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Objective: To evaluate the variability in arterial blood gas (ABG) assessment of pulmonary function with different body positioning in dogs with suspected aspiration pneumonia. Key Findings: The median differences in alveolar–arterial gradient, Pao2, and Paco2 values in different recumbencies were not statistically significantly different, both within patients and across the study population. No difference was noted in ABG values in the subgroups with unilateral or bilateral disease or that were more affected on the right side versus the left side. Significance: This preliminary study provides data that can be used to calculate appropriate sample sizes for subsequent studies investigating the impact of recumbency on pulmonary function in patients with aspiration pneumonia. [ABSTRACT FROM AUTHOR]

Background: New drugs for veterinary patients with acute respiratory distress syndrome (ARDS) are urgently needed. Early or late postinfection treatment of influenza‐infected mice with the liponucleotide cytidine diphosphocholine (CDP‐choline) resulted in decreased hypoxemia, pulmonary edema, lung dysfunction, and inflammation without altering viral replication. These findings suggested CDP‐choline could have benefit as adjunctive treatment for ARDS in veterinary patients (VetARDS). Objectives: Determine if parenterally administered CDP‐choline can attenuate mild VetARDS in dogs with aspiration pneumonia. Animals: Dogs admitted to a veterinary intensive care unit (ICU) for aspiration pneumonia. Methods: Subjects were enrolled in a randomized, double‐blinded, placebo‐controlled trial of treatment with vehicle (0.1 mL/kg sterile 0.9% saline, IV; n = 8) or CDP‐choline (5 mg/kg in 0.1 mL/kg 0.9% saline, IV; n = 9) q12h over the first 48 hours after ICU admission. Results: No significant differences in signalment or clinical findings were found between placebo‐ and CDP‐choline‐treated dogs on admission. All dogs exhibited tachycardia, tachypnea, hypertension, hypoxemia, hypocapnia, lymphopenia, and neutrophilia. CDP‐choline administration resulted in rapid, progressive, and clinically relevant increases in oxygenation as determined by pulse oximetry and ratios of arterial oxygen partial pressure (PaO2 mmHg) to fractional inspired oxygen (% FiO2) and decreases in alveolar‐arterial (A‐a) gradients that did not occur in placebo (saline)‐treated animals. Treatment with CDP‐choline was also associated with less platelet consumption over the first 48 hours, but had no detectable detrimental effects. Conclusions and Clinical Importance: Ctyidine diphosphcholine acts rapidly to promote gas exchange in dogs with naturally occurring aspiration pneumonia and is a potential adjunctive treatment in VetARDS patients. [ABSTRACT FROM AUTHOR]

Objective: To examine geriatric classification as a predictor of survival in moderate to severely injured dogs denoted by animal trauma triage (ATT) scores ≥3 or modified Glasgow Coma Scale (mGCS) scores ≤14. Design: Retrospective observational cohort study utilizing data collected between September 2013 and May 2019 with follow‐up until death or hospital discharge. Setting: Thirty‐one trauma centers including university teaching hospitals and private referral centers. Animals: A total of 6169 dogs entered into the Veterinary Committee on Trauma Registry with complete data entry including age, weight, outcome, mGCS (≤14), and/or ATT (≥3). Interventions: None. Measurements and Main Results: The effect of geriatric classification on survival was estimated using shared‐frailty cox proportional hazard models. Model 1 dependent variables: death despite intervention or euthanasia due to grave prognosis. Model 2 dependent variables: death by euthanasia due to financial influence or combined influence of finances and grave prognosis. Model 3 evaluated interactions between geriatric classification and moderate versus severe trauma. The shared‐frailty models controlled for contributing site as a random effect and other confounding variables, including trauma severity. Model 1: geriatrics had a significantly increased hazard risk (HR) for death (HR = 1.48, P < 0.0001). Model 2: geriatrics had an insignificant increased HR for death (HR = 1.34, P = 0.08). Model 3: geriatrics demonstrated significantly increased mortality risk with moderate level trauma. Additional Model 1 variables independently associated with mortality include ATT perfusion, neurologic, respiratory subscores, mGCS motor subscore, weight, and spinal trauma. Additional Model 2 variables independently associated with mortality include ATT perfusion subscore and neuter status. In general, statistical differences between cohorts were found with regard to lactate, PCV, total protein, and glucose. Conclusions: Among moderately injured dogs who experienced death despite intervention or euthanasia due to grave prognosis, mortality risk is significantly higher in geriatrics as compared to nongeriatrics. [ABSTRACT FROM AUTHOR]

