2023 AAHA Senior Care Guidelines for Dogs and Cats.

Veterinary professionals are taught to recognize that "old age is not a disease." However, clients may have the perception that older dogs and cats undergo an unavoidable physical, mental, and behavioral decline attributable simply to old age. The veterinary team's role includes providing medical care and support to senior pets to maintain their quality of life, as well as supporting and educating clients on proper senior animal care and addressing any misconceptions about the aging process. These Guidelines describe a systematic approach to the healthcare of the senior pet that is based on an evidence-guided assessment of both healthy and unhealthy canine and feline patients. By using evidence-guided medicine, which may include conventional and integrative approaches as well as environmental management for the senior pet, the patient's quality of life can be enhanced and potentially extended during this vulnerable life stage. Developing a senior program for the veterinary practice requires appropriate training of the entire healthcare team and includes a robust client education program that focuses on the wellbeing of the senior pet. Palliative and hospice care should be included in the education and information provided for both the veterinary team and the families of senior pets.

Ocular Injuries Related to Grooming Visits in Dogs: 161 Cases (2004-2020).

Owners of dogs with ocular issues often suspect their pet's eye problems are linked to recent grooming visits. A medical records search was performed to identify dogs presenting with ocular complaints initially noted within 24 hr of a commercial grooming appointment. Data collected included signalment, type of injury, treatment, and notations regarding behavioral issues potentially contributing to injury. One hundred sixty-one episodes involving 159 dogs were identified. Male dogs accounted for 57% of episodes. Median age at presentation was 59 mo. Shih tzu were involved in 34% of incidents, and 71% involved small-breed dogs. Aggressive or reactive behaviors were reported in 33% of dogs. Corneal ulceration was the most common injury (71% of incidents), followed by conjunctivitis (11%), eyelid lacerations (7%), and subconjunctival hemorrhage (6%). Surgical management was required in 14% of cases, including four dogs that underwent enucleation. Ocular injury during grooming appointments can occur via several mechanisms including trauma, exposure to grooming products, or inadvertent strangulation. Small-breed dogs, particularly shih tzu, appear to be at increased risk. Reactive or aggressive behavior likely increases risk of ocular injury. Veterinarians can help limit grooming-associated ocular injuries by recommending behavioral or pharmacological interventions before grooming visits.

Variables Influencing Intravenous Catheterization Success by Final-Year Veterinary Students in the Emergency Room.

Successful placement of intravenous catheters (IVC) is a basic and essential clinical skill for veterinary students. The purposes of this study were to determine the overall success rate for IVC placement in cats and dogs when final-year veterinary students are performing the procedure in a clinical setting, to determine if self-assessed experience level affects IVC placement success rates, and to identify factors affecting student success with this procedure. Final-year students were asked to complete an anonymous survey following each catheter placement attempt during their 3-week core emergency medicine rotation. The survey included self-assessed level of experience, patient species, indication for IVC placement, restrainer, catheter type, insertion site, use of sedation, and perceived degree of coaching. Success or failure in catheter placement was recorded and two attempts were allowed. A Chi-square test was used to evaluate differences between insertion outcomes in dogs and cats. A univariate logistic regression analysis was used to assess the relationship between success and all other variables. A total of 256 catheters were attempted by students, with an overall success rate of 61%. The cephalic vein was associated with successful placement compared with the saphenous vein (p = .005). There was no relationship between successful catheter placement and self-assessed experience, species, indication for IVC placement, insertion site, use of sedation, catheter type, or restrainer. Final-year veterinary students do not master intravenous catheterization in the emergency room setting, and additional studies are required to improve clinical instruction in this area.

WHOLE BLOOD THROMBOELASTOGRAPHY IN HEALTHY ADULT CAMELIDS (VICUGNA PACOS AND CAMELUS DROMEDARIUS).

