs. CASE SERIES SUMMARY: Three dogs presented with clinical signs consistent with acquired MG. All 3 dogs were medically managed prior to being treated with TPE. Two of the 3 dogs had increased acetylcholine receptor antibody titers that decreased after TPE. One dog diagnosed with primary MG became clinically normal after 2 sessions of TPE and continued to do well with medical management several months later. The second dog was diagnosed with a suspect thymoma, and TPE was performed as a bridge to surgery, with marked improvement of clinical signs after TPE. The dog was ultimately diagnosed with a thymic carcinoma. The third dog had a positive acetylcholine antibody titer and was ultimately diagnosed with hemangiosarcoma (spleen and liver) and invasive mediastinal thymoma. This dog developed severe pneumonia, was ventilator dependent, and died of multiple organ dysfunction. No immediate complications were observed secondary to TPE. All 3 dogs were concurrently treated with either immunosuppressive agents, anticholinesterase drugs, or both. NEW OR UNIQUE INFORMATION PROVIDED: The use of TPE in dogs with MG appears to be well tolerated and safe. It may be a reasonable adjunct therapy to acetylcholinesterase drugs in cases that are not responding to medical management alone. Therapeutic plasma exchange might also be considered preoperatively to prevent postoperative complications in dogs with severe MG, although further studies should be performed.

Does do not resuscitate (DNR) always mean DNR? Exploring DNR orders in small animal veterinary medicine.

This study investigated the use of and adherence to do not resuscitate (DNR) orders in small animal veterinary medicine. A link to a survey of respondent characteristics and clinical scenarios in which interpretation of the DNR order was questionable was distributed by e-mail to veterinarians in specialty and general practice, veterinary technicians, and veterinary students on veterinary e-mail lists in North America and Europe. Complete responses were obtained from 648 individuals, including 493 veterinarians, 58 veterinary technicians, and 97 veterinary students. Men, experienced veterinarians, and respondents participating in multiple cardiopulmonary resuscitation (CPR) events yearly were more likely to perform CPR despite DNR orders. Veterinarians in North America were more likely to provide CPR, compared to those elsewhere. Most respondents would override a DNR in the case of an in-hospital iatrogenic cardiac arrest or unexpected arrest during sedation, but would provide CPR when requested by owners, even if judged futile. Codes are not routinely suspended for patients undergoing anesthesia or regularly re-evaluated during hospitalization. Key clinical message: Inconsistency surrounding the assignment of and adherence to DNR orders in veterinary patients should be considered when establishing protocols for discussion and implementation of CPR codes.

Est-ce que ne pas réanimer (DNR) signifie toujours DNR? Exploration des consignes DNR en médecine vétérinaire des petits animaux. La présente étude visait à examiner l'utilisation et l'adhésion aux consignes de ne pas réanimer (DNR) en médecine vétérinaire des petits animaux. Un lien à un sondage des caractéristiques des répondants et des scénarios cliniques dans lesquels l'interprétation de la consigne DNR était questionnable fut distribué par courriel à des vétérinaires en pratique spécialisée et générale, des techniciens vétérinaires, et des étudiants vétérinaires sur des listes de courriel vétérinaire en Amérique du Nord et en Europe. Des réponses complètes furent obtenues de 648 individus, incluant 493 vétérinaires, 58 techniciens vétérinaires, et 97 étudiants vétérinaires. Les hommes, les vétérinaires avec expérience, et les répondants participant à de multiples évènements de réanimation cardiorespiratoire (CPR) annuellement étaient plus susceptibles d'effectuer des manoeuvres de CPR malgré des consignes DNR. Les vétérinaires nord-américains étaient plus susceptibles d'effectuer des manoeuvres de CPR comparativement à ceux d'ailleurs. La plupart des répondant ne respecterait pas une consigne DNR lors d'un arrêt cardiaque iatrogénique en clinique ou un arrêt imprévu lors de la sédation, mais effectuerait des manoeuvres de CPR lorsque demandées par les propriétaires, même si elles sont jugées futiles. Les codes ne sont pas suspendus de routine pour les patients soumis à une anesthésie ou réévalués régulièrement durant l'hospitalisation. Message clinique clé : L'incohérence entourant l'attribution et l'adhésion aux consignes de DNR chez les patients vétérinaires devrait être considérée lors de l'établissement de protocoles de discussion et de mise en place de codes de CPR.(Traduit par Dr Serge Messier).

