ABSTRACT
Sildenafil is a drug used to successfully manage a variety of cardiopulmonary disorders in people and dogs, but there is limited information on its use in cats. The objective was to review the medical records of cats that received sildenafil as part of their clinical management. Medical records and pharmacy databases were searched for cats that received sildenafil for ≥24 h between 2009 and 2021, and data were collected from medical records. Fifty-five cats received sildenafil for ≥24 h and were included in the study: 43 with primary cardiac disease (acquired, n = 28; congenital, n = 15) and 12 with primary respiratory disease. Side effects possibly attributed to sildenafil were identified in two cats (systemic hypotension, n = 1; polydipsia, n = 1), and sildenafil was discontinued in the cat with hypotension. Sildenafil was discontinued in an additional three cats due to a lack of improvement in clinical signs. No cat was documented to develop worsening pulmonary edema within 72 h of starting sildenafil. Median duration of sildenafil administration was 87 days (range, 2-2362 days). Sildenafil administration in cats appeared to be generally well-tolerated. Studies are needed to determine whether sildenafil administration to cats with cardiopulmonary disease improves the quality of life or survival times.
ABSTRACT
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.
Subject(s)
Cardiopulmonary Resuscitation , Cat Diseases , Dogs , Animals , Cats , Cardiopulmonary Resuscitation/veterinary , Cardiopulmonary Resuscitation/standards , Cardiopulmonary Resuscitation/methods , Cat Diseases/therapy , Dog Diseases/therapy , Heart Arrest/veterinary , Heart Arrest/therapyABSTRACT
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.
Subject(s)
Dog Diseases , Animals , Dogs , Cats , Dog Diseases/therapy , Dog Diseases/drug therapy , Cardiopulmonary Resuscitation/veterinary , Cardiopulmonary Resuscitation/standards , Cat Diseases/therapy , Cat Diseases/drug therapy , Veterinary Medicine/standards , Heart Arrest/veterinary , Heart Arrest/therapyABSTRACT
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.
Subject(s)
Cat Diseases , Thromboembolism , Animals , Cats , Cat Diseases/blood , Thromboembolism/veterinary , Thromboembolism/blood , Female , Male , Prospective Studies , Blood Coagulation Tests/veterinary , Blood Coagulation/physiology , Case-Control StudiesABSTRACT
Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.
Subject(s)
Cat Diseases , Dog Diseases , Purpura, Thrombocytopenic, Idiopathic , Dogs , Cats , Dog Diseases/therapy , Dog Diseases/drug therapy , Cat Diseases/therapy , Cat Diseases/drug therapy , Animals , Purpura, Thrombocytopenic, Idiopathic/veterinary , Purpura, Thrombocytopenic, Idiopathic/therapy , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Immunosuppressive Agents/therapeutic use , ConsensusABSTRACT
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.
Subject(s)
Animals, Newborn , Dog Diseases , Dystocia , Hypocalcemia , Hypoglycemia , Animals , Dogs , Female , Dystocia/veterinary , Dystocia/therapy , Pregnancy , Dog Diseases/therapy , Dog Diseases/mortality , Hypocalcemia/veterinary , Hypoglycemia/veterinary , Retrospective Studies , Cesarean Section/veterinary , Pregnancy Outcome/veterinaryABSTRACT
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.
Subject(s)
Cardiopulmonary Resuscitation , Chickens , Animals , Female , Humans , Blood Pressure/physiology , Cardiopulmonary Resuscitation/veterinary , Cardiopulmonary Resuscitation/methods , Cross-Over Studies , Prospective Studies , Ventricular Fibrillation/veterinary , Proof of Concept StudyABSTRACT
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.
ABSTRACT
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.
Subject(s)
Cat Diseases , Dog Diseases , Sepsis , Animals , Cats , Dogs , Cat Diseases/diagnosis , Dog Diseases/diagnosis , Hospitals, Teaching , Sepsis/diagnosis , Sepsis/veterinary , Sepsis/complicationsABSTRACT
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.