Thromboelastography (TEG) provides a global assessment of hemostasis and fibrinolysis and has broad applications to identify and monitor coagulation dysfunction in veterinary patients. Although alpacas are susceptible to a wide variety of coagulopathies, the assessment of TEG has not been reported in clinically healthy alpacas to date. The purpose of this study was to evaluate the analytical performance of recombinant human tissue factor (rhTF)- and kaolin-activated TEG and to establish reference intervals for TEG parameters (reaction [R] and clotting [K] times, angle [α], maximum amplitude [MA], and shear elastic modulus [G]) in healthy, adult alpacas. Kaolin and rhTF-activated TEG were performed using citrated whole blood samples from 20 clinically healthy, nonpregnant, adult Huacaya alpacas each after 30 min of sample storage at room temperature. Six individuals of a related species, dromedary camels, were also sampled for comparative purposes. All data were presented descriptively, assessed for normality, and compared using either independent-sample t tests or Mann-Whitney U tests, with P ≤ 0.05 considered significant. Reference intervals were calculated using a robust method and Box-Cox-transformed data. Mean TEG values (reference intervals) were determined for rhTF-activated TEG as follows: R 6.99 min (3.41-12.71), K 3.43 min (1.61-6.42), α 48.51° (27.21-67.38), MA 52.05 mm (21.53-65.92), and G 5.71 kdyn/cm2 (1.87-9.60), while mean values (reference intervals) for kaolin-activated TEG included R 7.72 min (4.48-11.43), K 4.24 min (2.03-9.20), α 45.06° (23.66-64.20), MA 52.18 mm (33.49-66.63), and G 5.78 kdyn/cm2 (NR-9.66). None of the measured TEG values differed significantly between activators, suggesting that activator choice may have a limited effect on TEG parameters in healthy alpacas. TEG results in alpacas were comparable to those of dromedary camels. These results will thus provide a useful starting point in the evaluation of hemostasis in adult camelids.

Novel strategy to decrease the fraction of inspired oxygen (FiO2) of an anesthetic circuit using a commercially available fish tank air pump: An in vitro study.

The aim of this study was to determine whether use of a commercially available fish tank air pump (FTAP) could predictably lower the fraction of inspired oxygen (FiO2) within an anesthetic circuit below the level of risk for O2 toxicity (FiO2 < 0.6). Three different anesthesia machines and an anesthesia ventilator were each outfitted with an FTAP. The FiO2 was measured at 4 different tidal volumes and 3 O2 flow rates at a set respiratory rate of 15 breaths per minute, and mean FiO2 was calculated. For each O2 flow rate and tidal volume combination, the FiO2 was reduced (FiO2 < 1). The FiO2 was more reliably decreased at lower O2 flow rates. A significant limitation of the study was the makeshift construction, leading to measurable leaks within the circuit. This technique could represent an economical and practical approach to providing ventilatory support in a resource limited setting.

Nouvelle stratégie pour diminuer la fraction d'oxygène inspiré (FiO 2 ) d'un circuit anesthésique à l'aide d'une pompe à air pour aquarium disponible commercialement : une étude in vitro . Le but de cette étude était de déterminer si l'utilisation d'une pompe à air pour aquarium (FTAP) disponible commercialement pouvait réduire de manière prévisible la fraction d'oxygène inspiré (FiO2) dans un circuit anesthésique en dessous du niveau de risque de toxicité de l'O2 (FiO2 < 0,6). Trois appareils d'anesthésie différents et un ventilateur d'anesthésie étaient chacun équipés d'un FTAP. La FiO2 a été mesurée à quatre volumes courants différents et trois débits d'O2 à une fréquence respiratoire fixe de 15 respirations par minute, et la FiO2 moyenne a été calculée. Pour chaque combinaison de débit d'O2 et de volume courant, la FiO2 a été réduite (FiO2 < 1). La FiO2 était diminuée de manière plus fiable à des débits d'O2 moindres. Une limitation importante de l'étude était la construction de fortune, conduisant à des fuites mesurables dans le circuit. Cette technique pourrait représenter une approche économique et pratique pour fournir une assistance ventilatoire dans un environnement à ressources limitées.(Traduit par Dr Serge Messier).

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).

Lung lobe torsion in 35 dogs and 4 cats.