Cochleotoxicity and acute kidney injury secondary to parenteral gentamicin administration in a dog.

A 5-year-old neutered male Labrador retriever dog was presented on referral for anuric acute kidney injury (AKI) presumed secondary to parenteral gentamicin administration. Initial management of AKI included a high dose of furosemide for 16 hours which may have contributed to the renal and cochlear damage. The dog received a total of 8 intermittent hemodialysis sessions during hospitalization. While in hospital, the dog became deaf, and brainstem auditory evoked response testing revealed absence of waveforms in both ears, consistent with bilateral deafness due to severe cochleotoxicity. After 33 days of hospitalization, the dog was discharged with persistent deafness, confirmed by a second brainstem auditory evoked response.

Cochléotoxicité et dommage rénal aigu secondaires à l'administration parentérale de gentamicine à un chien. Un chien mâle castré de race Labrador âgé de 5 ans a été présenté en référence pour dommage rénal aigu anurique (AKI) présumé secondaire à l'administration parentérale de gentamicine. La gestion initiale de l'AKI incluait une dose élevée de furosémide pour 16 heures, ce qui pourrait avoir contribué aux dommages rénaux et cochléaire. Le chien a reçu un total de huit sessions intermittentes d'hémodialyse pendant son hospitalisation. Durant son séjour à l'hôpital, le chien est devenu sourd, et un test pour les potentiels évoqués auditifs du tronc cérébral a révélé l'absence d'ondes dans les deux oreilles, ce qui est cohérent avec une surdité bilatérale due à une cochléotoxicité sévère. Après 33 jours d'hospitalisation, le chien a obtenu son congé malgré une surdité persistante, confirmée par un deuxième test de potentiels évoqués auditifs du tronc cérébral.(Traduit par Dr Serge Messier).

Treatment of a massive naproxen overdose with therapeutic plasma exchange in a dog.

In comparison with other over-the-counter anti-inflammatory drugs, naproxen has a longer half-life in dogs and can lead to severe morbidity and mortality. This report describes the successful use of membrane-based therapeutic plasma exchange after a massive ingestion of naproxen by a dog resulting in 86% reduction in plasma concentration.

A Randomized Double Blinded Placebo-Controlled Clinical Trial of a Probiotic or Metronidazole for Acute Canine Diarrhea.

Acute diarrhea is a common, often self-limiting, cause of presentation for veterinary care, yet there is a paucity of data on frequently-prescribed treatments. The purpose of this randomized, double blinded placebo-controlled clinical trial was to compare two anecdotally-recommended treatments: a probiotic combination and metronidazole. Sixty dogs without concurrent comorbidities were randomized into three treatment groups. The time to resolution of diarrheal signs was evaluated using owner surveys and fecal scoring charts. Dogs presenting with acute diarrhea achieved acceptable fecal consistency after 3.5 ± 2.2 days when receiving probiotic, 4.6 ± 2.4 days with oral metronidazole, and 4.8 ± 2.9 days with placebo; statistically significant differences were not identified between treatment groups (p = 0.17). These findings failed to provide evidence for the common use of metronidazole in this cohort of dogs with acute canine diarrhea, and a larger study population would be required to identify a statistically significant effect of probiotics.

Antiepileptic Drug Use Patterns in Suspect Epileptic Dogs Among Neurology and Emergency Specialists.