Subject(s)
Dog Diseases , Sepsis , Thiamine Deficiency , Humans , Dogs , Animals , Thiamine , Prospective Studies , Critical Illness , Chromatography, High Pressure Liquid/veterinary , Prevalence , Thiamine Deficiency/epidemiology , Thiamine Deficiency/veterinary , Sepsis/epidemiology , Sepsis/veterinary , Thiamine Pyrophosphate , Lactates , Dog Diseases/epidemiologyABSTRACT
OBJECTIVE: To estimate the point prevalence and duration of hyperfibrinolysis (HF) in dogs undergoing surgical control of spontaneous hemoperitoneum (SHP). DESIGN: Prospective observational study. SETTING: Single veterinary teaching hospital. ANIMALS: Forty-five client-owned dogs with SHP were screened for HF. Eighteen HF dogs treated surgically were studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Dogs with SHP and evidence of shock admitted for surgical control of hemorrhage were screened for HF. Blood samples were collected for PCV, total plasma protein, platelet count, and thromboelastography with 50 U/mL of tissue plasminogen activator at presentation and every 8 hours postoperatively until 72 hours, discharge, or death. HF was defined as a tissue plasminogen activator-activated thromboelastography lysis percentage measured 30 minutes after maximum amplitude (LY30) of ≥20%. LY30 values were compared to a cohort of samples obtained from healthy dogs (n = 22). The point prevalence of HF in all dogs screened was 40% (18/45 dogs), and the mean LY30 at baseline for HF dogs was 48.9% (±24.2%), which was significantly higher than that of control dogs (4.8% ± 7.1%, P < 0.001) and non-HF dogs (1.9% ± 5.7%, P < 0.001). In HF dogs, there was a significant decrease in LY30 between baseline and 8 hours (P < 0.0001) and between 8 and 16 hours (P = 0.035) but no significant change thereafter. LY30 at 8 hours (4%, range: 0%-23.4%) was not statistically different from control dogs (6.5%, range: 1.2%-32.8%, P = 0.664) suggesting early resolution of HF in this population. Only 2 of 18 dogs were persistently hyperfibrinolytic at 24 hours. Malignancy was diagnosed in 12 of 18 dogs (66.6%), while a benign etiology occurred in 6 of 18 dogs (33.3%). All HF dogs survived to discharge. CONCLUSIONS: HF occurs in some dogs with hypovolemic shock due to hemoperitoneum but resolves rapidly following surgical control of bleeding without antifibrinolytic medications. Routine postoperative use of antifibrinolytics in dogs with hemoperitoneum in dogs undergoing surgical control of bleeding may not be warranted.
Subject(s)
Antifibrinolytic Agents , Blood Coagulation Disorders , Dog Diseases , Shock , Dogs , Animals , Hemoperitoneum/surgery , Hemoperitoneum/veterinary , Hemoperitoneum/complications , Tissue Plasminogen Activator , Hospitals, Animal , Fibrinolysis , Hospitals, Teaching , Blood Coagulation Disorders/veterinary , Thrombelastography/veterinary , Shock/veterinary , Dog Diseases/surgeryABSTRACT
OBJECTIVE: To determine if human automated external defibrillators (AEDs) could successfully record cardiac electrical activity in dogs, make appropriate recommendations regarding shock delivery, and characterize skin preparation required for a readable ECG based on dog haircoat characteristics. DESIGN: Prospective study of AED use in dogs conducted between January and March 2021. SETTING: University teaching hospital. ANIMALS: Three groups of client-owned dogs were evaluated. Group 1 consisted of 23 healthy dogs with sinus rhythms, group 2 consisted of 9 dogs with documented cardiac arrhythmias, and group 3 consisted of 9 dogs receiving CPR following naturally occurring cardiopulmonary arrest. MATERIALS AND METHODS: Haircoat characteristics and clipping or ECG paste required to obtain a readable ECG were recorded. The time interval from a readable ECG by the investigator until AED shock advisement was measured. Correctness of shock advice was recorded. Analyses were performed using commercial statistical software. P-values <0.05 were considered significant. RESULTS: The attending veterinarian judged the ECG on the AED to be readable in all dogs. Time to shock advisement in all dogs was median 18 (range: 7-180) seconds. Dogs with heavy, long, or double haircoats required clipping in 24 of 27 (89%) cases to obtain a readable ECG. ECG paste on the AED pad was required in 36 of 40 dogs (90%) in order to obtain a readable ECG. The AED advice for delivery of shock was appropriate in 51 of 52 (98%) queries of the machine across all groups. CONCLUSIONS: Human AEDs can successfully record cardiac electrical activity in dogs. AEDs appropriately recommend delivery of a shock most times, contingent on skin preparation. Dogs with double, long, or heavy haircoats should be clipped prior to pad application. ECG paste will aid AED reading in all haircoat types. Further investigation is warranted into AED use in dogs, particularly in general practices.
