Lindsay M. Kellett-Gregory

The clinical practice of CPCR in small animals: an internet-based survey.

OBJECTIVE To characterize the provision of CPCR by small animal veterinarians in clinical practice and to assess how this practice varies among different levels of expertise. DESIGN Internet-based survey. SETTING Academia, referral practice, and general practice. SUBJECTS Six hundred and two small animal veterinarians in clinical practice. Respondents were grouped a priori according to level of expertise: board-certified (ACVECC, ACVA, ECVAA) specialists; general practitioners in emergency clinics; general practitioners in general practice (GPG). INTERVENTIONS Email invitations to the online questionnaire were disseminated via a veterinary internet platform and mailing list server discussion groups. Questions explored respondent characteristics, CPCR preparedness, infrastructural and personnel resources, and techniques of basic and advanced life support. MAIN RESULTS In this group of practitioners, the majority (65%) were in general practice. GPG were more likely to perform CPCR <5 times per year and to have 3 or fewer members on their resuscitation team. Most practitioners have a crash cart and drug-dosing chart available. GPG were less likely to obtain resuscitation codes on their patients, and less likely to use end-tidal carbon dioxide monitoring or defibrillation. Intubation, oxygen supplementation, vascular access, and external thoracic compressions were widely used, however, GPG were more likely to use lower chest compression rates. Drugs used for CPCR differed among the groups with GPG more likely to use doxapram and glucocorticoids. CONCLUSIONS CPCR is heterogeneously performed in small animal veterinary medicine; differences exist, both among and within different types of veterinarians with varying levels of expertise, in respect to available infrastructure, personnel and CPCR techniques used.

Autologous canine red blood cell transfusion using cell salvage devices

Objective To describe the use of automated blood salvage devices for autotransfusion in dogs. Technique Blood salvage devices can be used to collect blood from the intraoperative surgical field or postsurgical drainage sites. The salvage device washes cells in 0.9% saline, removing plasma proteins, other cellular components, and activators of coagulation and inflammation. Washed red blood cells may be safely returned to the patient, minimizing the need for allogeneic blood transfusions. Significance Blood salvage has been safely used in human medicine for decades and is feasible in veterinary medicine. Potential advantages include reduced reliance on banked blood for massive transfusions and minimization of morbidities associated with the use of allogeneic and stored blood products. Concerns about the safety of salvaged blood have been largely dispelled in human medicine but further investigation regarding the safety of such procedures in veterinary patients is warranted.OBJECTIVE To describe the use of automated blood salvage devices for autotransfusion in dogs. TECHNIQUE Blood salvage devices can be used to collect blood from the intraoperative surgical field or postsurgical drainage sites. The salvage device washes cells in 0.9% saline, removing plasma proteins, other cellular components, and activators of coagulation and inflammation. Washed red blood cells may be safely returned to the patient, minimizing the need for allogeneic blood transfusions. SIGNIFICANCE Blood salvage has been safely used in human medicine for decades and is feasible in veterinary medicine. Potential advantages include reduced reliance on banked blood for massive transfusions and minimization of morbidities associated with the use of allogeneic and stored blood products. Concerns about the safety of salvaged blood have been largely dispelled in human medicine but further investigation regarding the safety of such procedures in veterinary patients is warranted.

Plasma lactate concentrations in septic peritonitis: A retrospective study of 83 dogs (2007–2012)