This study used a cross-sectional survey designed to inquire about antiepileptic drug (AED) use in newly diagnosed idiopathic epileptic dogs among board-certified emergency and neurology specialists. Results were obtained from 300 completed surveys by 128 board-certified neurologists and 172 board-certified emergency and critical care (ECC) specialists. Case volume was slightly different between groups, with 36% of neurologists and 18% of ECC specialists managing >50 cases of first-time canine seizure patients yearly. The initial AED of choice was similar between the groups, with 66% of neurologists and 64% of ECC specialists using phenobarbital and 16% of neurologists and 26% of ECC specialists using levetiracetam. Although most respondents gave a loading dose of phenobarbital, roughly one-fourth of neurologists did not load the drug versus 6% of ECC specialists. The total loading dose was similar between respondents (16 mg/kg) but varied in administration protocol. Approximately half of neurologists and nearly two-thirds of ECC specialists gave a higher initial dose of levetiracetam than recommended. Almost all the respondents who gave a higher initial dose of levetiracetam used 60 mg/kg IV once. Understanding the common practices in AED use may promote future discussions regarding best practices in the management of canine idiopathic epilepsy.

Diagnostic usefulness of laparoscopy versus exploratory laparotomy for dogs with suspected gastrointestinal obstruction.

OBJECTIVE To evaluate the feasibility of laparoscopy versus exploratory laparotomy for the diagnosis of specific lesions in dogs with suspected gastrointestinal obstruction. DESIGN Controlled trial. ANIMALS 16 client-owned dogs with physical and radiographic findings consistent with gastrointestinal obstruction. PROCEDURES Single-incision laparoscopy with intracorporeal and extracorporeal examination of the gastrointestinal tract was performed by 1 surgeon. Immediately afterward, exploratory laparotomy was performed by a second surgeon. Accessibility and gross appearance of organs, surgical diagnoses, incision lengths, procedure duration, and complications were compared between diagnostic techniques. RESULTS Mean (95% confidence interval) incision length was 4.9 cm (3.9 to 5.9 cm) for laparoscopy and 16.4 cm (14.0 to 18.7 cm) for exploratory laparotomy. Mean (95% confidence interval) procedure duration was 36.8 minutes (31.6 to 41.2 minutes) and 12.8 minutes (11.4 to 14.3 minutes), respectively. Diagnoses of the cause of obstruction were the same with both methods. In 13 dogs, the laparoscopic examination was successfully completed, and in the other 3, it was incomplete. In 4 dogs in which laparoscopy was successful, conversion to exploratory laparotomy or considerable extension of the laparoscopic incision would have been required to allow subsequent surgical treatment of identified lesions. No dogs developed major complications, and minor complication rates were similar between procedures. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopy was feasible and clinically applicable in dogs with suspected gastrointestinal obstruction. Careful patient selection and liberal criteria for conversion to an open surgical approach are recommended when laparoscopy is considered for the diagnosis of gastrointestinal lesions in dogs.

Kidney injury in a dog following bee sting-associated anaphylaxis.

This report describes a case of honeybee envenomation in a dog that developed anaphylaxis after being stung by approximately 10 bees. The dog subsequently developed acute kidney injury. The dog had a previous mild increase in blood urea nitrogen with normal creatinine, possibly indicating an insidious chronic renal degenerative process that went into acute decompensation at the time of bee envenomation.

Lésion rénale chez un chien après l'anaphylaxie associée à une piqûre d'abeille. Ce rapport décrit un cas d'envenimement d'un chien qui a été piqué par environ 10 abeilles et a développé l'anaphylaxie puis une lésion rénale aiguë. Le chien avait eu une légère hausse antérieure de l'azote uréique du sang avec une créatinine normale, ce qui indique éventuellement un processus dégénératif rénal chronique insidieux qui s'est développé en une décompensation aiguë au moment de l'envenimement par les abeilles.(Traduit par Isabelle Vallières).