Subject(s)
Cardiopulmonary Resuscitation , Dog Diseases , Heart Arrest , Humans , Dogs , Animals , Prospective Studies , Defibrillators/veterinary , Heart Arrest/veterinary , Arrhythmias, Cardiac/veterinary , Cardiopulmonary Resuscitation/education , Cardiopulmonary Resuscitation/veterinary , Dog Diseases/therapyABSTRACT
OBJECTIVES: The aim of this study was to investigate a potential association between the COVID-19 pandemic stay-at-home orders and the prevalence of emergency room presentations for urethral obstruction (UO) in feline patients. METHODS: Medical records and hospital census were retrospectively searched to identify the total number of cats and total number of male cats with UO presenting to two academic veterinary medical centers from 22 March to 10 August in the years 2018 (123), 2019 (137) and 2020 (175). Cats were grouped based on the year of presentation and the proportions of UO cases relative to all cats presenting to the emergency rooms during the same time frame. Absolute (year of interest - reference year) and relative ([year of interest - reference year]/[reference year]) change in prevalence was determined. These were compared for each year using a two-sample z-test. RESULTS: The absolute and relative prevalence of UO presentations across the combined population increased significantly during the COVID-19 pandemic in comparison with 2018 (2.2% and 59%, respectively; P = 0.0003) and 2019 (1.9% and 48%, respectively; P = 0.0021). For the individual institutions, a significant increase in UO presentations was found for institution A when comparing 2020 with both 2018 (P = 0.0072) and 2019 (P = 0.0073), but not for institution B (P = 0.057 and P = 0.18, respectively). No significant differences were found when 2018 and 2019 were compared across the combined population or within institutions. CONCLUSIONS AND RELEVANCE: The results of this study demonstrate an increased prevalence of UO during the initial months of the COVID-19 pandemic, which may be related to environmental change and stress imposed by stay-at-home orders.
Subject(s)
COVID-19 , Cat Diseases , Urethral Obstruction , Cats , Animals , Male , Retrospective Studies , Pandemics , Prevalence , Universities , COVID-19/epidemiology , COVID-19/veterinary , Urethral Obstruction/epidemiology , Urethral Obstruction/veterinaryABSTRACT
OBJECTIVE: To describe the clinical outcome of dogs that developed pneumothorax after an encounter with a porcupine. ANIMALS: 25 client-owned dogs from 2 practices in New England. PROCEDURES: The medical records were searched for those of dogs that underwent care for porcupine quilling-associated pneumothorax (PQAP) between August 1, 2001, and October 15, 2023. Dogs were all large-breed dogs or large mixed-breed dogs and most frequently had clinical signs associated with pneumothorax, including labored breathing and tachypnea. RESULTS: No cases occurred in winter months. Diagnostic imaging was useful for identifying pneumothorax, but not for localizing quills. Twenty-one of the 25 dogs underwent median sternotomy for quill removal, with quills found in lung tissue of 19 dogs. Two dogs had no intrathoracic quills identified at thoracotomy, but residual quills were identified in the intercostal muscles. Four dogs were discharged without surgery after apparent resolution of the pneumothorax. All dogs survived to hospital discharge; however, 5 dogs required subsequent quill removal from ongoing quill migration. CLINICAL RELEVANCE: Porcupine quillings may result in traumatic pneumothorax associated with quill migration. Following quill removal, monitoring for the development of a pneumothorax is advised. Surgical removal of quills from the lungs has a good prognosis.