The purpose of this study was to assess survival to discharge of animals with surgical or postmortem confirmation of a lung lobe torsion (LLT) as well as to evaluate pre-operative effusion, lung lobe affected, and patient size as prognostic indicators. Medical records search identified 35 dogs and 4 cats with a confirmed diagnosis including 17 small-breed dogs, 18 large-breed dogs, 3 domestic shorthair cats, and 1 minskin cat. Lobes affected included right middle (n = 18), left cranial (n = 18), right cranial (n = 2), left caudal (n = 1), and accessory (n = 1). Two animals died before surgery; the remaining 37 animals underwent thoracotomy. All treated small-breed dogs and cats survived; 12/18 large-breed dogs survived, with an overall survival to discharge of 87%. Pre-operative pleural effusion and affected lung lobe did not affect survival to discharge in this population. Small dogs and cats with LLT appear to have an excellent survival to discharge following thoracotomy and the survival is good in larger dogs.

Torsion de lobe pulmonaire chez 35 chiens et 4 chats. Le but de cette étude est d'évaluer le taux de survie jusqu'à la sortie d'hôpital, chez des animaux ayant eu confirmation chirurgicale ou post-mortem de torsion de lobe pulmonaire (TLP), ainsi que d'évaluer la présence d'épanchement pleural, le lobe pulmonaire affecté et la taille des patients en tant que facteurs pronostics. Les dossiers médicaux de 35 chiens et 4 chats avec un diagnostic de TLP confirmé furent identifiés, comprenant 17 chiens de petite race, 18 chiens de grande race, 3 chats Européens et 1 Minskin. Les lobes pulmonaires affectés étaient le lobe moyen droit (n = 18), le lobe cranial gauche (n = 18), le lobe cranial droit (n = 2), le lobe caudal gauche (n = 1) et le lobe accessoire (n = 1). Deux animaux décédèrent avant chirurgie, et une thoracotomie fut pratiquées chez les 37 animaux restant. Tous les chiens de petites races et les chats survécurent à leur chirurgie; 12/18 des chiens de grande race survécurent, et le taux de survie global était de 87 %. La présence d'épanchement pleural et le lobe pulmonaire affecté n'avaient pas d'influence sur la probabilité de survie dans cette population. Le taux de survie au congé hospitalier semble excellent chez les chiens de petite taille et les chats diagnostiqués avec une torsion de lobe pulmonaire et il est bon pour les chiens de grande taille.(Traduit par les auteurs).

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).

Vasopressor use in 41 critically ill cats (2007-2016).

This study describes the use of vasopressors in critically ill cats. Records of 41 cats hospitalized in the ICU were evaluated. Signalment, blood pressure, underlying conditions, evidence of sepsis, type of treatment (surgical versus non-surgical), vasopressor type and duration, adverse events attributed to vasopressors, and survival were recorded. Twenty-one cats (51%) had an underlying disease considered amenable to surgical treatment while 20 (49%) cats did not. Evidence of sepsis was present in 24 (59%) cats. Thirty-four cats developed a Doppler blood pressure (DBP) > 80 mmHg during therapy, and 29 cats became normotensive (DBP > 90 mmHg). Seven cats did not increase their DBP to > 80 mmHg. All cats received dopamine and/or norepinephrine and 6 cats also received other vasopressors. Sixteen cats survived (39%). Surgical intervention was associated with a higher survival (P = 0.004). Critically ill hypotensive cats may benefit from administration of vasopressors.

Utilisation de vasopressine chez 41 chats en état critique (2007­2016). Cette étude décrit l'utilisation de vasopresseurs chez les chats en condition critique. Les dossiers médicaux de 41 chats hospitalisés ont été évalués. Le signalement, pression sanguine, conditions sous-jacentes, évidence de sepsis, type de traitement (chirurgical contre médical), type de vasopresseurs et durée, effets adverses reliés à l'utilisation des vasopresseurs et survie ont été comptabilisés. Vingt et un chats (51 %) avaient une condition sous-jacente susceptible au traitement chirurgical contrairement aux 20 autres chats (49 %). L'évidence de sepsis était présente dans 24 (59 %) chats. Trente-quatre chats ont développé une pression sanguine au Doppler (DBP) > 80 mmHg durant le traitement et 29 chats sont devenus normotensifs (DBP > 90 mmHg). Sept chats n'ont pas eu d'augmentation de leur DBP > 80 mmHg. Tous les chats ont reçu de la dopamine et/ou de la norépinéphrine et 6 chats ont reçus d'autres vasopresseurs. Seize chats ont survécu (39 %). Une intervention chirurgicale est associée à un plus grand taux de survie (P = 0,004). Les chats hypotensifs en condition critique peuvent bénéficier de l'utilisation de vasopresseurs.(Traduit par les auteurs).