Background: Reduced pelvic limb reflexes in dogs with spinal cord injury typically suggests a lesion of the L4‐S3 spinal cord segments. However, pelvic limb reflexes might also be reduced in dogs with a T3‐L3 myelopathy and concurrent spinal shock. Hypothesis/Objectives: We hypothesized that statistical models could be used to identify clinical variables associated with spinal shock in dogs with spinal cord injuries. Animals: Cohort of 59 dogs with T3‐L3 myelopathies and spinal shock and 13 dogs with L4‐S3 myelopathies. Methods: Data used for this study were prospectively entered by partner institutions into the International Canine Spinal Cord Injury observational registry between October 2016 and July 2019. Univariable logistic regression analyses were performed to assess the association between independent variables and the presence of spinal shock. Independent variables were selected for inclusion in a multivariable logistic regression model if they had a significant effect (P ≤.1) on the odds of spinal shock in univariable logistic regression. Results: The final multivariable model included the natural log of weight (kg), the natural log of duration of clinical signs (hours), severity (paresis vs paraplegia), and pelvic limb tone (normal vs decreased/absent). The odds of spinal shock decreased with increasing weight (odds ratio [OR] = 0.28, P =.09; confidence interval [CI] 0.07‐1.2), increasing duration (OR = 0.44, P =.02; CI 0.21‐0.9), decreased pelvic limb tone (OR = 0.04, P =.003; CI 0.01‐0.36), and increased in the presence of paraplegia (OR = 7.87, P =.04; CI 1.1‐56.62). Conclusions and Clinical Importance: A formula, as developed by the present study and after external validation, could be useful for assisting clinicians in determining the likelihood of spinal shock in various clinical scenarios and aid in diagnostic planning. [ABSTRACT FROM AUTHOR]

A 3‐year‐old spayed female Siberian Husky presented for evaluation following ingestion of approximately 429 mg/kg of lamotrigine extended‐release. She demonstrated severe neurologic and cardiac signs and was treated with lipid emulsion, anticonvulsants, antiarrhythmics and aggressive decontamination and supportive care. She was successfully discharged from the hospital 5 days later. [ABSTRACT FROM AUTHOR]