Subject(s)
Dog Diseases , Pneumothorax , Porcupines , Thoracic Injuries , Dogs , Animals , Pneumothorax/etiology , Pneumothorax/surgery , Pneumothorax/veterinary , Thoracic Injuries/surgery , Thoracic Injuries/veterinary , Sternotomy/veterinary , Thoracotomy/veterinary , Dog Diseases/surgery , Dog Diseases/diagnosisABSTRACT
OBJECTIVE: To introduce the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR registry and report cardiopulmonary arrest (CPA) and CPR event data collected to date. DESIGN: International, multi-institutional veterinary CPR registry data report. SETTING: Veterinary private practice and university teaching hospitals. ANIMALS: Data from 514 dogs and 195 cats undergoing CPR entered in the RECOVER CPR registry between February 2016 and November 2021. INTERVENTIONS: The RECOVER CPR registry is an online medical database created for standardized collection of hospital, animal, arrest, and outcome information on dogs and cats undergoing CPR. Data were collected according to the veterinary Utstein-style guidelines for standardized reporting of in-hospital CPR in dogs and cats. Case records were downloaded, duplicate and incomplete cases were removed, and summary descriptive data were reported. MEASUREMENTS AND MAIN RESULTS: Sixteen hospitals in the United States, Europe, and Australia contributed data on 709 CPR events to the registry. One hundred and forty-two (28%) dogs and 58 (30%) cats attained return of spontaneous circulation (ROSC), 62 (12%) dogs and 25 (13%) cats had ROSC >20 minutes, and 14 (3%) dogs and 4 (2%) cats survived to hospital discharge. The reason for CPR discontinuation was reported as owner choice in 321 cases (63%). The most common suspected causes for CPA were respiratory failure (n = 142, 20%), heart failure (n = 86, 12%), and hemorrhage (n = 76, 11%). CONCLUSION: The RECOVER CPR registry contains the first multicenter data set on small animal CPR. It confirms poor outcomes associated with CPA, emphasizing the need for large-sized studies to gain adequate information on characteristics associated with favorable outcomes.
Subject(s)
Cardiopulmonary Resuscitation , Cat Diseases , Dog Diseases , Heart Arrest , Cats , Animals , Dogs , United States , Cardiopulmonary Resuscitation/veterinary , Cat Diseases/therapy , Dog Diseases/therapy , Heart Arrest/therapy , Heart Arrest/veterinary , Registries , Hospitals, TeachingABSTRACT
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.
Subject(s)
Cat Diseases , Dog Diseases , Cats , Animals , Dogs , Cat Diseases/therapy , Quality of Life , Dog Diseases/therapyABSTRACT
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.
Subject(s)
Dog Diseases , Dogs , Animals , Male , Grooming , Dog Diseases/etiology , Dog Diseases/surgery , Eyelids , Retrospective StudiesABSTRACT
The viscoelastic coagulation monitor (VCM) is described as a point-of-care analyzer relying on activation of fresh whole blood (FWB) via contact between 2 glass plates. Kaolin is used as an activator in thromboelastography to reduce variability and shorten clotting times. The goal of this study was to compare VCM results from kaolin-activated, recalcified citrated samples with that from FWB. The VCM testing was performed using FWB and kaolin-activated, recalcified citrated samples. The VCM results were recorded for clot time (CT; seconds), clot formation time (CFT; seconds), alpha (degree), amplitude at 10 and 20 minutes (A10 and A20; VCM units), maximum clot firmness (MCF; VCM units), and lysis index (LI; %). Values were compared using a t-test or Wilcoxon-Mann-Whitney test, with a P-value < 0.05 considered significant. Variability between samples was calculated using Levene's test. The VCM kaolin activation resulted in significantly faster CT and CFT (P < 0.0001), higher alpha angle (P < 0.001), and higher A10 and A20 (P = 0.007, P = 0.015) compared to FWB. There was no difference in MCF, LI30, or LI45. There was no difference in variability identified. The addition of kaolin to recalcified citrated whole blood VCM samples results in more rapid clotting of FWB alone and could be considered for clinical use in dogs.