A Novel Model for Teaching Primary Care in a Community Practice Setting: Tufts at Tech Community Veterinary Clinic.

Providing veterinary students with opportunities to develop clinical skills in a realistic, hands-on environment remains a challenge for veterinary education. We have developed a novel approach to teaching clinical medicine to fourth-year veterinary students and technical high school students via development of a primary care clinic embedded within a technical high school. The primary care clinic targets an underserved area of the community, which includes many of the participating high school students. Support from the veterinary community for the project has been strong as a result of communication, the opportunity for veterinarians to volunteer in the clinic, and the careful targeting of services. Benefits to veterinary students include the opportunity to build clinical competencies and confidence, as well as the exposure to a diverse client population. The financial model of the clinic is described and initial data on outcomes for case load, clinic income, veterinary student evaluations, and high school students' success in passing the veterinary assisting examination are reported. This clinical model, involving a partnership between a veterinary school and a technical high school, may be adoptable to other clinical teaching situations.

Evaluation of cardiac troponin I in dogs presenting to the emergency room using a point-of-care assay.

We used a point-of-care assay to evaluate cardiac troponin I (cTnI) in clinically normal dogs and a heterogeneous population of dogs presenting to the emergency room (ER) and to determine whether cTnI has prognostic capabilities in an ER population. Fourteen clinically normal dogs and 129 dogs presented to the ER were evaluated. Of the study group, 88 dogs had normal cTnI (< 0.1 ng/mL), 29 had elevated cTnI (0.1 to 1.0 ng/mL), and 12 had high cTnI (> 1.0 ng/mL). Dogs with elevated cTnI had 8 times the odds of mortality compared to dogs with normal cTnI [odds ratio (OR): 8.2, 95% confidence interval (CI): 3.0, 22.3]. Dogs with high cTnI had 17 times higher odds of mortality compared to dogs with normal cTnI (OR: 17.6, 95% CI: 4.4, 70.1). We conclude that cTnI shows promise as a prognostic indicator for dogs presenting to the ER and can be easily evaluated using a point-of-care assay.

Évaluation de la troponine I chez les chiens présentés à la salle d'urgence à l'aide d'un test au point de service. Nous avons utilisé un test au point de service pour évaluer la troponine I (cTnI) cardiaque chez des chiens cliniquement normaux et une population présentée à la salle d'urgence (SU) pour déterminer si la cTnI comportait des capacités de pronostic dans une population de SU. Quatorze chiens cliniquement normaux et 129 chiens présentés à la SU ont été évalués. Dans le groupe à l'étude, 88 chiens présentaient une cTnI normale (< 0,1 ng/mL), 29 avaient une cTnI élevée (0,1 à 1,0 ng/mL) et 12 avaient une cTnI haute (> 1,0 ng/mL). Les chiens avec une cTnI élevée présentaient des risques 8 fois supérieurs de mortalité par rapport aux chiens avec une cTnI normale [rapport de cotes (RC): 8,2, intervalle de confiance (IC) de 95 % de 3,0, 22,3]. Les chiens avec une cTnI haute présentaient des risques 17 fois supérieurs de mortalité par rapport aux chiens ayant une cTnI normale (RV: 17,6, IC de 95 % : 4,4, 70,1). Nous concluons donc que la cTnI s'avère prometteuse comme indicateur de pronostic pour les chiens présentés à la SU et qu'elle peut être facilement évaluée à l'aide d'un test au point de service.(Traduit par Isabelle Vallières).

Accuracy of a computed tomography bronchial wall thickness to pulmonary artery diameter ratio for assessing bronchial wall thickening in dogs.