Objective To determine if absolute plasma lactate concentration or lactate clearance in dogs with septic peritonitis is associated with morbidity or mortality. Design Retrospective cohort study from 2007 to 2012. Setting University teaching hospital. Animals Eighty-three dogs with septic peritonitis were included. Patients had at least 1 plasma lactate measurement during the course of the hospitalization. Results Sixty-four percent of the patients survived to discharge, 22% were euthanized, and 14% died during hospitalization. Plasma lactate concentration >2.5 mmol/L on admission (29% of the patients) was associated with mortality (P = 0.001). Median admission plasma lactate concentration (n = 81) was significantly different between nonsurvivors (2.5 mmol/L, range 0.5–8.4) and survivors (1.4 mmol/L, range 0.5–9.7; P = 0.007). Admission plasma lactate concentration >4 mmol/L yielded a sensitivity of 36% and a specificity of 92% for nonsurvival. The inability to normalize plasma lactate concentration within 6 hours of admission (n = 10/24) yielded a sensitivity of 76% and specificity of 100% for nonsurvival. Postoperative hyperlactatemia (plasma lactate concentration >2 mmol/L; n = 18/76) had a sensitivity of 46% and specificity of 88% for nonsurvival. Persistent postoperative hyperlactatemia (n = 11/18) had a sensitivity of 92% and a specificity of 100% for nonsurvival. Lactate clearance less than 21% at 6 hours (n = 20) had a sensitivity of 54% and specificity of 91% for nonsurvival. Lactate clearance less than 42% at 12 hours (n = 18) had a sensitivity of 82% and a specificity of 100% for nonsurvival. Conclusions Admission plasma lactate concentration and lactate clearance were good prognostic indicators in dogs with septic peritonitis.OBJECTIVE To determine if absolute plasma lactate concentration or lactate clearance in dogs with septic peritonitis is associated with morbidity or mortality. DESIGN Retrospective cohort study from 2007 to 2012. SETTING University teaching hospital. ANIMALS Eighty-three dogs with septic peritonitis were included. Patients had at least 1 plasma lactate measurement during the course of the hospitalization. RESULTS Sixty-four percent of the patients survived to discharge, 22% were euthanized, and 14% died during hospitalization. Plasma lactate concentration >2.5 mmol/L on admission (29% of the patients) was associated with mortality (P = 0.001). Median admission plasma lactate concentration (n = 81) was significantly different between nonsurvivors (2.5 mmol/L, range 0.5-8.4) and survivors (1.4 mmol/L, range 0.5-9.7; P = 0.007). Admission plasma lactate concentration >4 mmol/L yielded a sensitivity of 36% and a specificity of 92% for nonsurvival. The inability to normalize plasma lactate concentration within 6 hours of admission (n = 10/24) yielded a sensitivity of 76% and specificity of 100% for nonsurvival. Postoperative hyperlactatemia (plasma lactate concentration >2 mmol/L; n = 18/76) had a sensitivity of 46% and specificity of 88% for nonsurvival. Persistent postoperative hyperlactatemia (n = 11/18) had a sensitivity of 92% and a specificity of 100% for nonsurvival. Lactate clearance less than 21% at 6 hours (n = 20) had a sensitivity of 54% and specificity of 91% for nonsurvival. Lactate clearance less than 42% at 12 hours (n = 18) had a sensitivity of 82% and a specificity of 100% for nonsurvival. CONCLUSIONS Admission plasma lactate concentration and lactate clearance were good prognostic indicators in dogs with septic peritonitis.

Comparison of computed tomography pulmonary angiography and point-of-care tests for pulmonary thromboembolism diagnosis in dogs

Objectives To evaluate the feasibility of CT pulmonary angiography for identification of naturally occurring pulmonary thromboembolism in dogs using predefined diagnostic criteria and to assess the ability of echocardiography, cardiac troponins, D-dimers and kaolin-activated thromboelastography to predict the presence of pulmonary thromboembolism in dogs. Methods Twelve dogs with immune-mediated haemolytic anaemia and evidence of respiratory distress were prospectively evaluated. Dogs were sedated immediately before CT pulmonary angiography using intravenous butorphanol. Spiral CT pulmonary angiography was performed with a 16 detector-row CT scanner using a pressure injector to infuse contrast media through peripheral intravenous catheters. Pulmonary thromboembolism was diagnosed using predefined criteria. Contemporaneous tests included echocardiography, arterial blood gas analysis, kaolin-activated thromboelastography, D-dimers and cardiac troponins. Results Based on predefined criteria, four dogs were classified as pulmonary thromboembolism positive, three dogs were suspected to have pulmonary thromboembolism and the remaining five dogs had negative scans. The four dogs identified with pulmonary thromboembolism all had discrete filling defects in main or lobar pulmonary arteries. None of the contemporaneous tests was discriminant for pulmonary thromboembolism diagnosis, although the small sample size was limiting. Clinical Significance CT pulmonary angiography can be successfully performed in dogs under sedation, even in at-risk patients with respiratory distress and can both confirm and rule out pulmonary thromboembolism in dogs.