Clearance of plasma ivermectin with single pass lipid dialysis in 2 dogs.

OBJECTIVE: To describe the use of single pass lipid dialysis (SPLD) for treatment of ivermectin toxicosis in 2 Australian Shepherd dogs with the ABCB1-1Δ gene mutation. CASE SERIES SUMMARY: Two Australian Shepherd dogs were presented for treatment of ivermectin toxicosis. Dogs were initially treated with intravenous lipid emulsion and supportive care, without improvement of clinical signs. They both developed respiratory paralysis and required mechanical ventilation. In order to increase the clearance of circulating ivermectin, SPLD was performed using dialysate containing 5% lipid. Blood samples were obtained immediately before and after dialysis and analyzed for serum ivermectin concentration. Ivermectin reduction ratio was calculated at 29% and 39% for each dog, respectively. When compared to intrinsic total body ivermectin clearance, only the second dog had a relative improvement of plasma clearance following SPLD. Both dogs were confirmed to be homozygous for ABCB1-1Δ gene mutations. Both dogs remained ventilator dependent for several days and ultimately made a full recovery. NEW OR UNIQUE INFORMATION PROVIDED: SPLD may be an adjunctive detoxification strategy for highly lipophilic toxins such as ivermectin.

Temporary percutaneous T-fastener gastropexy and continuous decompressive gastrostomy in dogs with experimentally induced gastric dilatation.

OBJECTIVE To evaluate a percutaneous, continuous gastric decompression technique for dogs involving a temporary T-fastener gastropexy and self-retaining decompression catheter. ANIMALS 6 healthy male large-breed dogs. PROCEDURES Dogs were anesthetized and positioned in dorsal recumbency with slight left-lateral obliquity. The gastric lumen was insufflated endoscopically until tympany was evident. Three T-fasteners were placed percutaneously into the gastric lumen via the right lateral aspect of the abdomen, caudal to the 13th rib and lateral to the rectus abdominis muscle. Through the center of the T-fasteners, a 5F locking pigtail catheter was inserted into the gastric lumen and attached to a device measuring gas outflow and intragastric pressure. The stomach was insufflated to 23 mm Hg, air was allowed to passively drain from the catheter until intraluminal pressure reached 5 mm Hg for 3 cycles, and the catheter was removed. Dogs were hospitalized and monitored for 72 hours. RESULTS Mean ± SD catheter placement time was 3.3 ± 0.5 minutes. Mean intervals from catheter placement to a ≥ 50% decrease in intragastric pressure and to ≤ 6 mm Hg were 2.1 ± 1.3 minutes and 8.4 ± 5.1 minutes, respectively. After catheter removal, no gas or fluid leakage at the catheter site was visible laparoscopically or endoscopically. All dogs were clinically normal 72 hours after surgery. CONCLUSIONS AND CLINICAL RELEVANCE The described technique was performed rapidly and provided continuous gastric decompression with no evidence of postoperative leakage in healthy dogs. Investigation is warranted to evaluate its effectiveness in dogs with gastric dilatation-volvulus.

Successful treatment of severe hypokalemia in a dog with acute kidney injury caused by leptospirosis.

OBJECTIVE: To report the case management of a patient with severe hypokalemia resulting in cardiopulmonary arrest caused by infection with leptospirosis. CASE SUMMARY: A 3-year-old intact female Dachshund presented for polyuria, polydipsia, and refractory hypokalemia, which progressed to flaccid paralysis and cardiorespiratory arrest. Following successful resuscitation, the dog was apneic and managed with mechanical ventilation while volume status and electrolytes were corrected. The dog showed rapid improvement allowing for weaning from the ventilator within the first day. The dog was identified as having leptospirosis causing severe kaliuresis (fractional excretion of potassium 31%). Following discharge from hospital, the dog was managed with doxycycline, oral potassium supplementation, and spironolactone and made a full clinical recovery. NEW OR UNIQUE INFORMATION PROVIDED: This report identifies an unusually severe presentation of leptospirosis in a dog from a region where the disease is not considered common, which was successfully treated despite cardiopulmonary arrest on initial presentation.