Computed tomography is increasingly being used in veterinary medicine to evaluate animals with pulmonary signs such as coughing, tachypnea, and exercise intolerance, however, a quantitative measure of bronchial wall thickening has yet to be validated in veterinary medicine. Canine chronic bronchitis is a disease that is characterized histologically by thickening of the bronchial walls. Thoracic CT images of 16 dogs with chronic bronchitis and 72 dogs presenting for conditions unrelated to cough were evaluated. A ratio comparing the bronchial wall thickness to the adjacent pulmonary artery diameter was obtained in the right and left cranial and caudal lung lobes. There was no significant difference in dogs with chronic bronchitis or unaffected dogs between the left and right hemithorax, patient weight, patient age, image slice thickness, or CT machine used. Dogs with chronic bronchitis were found to have a significantly greater ratio than unaffected dogs (P < 0.001). The ratios in the cranial lung lobes were found to be significantly greater than the caudal lung lobes in both chronic bronchitis and unaffected dogs (P < 0.001). A receiver operating characteristic curve of the ratios in the cranial lung lobes had an area under the curve of 0.912, indicating high accuracy in predicting for bronchial wall thickening. A ratio of ≥ 0.6 in the cranial lung lobes was found to have a sensitivity of 77% and specificity of 100% in predicting for the presence of chronic bronchitis, and we propose using this cut-off as supportive of bronchial wall thickening on CT.

A proof-of-concept study evaluating cardiac compression techniques for cardiopulmonary resuscitation in laying hens (Gallus gallus).

OBJECTIVE: To determine in adult chickens which of 3 CPR techniques, sternal compressions (SC), SC with interposed caudal coelomic compressions (ICCC), or lateral compressions (LC), results in the highest mean systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) as measured directly from the carotid artery. DESIGN: Prospective, nonblinded, experimental crossover study. SETTING: University teaching hospital laboratory. ANIMALS: Ten retired laying hens. INTERVENTIONS: Birds were sedated, anesthetized, and placed in dorsal recumbency. A carotid artery catheter was placed to directly measure arterial pressure. Ventricular fibrillation was induced with direct cardiac stimulation using a 9-Volt battery. Each bird then received 2 minutes of the 3 different cardiac compression techniques in a random order by 3 different compressors, with the compressor order also randomized. Birds were subsequently administered IV epinephrine, and transthoracic defibrillation was attempted. At the end of experimentation, each bird was euthanized, and simple gross necropsies were performed. Linear mixed models followed by pairwise paired t-tests were performed to evaluate differences in pressures generated by each technique. MEASUREMENTS AND MAIN RESULTS: The primary study outcomes were SAP, DAP, and MAP over 2 minutes of compressions for each compression technique. Pressures from ICCC (SAP: 27.6 ± 5.3 mm Hg, DAP: 18.7 ± 5.2 mm Hg, MAP: 21.7 ± 5.2 mm Hg) were significantly higher than those from LC (SAP: 18.9 ± 5.4 mm Hg, DAP: 11.6 ± 4.1 mm Hg, MAP: 14.1 ± 4.5 mm Hg). Pressures from SC (SAP: 24.5 ± 6.4 mm Hg, DAP: 15.2 ± 4.3 mm Hg, MAP: 18.3 ± 5.0 mm Hg) were not significantly different from ICCC or LC. CONCLUSIONS: External compressions can generate detectable increases in arterial pressure in chickens with ventricular fibrillation. SC with ICCC generated significantly higher arterial pressures than LC. SC alone generated blood pressures that were not significantly different from those generated by SC with ICCC or LC.

Viscoelastic coagulation monitoring parameters in cats with acute arterial thromboembolism.