Lycoperdonosis in Two Dogs

Lycoperdonosis is a rare respiratory disease that results from the inhalation of spores released from the Lycoperdon (puffball) mushroom. In the present study, 2 cases of confirmed canine lycoperdonosis are described. The first case presented to the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, and the second case was submitted for postmortem examination to the University of Tennessee Veterinary Teaching Hospital. Both dogs presented in respiratory distress, and owners reported that the dogs had been playing or digging in areas with puffball mushrooms prior to the onset of clinical signs. In the initial case, thoracic radiographs revealed a diffuse interstitial and multifocal alveolar pulmonary pattern. Despite aggressive medical treatment and mechanical ventilation, the dog continued to worsen and was euthanized. Postmortem examination revealed firm lung lobes and enlarged tracheobronchial lymph nodes. Histologically, there was a severe diffuse histiocytic and pyogranulomatous bronchointerstitial pneumonia. Throughout the lung and lymph nodes, most commonly within macrophages, were round, 3–5μm in diameter, Gomori methenamine silver—positive structures, consistent with Lycoperdon spores. An approximately 750–base pair DNA fragment was amplified from lung of both cases by polymerase chain reaction using primers specific to yeast ribosomal DNA, and the sequence of the fragment was determined to be most closely related to Lycoperdon pyriforme. Importantly, reexamination of an endotracheal wash from the initial case revealed intrahistiocytic spores, suggesti

Ionized calcium concentrations in cats with septic peritonitis: 55 cases (1990-2008).

OBJECTIVE To report the prevalence of ionized hypocalcemia (iHCa) in cats with septic peritonitis, and to determine whether hypocalcemic cats had increased morbidity and mortality when compared with normocalcemic cats. DESIGN Retrospective clinical study. SETTING University teaching hospital. ANIMALS Fifty-five client-owned cats with septic peritonitis. MEASUREMENTS Medical records of 55 cats with confirmed septic peritonitis meeting the study inclusion criteria were reviewed. Information obtained included signalment, cause of peritonitis, length of hospitalization (LOH), length of ICU stay, and outcome. Results from serum biochemical analysis, blood gas analysis, and coagulation testing from the time of diagnosis, and all ionized calcium (iCa) measurements during hospitalization were recorded. Systolic blood pressure, the presence of arrhythmias and administration of vasopressor agents, blood products, and sodium bicarbonate were documented. iCa concentration at the time of diagnosis and lowest recorded value during hospitalization were compared with LOH and length of ICU stay, survival to hospital discharge, and clinical and clinicopathologic data. MAIN RESULTS iHCa (iCa<1.20 mmol/L) was found in 89% of cats (49/55) at the time of diagnosis of septic peritonitis and 93% (51/55) at any time during hospitalization. There was no association between the presence or severity of iHCa at diagnosis and survival to hospital discharge. LOH (P=0.046) and duration of ICU stay (P=0.026) were significantly correlated with the lowest iCa recorded during hospitalization. Failure to normalize iCa during hospitalization was associated with a decreased survival rate to discharge (P=0.029) in patients with iHCa. iHCa was not associated with an increased prevalence of hypotension, coagulopathy, arrhythmias, or evaluated therapies. CONCLUSIONS iHCa is more prevalent in cats with septic peritonitis than described previously. Failure of iCa to normalize during hospitalization may be a negative prognostic indicator. iHCa may be predictive of a longer LOH and ICU stay, but is not necessarily associated with a poorer prognosis.