Severe Pit Viper Envenomation with Extended Clinical Signs and Treatment Complications in a Dog.

This manuscript describes the extended clinical abnormalities that can occur in severe snake envenomation and the clinical signs associated with antivenom hypersensitivity in a 3 yr old dog. Treatment consisted of IV fluid therapy, analgesics, a vasopressor, cardiac antiarrhythmia drugs, and polyvalent pit viper antivenom. Following initial response to treatment, relapse of clinical signs occurred. Most interesting was the recrudescence of clinical signs on day 7 that may have been caused by the release of deposited venom during surgical debridement of necrotic skin. The resulting extensive clinical signs required multiple vials of antivenom (22 vials over a 7 day period). Both F(ab')2 antivenom and antivenin (Crotalidae) polyvalent were used in this dog because of availability logistics. It is thought that this large amount of antivenom resulted in type I (anaphylaxis) and type III hypersensitivity (serum sickness) reactions. The dog made a complete clinical recovery. This description of extended, fluctuating clinical abnormalities that were associated with envenomation together with the development of hypersensitivity reactions that were presumably secondary to antivenom administration is information that can be useful for the management of patients afflicted with severe pit viper envenomation.

Use of IV lipid emulsion for treatment of ivermectin toxicosis in a cat.

Ivermectin toxicosis in cats is infrequently reported. IV lipid emulsion (ILE) is a novel treatment in veterinary medicine that has been used for amelioration of adverse effects seen with multiple lipid soluble compounds. Previously, ILE has been investigated in experimental models with rats, rabbits, pigs, and dogs, mainly for resuscitation of cardiopulmonary arrest and treatment of hypotension due to local anesthetic drug overdose. There are few case reports in veterinary medicine of using ILE for drug toxicity. Only one feline case has been reported, with IV lipids used for treatment of lidocaine toxicity. This report describes a case of ivermectin toxicosis in a 1 yr old domestic shorthair that was safely and successfully treated using ILE.

Positive impact of an emergency department protocol on time to antimicrobial administration in dogs with septic peritonitis.

OBJECTIVE: To determine whether the development of a specific antimicrobial protocol for the treatment of canine intra-abdominal sepsis would improve time to appropriate antimicrobial administration following diagnosis of bacterial peritonitis. DESIGN: Case controlled observational study. SETTING: A tertiary referral small animal teaching hospital. ANIMALS: Twenty dogs undergoing surgery for septic peritonitis prior to the deployment of the abdominal sepsis protocol served as a case control population and 40 dogs identified as having septic peritonitis after deployment of the protocol served as the study population. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Median time from diagnosis of septic peritonitis to antimicrobial administration was 6 hours (range 1-10 h) in the preprotocol group (PRE), and 1 hour (range 1-2 h) in the postprotocol group (POST) (P = 0.001). Five of 20 (25%) culture and sensitivity results yielded negative cultures in the PRE versus 6 of 34 (17.6%) in the POST. Inappropriate empirical antimicrobials were selected 3 of 20 times (15%) in the PRE and 3 of 34 times (8.8%) in the POST. The overall survival to discharge was 60% in the PRE and 70% in the POST (P = 0.425). CONCLUSIONS: The development of an emergency department antimicrobial protocol significantly decreased time to antimicrobial administration following identification of septic peritonitis in dogs.

The effect of using an impedance threshold device on hemodynamic parameters during cardiopulmonary resuscitation in dogs.