BACKGROUND: Hypercoagulability has been documented in cats with cardiac disease. However, hemostatic parameters, including viscoelastic coagulation monitoring (VCM) have not been reported in cats with arterial thromboembolism (ATE). HYPOTHESIS/OBJECTIVES: Compare VCM parameters in cats with acute cardiogenic ATE and in control cats. ANIMALS: Sixteen cats with ATE and 30 control cats. METHODS: Multicenter university-based prospective study. Cardiogenic ATE was diagnosed based on physical examination and by ultrasonographically-diagnosed left atrial enlargement. Viscoelastic coagulation monitor analysis, CBC, serum biochemistry profile and coagulation profile were performed at admission in cats with ATE. Analysis from healthy control cats was performed using blood collected by direct venipuncture. Our objective was comparison of VCM parameters clot time (CT), clot formation time (CFT), alpha angle (Angle), maximum clot formation (MCF), amplitude at 10 and 20 minutes (A10 and A20, respectively) and clot lysis index at 30 and 45 minutes (LI30 and LI45, respectively) between ATE and control cats. RESULTS: Cats with ATE had a decreased angle compared to control cats, with a median (range) of 43° (30-48°) compared to 47° (14-59°; P = .01). The parameters A10, A20 and MCF were decreased in ATE cats compared to control cats with a median (range) of 19 units (8-32) compared to 22 units (6-38), 24.5 units (11-40) compared to 29 units (10-47) and 29.5 units (13-44) compared to 33.5 units (14-53), respectively (P = .01, .01 and .01, respectively). The parameters CT, CFT, LI30 and LI45 were similar between groups (P = .22, .09, .62 and .34, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: Cats with cardiogenic ATE cats have VCM parameters consistent with hypocoagulability compared with healthy cats.

Intranasal and intravenous apomorphine outperform ropinirole ocular drops for induction of emesis in dogs within ten minutes: a randomized, controlled clinical trial.

OBJECTIVE: The primary goal was to compare the efficacy of administration of apomorphine (APO) administered by intranasal (IN), transconjunctival (TC), SC and IV routes with ropinirole eye drops for induction of emesis in dogs with a secondary goal to evaluate the time of emesis as well as difficulty in administration. ANIMALS: 125 client-owned dogs. METHODS: Dogs were randomly enrolled between October 1, 2021, and March 30, 2022, into groups of 25: IV APO, IN APO, TC APO, SC APO, and ropinirole eye drops. The IV, SC, and TC groups were dosed at 0.03 mg/kg, the IN group was dosed at 0.06 mg/kg, and the ropinirole group was dosed according to manufacturer guidelines. Data collected included success rate of emesis within 600 seconds, time to emesis, time to administer, and difficulty score. Results were compared to IV with P values and CIs being adjusted for multiple comparisons. RESULTS: Emesis was successful within 600 seconds using IV APO in 22 of 25 dogs. By comparison, IN APO induced emesis in 18 of 25 dogs (P = .63). Ropinirole (14/25), SC APO (6/25), and TC APO (4/25) were significantly less successful (P = .047, P = < .001, and P < 0.001, respectively). When emesis was successful, it occurred most rapidly with TC APO, followed by IN APO and then ropinirole. It was most difficult to administer IV APO and TC APO. CLINICAL RELEVANCE: Similar to IV APO, IN APO was a rapid, easy, and effective method of inducing emesis in dogs and should be considered when IV administration is not possible. Ropinirole was easy to administer but successfully induced emesis less reliably within a 10-minute timeframe. APO administered TC using the commercially compounded injectable formulation was ineffective.

Resource setting impacts neonatal but not maternal survival in bitches treated for dystocia: 243 cases (2015-2020).

OBJECTIVE: To compare maternal and fetal outcomes of dystocia managed surgically and nonsurgically at referral hospitals (RHs) versus community medicine clinics (CMCs), determine the rate of C-section, and evaluate the incidence of hypoglycemia and hypocalcemia in bitches presented with dystocia. ANIMALS: Bitches presented with dystocia at 2 RHs and 2 CMCs. METHODS: Information on signalment, presence of hypoglycemia and/or hypocalcemia, diagnostic imaging performed, nonsurgical and surgical interventions performed, maternal and fetal outcomes, and total cost of care was obtained from the electronic medical records of bitches presenting for dystocia between October 2015 and October 2020. Descriptive statistics were performed and outcome compared between RHs and CMCs using a Fisher exact test, with a P < .05 considered significant. RESULTS: 230 bitches were evaluated with 243 separate episodes of dystocia, with 183 (75%) episodes treated at an RH and 60 (25%) at a CMC. There was a low incidence of hypoglycemia (5% [9/178]) and ionized hypocalcemia (1% [2/164]). Seventy-three percent (177/243) of bitches underwent surgical intervention, 25% (61/243) received nonsurgical management, and 2% (5/243) transferred to their primary veterinarian. There was no difference in survival for bitches operated at an RH compared with a CMC. However, bitches operated at an RH were more likely (P = .04) to be discharged with at least 1 live neonate. CLINICAL RELEVANCE: In bitches diagnosed with dystocia, hypoglycemia and hypocalcemia were rare. The majority of bitches underwent a C-section. The setting where the C-section was performed did not impact maternal survival.