Retrospective Study: Ionized calcium concentrations in cats with septic peritonitis: 55 cases (1990–2008)

OBJECTIVE To report the prevalence of ionized hypocalcemia (iHCa) in cats with septic peritonitis, and to determine whether hypocalcemic cats had increased morbidity and mortality when compared with normocalcemic cats. DESIGN Retrospective clinical study. SETTING University teaching hospital. ANIMALS Fifty-five client-owned cats with septic peritonitis. MEASUREMENTS Medical records of 55 cats with confirmed septic peritonitis meeting the study inclusion criteria were reviewed. Information obtained included signalment, cause of peritonitis, length of hospitalization (LOH), length of ICU stay, and outcome. Results from serum biochemical analysis, blood gas analysis, and coagulation testing from the time of diagnosis, and all ionized calcium (iCa) measurements during hospitalization were recorded. Systolic blood pressure, the presence of arrhythmias and administration of vasopressor agents, blood products, and sodium bicarbonate were documented. iCa concentration at the time of diagnosis and lowest recorded value during hospitalization were compared with LOH and length of ICU stay, survival to hospital discharge, and clinical and clinicopathologic data. MAIN RESULTS iHCa (iCa<1.20 mmol/L) was found in 89% of cats (49/55) at the time of diagnosis of septic peritonitis and 93% (51/55) at any time during hospitalization. There was no association between the presence or severity of iHCa at diagnosis and survival to hospital discharge. LOH (P=0.046) and duration of ICU stay (P=0.026) were significantly correlated with the lowest iCa recorded during hospitalization. Failure to normalize iCa during hospitalization was associated with a decreased survival rate to discharge (P=0.029) in patients with iHCa. iHCa was not associated with an increased prevalence of hypotension, coagulopathy, arrhythmias, or evaluated therapies. CONCLUSIONS iHCa is more prevalent in cats with septic peritonitis than described previously. Failure of iCa to normalize during hospitalization may be a negative prognostic indicator. iHCa may be predictive of a longer LOH and ICU stay, but is not necessarily associated with a poorer prognosis.

Monitoring small animal patients in the intensive care unit

All patients in an intensive care unit (ICU) have instability in at least one of the major body systems (cardiovascular, neurological and respiratory systems) or the potential for this to develop. If these systems are not functioning appropriately, death can result. The aim of intensive care is therefore to prevent this by monitoring for, recognising and treating any instability. This article focuses on when intensive care is required and how to monitor a patient in the ICU effectively.

Retrospective Study: Ionized calcium concentrations in cats with septic peritonitis: 55 cases (1990-2008): Hypocalcemia in cats with septic peritonitis

OBJECTIVE To report the prevalence of ionized hypocalcemia (iHCa) in cats with septic peritonitis, and to determine whether hypocalcemic cats had increased morbidity and mortality when compared with normocalcemic cats. DESIGN Retrospective clinical study. SETTING University teaching hospital. ANIMALS Fifty-five client-owned cats with septic peritonitis. MEASUREMENTS Medical records of 55 cats with confirmed septic peritonitis meeting the study inclusion criteria were reviewed. Information obtained included signalment, cause of peritonitis, length of hospitalization (LOH), length of ICU stay, and outcome. Results from serum biochemical analysis, blood gas analysis, and coagulation testing from the time of diagnosis, and all ionized calcium (iCa) measurements during hospitalization were recorded. Systolic blood pressure, the presence of arrhythmias and administration of vasopressor agents, blood products, and sodium bicarbonate were documented. iCa concentration at the time of diagnosis and lowest recorded value during hospitalization were compared with LOH and length of ICU stay, survival to hospital discharge, and clinical and clinicopathologic data. MAIN RESULTS iHCa (iCa<1.20 mmol/L) was found in 89% of cats (49/55) at the time of diagnosis of septic peritonitis and 93% (51/55) at any time during hospitalization. There was no association between the presence or severity of iHCa at diagnosis and survival to hospital discharge. LOH (P=0.046) and duration of ICU stay (P=0.026) were significantly correlated with the lowest iCa recorded during hospitalization. Failure to normalize iCa during hospitalization was associated with a decreased survival rate to discharge (P=0.029) in patients with iHCa. iHCa was not associated with an increased prevalence of hypotension, coagulopathy, arrhythmias, or evaluated therapies. CONCLUSIONS iHCa is more prevalent in cats with septic peritonitis than described previously. Failure of iCa to normalize during hospitalization may be a negative prognostic indicator. iHCa may be predictive of a longer LOH and ICU stay, but is not necessarily associated with a poorer prognosis.