OBJECTIVE: To investigate the hemodynamic effects following the use of an impedance threshold device (ITD) in a canine model of cardiopulmonary arrest. DESIGN: Experimental, randomized crossover study. SETTING: Cardiovascular research laboratory at a university veterinary center. ANIMALS: Eight purpose bred beagle dogs. INTERVENTIONS: Dogs were anesthetized and instrumented for the measurement of right atrial pressure , systolic blood pressure, mean blood pressure, and diastolic arterial blood pressure, end-tidal CO(2) , and carotid blood flow (CBF). CBF was determined via ultrasonic flow probe placed around the carotid artery. Animals were taking part in an unassociated terminal study and following subsequent euthanasia with pentobarbital, standardized cardiopulmonary resuscitation (CPR) was performed with an impedance threshold device attached (ITD-CPR group) and without (S-CPR group). Order of treatment was randomized. MEASUREMENTS AND MAIN RESULTS: ITD group had increased CBF, coronary perfusion pressure, and a decrease in right atrial diastolic pressure. No differences in end-tidal CO(2) , diastolic arterial blood pressure, mean blood pressure, or systolic blood pressure were seen. Return of spontaneous circulation was not observed in any of the animals CONCLUSIONS: Use of the ITD resulted in favorable changes in hemodynamic parameters in dogs undergoing CPR. The ITD may be a useful adjunct during CPR in dogs and warrants clinical evaluation.

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support.

OBJECTIVE: To systematically evaluate the evidence of the effect of advanced life support techniques on outcome in veterinary cardiopulmonary resuscitation (CPR) and to outline knowledge gaps. 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. SETTING: Academia, referral practice, and general practice RESULTS: Sixteen population, intervention, control group, outcome questions were evaluated to determine if recommendations could be made concerning drug therapy, including vasopressors, vagolytics, corticosteroids, reversal agents, buffer therapy, and correction of electrolyte disturbances. Electrical defibrillation strategies as well as other advanced interventions such as open-chest CPR, impedance threshold devices, and special considerations regarding anesthesia-related cardiopulmonary arrest (CPA) were also investigated. CONCLUSIONS: There is strong evidence supporting the use of standard-dose (0.01 mg/kg) epinephrine in CPR, as well as early electrical defibrillation for animals experiencing CPA due to ventricular fibrillation or pulseless ventricular tachycardia, preferentially using a biphasic defibrillator. For CPA due to certain causes and with the availability of advanced postcardiac arrest support, open chest CPR is preferred. Many knowledge gaps regarding other pharmacologic and advanced therapies were identified, and further studies are recommended to better systematically address these questions.

Low tidal volume ventilation in healthy dogs.

OBJECTIVE: To determine if low tidal volume (V(T) ) ventilation is associated with the development of respiratory acidosis and changes in lung function in healthy dogs. DESIGN: Randomized prospective experimental cross-over study. SETTING: Pulmonary function laboratory at a university teaching hospital. ANIMALS: Five healthy Beagle dogs. INTERVENTIONS: Dogs were anesthetized and randomly mechanically ventilated with V(T) of 6, 8, 10, 12, and 15 mL/kg while maintaining a constant minute volume. MEASUREMENTS AND MAIN RESULTS: Arterial blood gases and pulmonary mechanics were collected after 15 minutes of equilibration at each V(T). Repeated measures ANOVA was used to determine the effect of V(T) with a P-value of <0.05 considered significant, and a Pearson product moment was used to determine correlation between V(T) and pH and PaCO(2). V(T) had a significant effect on PaCO(2) (P < 0.001) and on pH (P < 0.001) with lower V(T) being associated with higher PaCO(2) and lower pH. There was a strong correlation between V(T) and PaCO(2) (r = -0.87) and V(T) and pH (r = 0.83). Increased airway pressures and pulmonary compliance were associated with increasing V(T). CONCLUSIONS: There is a predictable decrease in the pH, decrease in airway pressure, decrease in compliance, and increase in the PaCO(2) associated with lower V(T). Low V(T) ventilation is well tolerated in healthy dogs; the role of low V(T) ventilation in dogs with acute lung injury/acute respiratory distress syndrome as well as the influence of positive end expiratory pressure requires further evaluation.