Establishment of a reference interval for thiamine concentrations in healthy dogs and evaluation of the prevalence of absolute thiamine deficiency in critically ill dogs with and without sepsis using high-performance liquid chromatography.

OBJECTIVE: To determine the normal reference interval (RI) for thiamine concentrations in healthy dogs and investigate the prevalence of thiamine deficiency in critically ill dogs with and without sepsis. DESIGN: Prospective, observational, multicenter study, conducted between 2019 and 2021. SETTING: Two veterinary university teaching hospitals. ANIMALS: A total of 109 dogs were enrolled into 3 groups: 40 healthy dogs, 33 dogs with suspected or confirmed sepsis and evidence of tissue hypoperfusion (Doppler blood pressure ≤90 mm Hg or plasma lactate ≥3 mmol/L), and 36 dogs with other critical illnesses and evidence of tissue hypoperfusion. INTERVENTIONS: For each dog, CBC, serum biochemistry, plasma lactate concentration, whole-blood thiamine concentration, blood pressure, vital parameters, Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast score, and clinical outcomes were recorded, alongside basic patient parameters and dietary history. Whole-blood thiamine pyrophosphate (TPP) concentrations were measured using high-performance liquid chromatography. MEASUREMENTS AND MAIN RESULTS: The RI for whole-blood TPP in healthy dogs was 70.9-135.3 µg/L. Median TPP concentrations were significantly lower in septic dogs compared to healthy controls (P = 0.036). No significant difference in median TPP concentrations was found between septic dogs and nonseptic critically ill dogs, or between healthy dogs and nonseptic critically ill dogs. TPP concentrations were below the normal RI in 27.3% of septic dogs, compared to 19.4% of nonseptic critically ill dogs (P = 0.57). No correlations were found between TPP concentrations and lactate concentrations, age, body condition scores, time since last meal, RBC count, serum alanine aminotransferase, APPLEfast scores, or patient outcomes. CONCLUSIONS: TPP concentrations were significantly lower in septic dogs compared to healthy controls, with an absolute thiamine deficiency found in 27.3% of septic dogs. The established TPP RI allows for further investigation of thiamine deficiency in critically ill dogs.

2024 RECOVER Guidelines: Advanced Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR.

OBJECTIVE: To systematically review the evidence and devise clinical recommendations on advanced life support (ALS) in dogs and cats and to identify critical knowledge gaps. DESIGN: Standardized, systematic evaluation of literature pertinent to ALS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by Evidence Evaluators, and findings were reconciled by ALS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk:benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: Seventeen questions pertaining to vascular access, vasopressors in shockable and nonshockable rhythms, anticholinergics, defibrillation, antiarrhythmics, and adjunct drug therapy as well as open-chest CPR were reviewed. Of the 33 treatment recommendations formulated, 6 recommendations addressed the management of patients with nonshockable arrest rhythms, 10 addressed shockable rhythms, and 6 provided guidance on open-chest CPR. We recommend against high-dose epinephrine even after prolonged CPR and suggest that atropine, when indicated, is used only once. In animals with a shockable rhythm in which initial defibrillation was unsuccessful, we recommend doubling the defibrillator dose once and suggest vasopressin (or epinephrine if vasopressin is not available), esmolol, lidocaine in dogs, and/or amiodarone in cats. CONCLUSIONS: These updated RECOVER ALS guidelines clarify the approach to refractory shockable rhythms and prolonged CPR. Very low quality of evidence due to absence of clinical data in dogs and cats continues to compromise the certainty with which recommendations can be made.

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.

2024 RECOVER Guidelines: Updated treatment recommendations for CPR in dogs and cats.

OBJECTIVE: After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring. DESIGN: These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided. CONCLUSIONS: While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.