Le moniteur de coagulation viscoélastique (VCM) évalue l'hémostase au point de service en utilisant du sang entier frais activé au contact de deux disques de verre. Le kaolin est un activateur utilisé en thromboélastographie pour réduire la variabilité et raccourcir le temps de coagulation.Le but de cette étude était de comparer les résultats du VCM obtenus sur des échantillons citratés recalcifiés et activés par du kaolin, avec ceux obtenus sur sang entier frais. Les échantillons sanguins ont été prélevés sur des chiens sains. Les tests avec le VCM ont été réalisés sur des échantillons de sang entier frais et sur des échantillons de sang citraté recalcifié et activé par du kaolin. Les résultats du VCM ont été enregistrés : temps de coagulation (CT; secondes), temps de formation du caillot (CFT; secondes), angle alpha (degrés), amplitude à 10 et 20 minutes (A10 et A20; unités VCM), fermeté maximale du caillot (MCF; unités VCM), index de lyse à 30 et 45 minutes après la MCF (LI; pourcentage). Les valeurs ont été comparées à l'aide d'un un test t apparié ou un test de Wilcoxon-Mann-Whitney, avec une valeur P < 0,05 considérée comme significative. La variabilité entre les échantillons a été calculée à l'aide d'un test de Levene.Les résultats du VCM réalisé sur les échantillons activés par du kaolin présentaient une diminution significative du CT et CFT (P < 0,0001) ainsi qu'une augmentation significative de l'angle alpha (P < 0,001) et de A10 et A20 (P = 0,007, P = 0,015). Aucune différence n'a été démontrée dans la MCF, l'index LI30 ou LI45. Aucune différence de variabilité n'a été identifiée.L'ajout du kaolin aux échantillons VCM de sang entier citraté recalcifié aboutit à une activation de la coagulation plus rapide que par simple contact avec les disques de verre et pourrait être envisagé pour l'usage clinique chez le chien.(Traduit par les auteurs).
Subject(s)
Kaolin , Point-of-Care Systems , Animals , Benzeneacetamides , Blood Coagulation , Blood Coagulation Tests/methods , Blood Coagulation Tests/veterinary , Citrates , Citric Acid , Dogs , Kaolin/pharmacology , Piperidones , Thrombelastography/methods , Thrombelastography/veterinaryABSTRACT
A mixed breed dog was treated for severe hemolytic anemia secondary to Babesia canis infection. Within 14 hours of hospitalization, the dog developed respiratory distress and hypoxemia. The patient improved with lung-protective mechanical ventilation and neuromuscular blockade. The dog survived to discharge and was reportedly healthy at three-month follow-up.
ABSTRACT
OBJECTIVES: To systematically review available evidence and establish guidelines related to the use of thrombolytics for the management of small animals with suspected or confirmed thrombosis. DESIGN: PICO (Population, Intervention, Control, and Outcome) questions were formulated, and worksheets completed as part of a standardized and systematic literature evaluation. The population of interest included dogs and cats (considered separately) and arterial and venous thrombosis. The interventions assessed were the use of thrombolytics, compared to no thrombolytics, with or without anticoagulants or antiplatelet agents. Specific protocols for recombinant tissue plasminogen activator were also evaluated. Outcomes assessed included efficacy and safety. Relevant articles were categorized according to level of evidence, quality, and as to whether they supported, were neutral to, or opposed the PICO questions. Conclusions from the PICO worksheets were used to draft guidelines, which were subsequently refined via Delphi surveys undertaken by the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) working group. RESULTS: Fourteen PICO questions were developed, generating 14 guidelines. The majority of the literature addressing the PICO questions in dogs is experimental studies (level of evidence 3), thus providing insufficient evidence to determine if thrombolysis improves patient-centered outcomes. In cats, literature was more limited and often neutral to the PICO questions, precluding strong evidence-based recommendations for thrombolytic use. Rather, for both species, suggestions are made regarding considerations for when thrombolytic drugs may be considered, the combination of thrombolytics with anticoagulant or antiplatelet drugs, and the choice of thrombolytic agent. CONCLUSIONS: Substantial additional research is needed to address the role of thrombolytics for the treatment of arterial and venous thrombosis in dogs and cats. Clinical trials with patient-centered outcomes will be most valuable for addressing knowledge gaps in the field.