Objective: To evaluate characteristics of septic shock patients treated with hydrocortisone (HC) due to suspicion of critical illness–related corticosteroid insufficiency (CIRCI) as compared to septic shock patients without suspicion of CIRCI. Design: Retrospective study between February 2010 and October 2017. Setting: University teaching hospital ICU. Animals: Data were collected for 47 dogs with septic shock. Twenty‐one dogs were treated with HC (HC‐treated) due to suspicion of CIRCI. Twenty‐six dogs did not receive HC (non‐HC‐treated). Interventions: HC was administered either as an intermittent IV bolus or as a constant rate infusion (CRI) to those patients with suspected CIRCI. Measurements and main results: Significantly higher baseline APPLEfull scores and predicted mortality were detected in the HC‐treated patients compared to non‐HC‐treated patients (0.87 vs 0.44 for predicted mortality, P = 0.039). Patients in the HC‐treated group were on more vasopressors and cardiotonics than those in the non‐HC‐treated group (2.5 vs 1.5, P <0.001). All patients initially responded to vasopressor administration, with average time to resolution of hypotension being 90 minutes for the HC‐treated group compared to 60 minutes for the non‐HC‐treated group (P = 0.640). However, HC‐treated patients took significantly longer to have a sustained resolution (a systolic blood pressure > 90 mm Hg or a mean blood pressure > 65 mm Hg for at least 4 h) of their hypotension after starting vasopressors, as compared to their non‐HC‐treated counterparts (8.5 vs 4 h, P = 0.001). Three (14.3%) HC‐treated patients survived to discharge compared to 9 (34.6%) non‐HC‐treated patients, but this was not statistically significant. Conclusions: HC‐treated patients had a higher baseline risk of mortality than non‐HC‐treated patients. There was no significant difference in survival between the HC‐treated and non‐HC‐treated septic shock patients. Further studies are needed to evaluate the use of HC in patients with suspected CIRCI. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of cryopoor plasma (CPP) continuous rate infusion (CRI) on albumin concentration and colloid osmotic pressure (COP) in critically ill dogs with hypoalbuminemia. Design: Retrospective study between 2013 and 2015 with a 90‐day follow‐up on survivors. Setting: University teaching hospital. Animals: Ten hypoalbuminemic dogs receiving a CPP CRI for albumin replacement or oncotic support. All patients with documented hypoalbuminemia or low COP receiving CPP administration for albumin or oncotic support during the study period were included. Interventions: CRI of CPP. Measurements and Main Results: Mean age was 7.4 ± 4.5 years. Mean survival prediction index score was 0.66 ± 0.13. Seven dogs were septic, with 2 of 7 in septic shock and 5 of 7 having septic peritonitis. The mean pre‐ and postinfusion albumin was 15 ± 4 g/L and 21 ± 2 g/L, respectively. The median pre‐ and postinfusion COP was 8.6 mm Hg (4.9–9.7 mm Hg) and 10.2 mm Hg (8.1–13.3 mm Hg), respectively. The median duration of CRI was 16 hours (11–121 h). The mean CPP rate was 1.8 ± 0.6 mL/kg/h, the mean crystalloid rate administered concurrently was 0.8 ± 0.9 mL/kg/h, and the mean hydroxyethyl starch rate administered concurrently was 1.2 ± 0.9 mL/kg/h. The difference in pre‐ and postinfusion albumin was significantly correlated with CPP rate (P = 0.0004), whereas the difference in pre‐ and postinfusion COP was correlated with hydroxyethyl starch rate (P = 0.0128). Mean duration of hospitalization was 8.6 ± 3.9 days. Mann–Whitney U and Fisher's exact tests were used to compare survivors and nonsurvivors. Survivors were significantly younger than nonsurvivors (3.5 vs 11.5 y, P = 0.033). No side effects were reported. Survival to discharge was 40% with identical 90‐day survival. Of the nonsurvivors, 50% died naturally. Conclusions: There was an association between the rate of CPP and the change in albumin after CPP CRI in critically ill dogs, suggesting that CPP may be a viable option for treatment of hypoalbuminemia. [ABSTRACT FROM AUTHOR]

To evaluate the stability of canine and feline hemostatic proteins in freeze-thaw-cycled (FTC) fresh frozen plasma (FFP). Prospective study. Veterinary Teaching Hospital. Nine blood donor dogs and 10 blood donor cats. Whole blood was collected and separated into packed RBC and plasma units according to standard methods. Each unit of plasma was divided into 2 equal aliquots and frozen (−41°C). One aliquot from each donor (FTC) was then thawed and then refrozen (−41°C) until time of analysis. The second aliquot (nonfreeze-thaw-cycled; NFTC) remained frozen until time of analysis. The hemostatic proteins assessed included coagulation factors, anticoagulant factors (antithrombin and Protein C), and adhesive proteins (fibrinogen and von Willebrand Factor). The coagulant activities of factors II, VII, VIII, IX, X, XI, and XII were measured in modified one-stage activated partial thromboplastin time or prothrombin time assays. Antithrombin and Protein C activities were measured in chromogenic substrate assays. Clottable fibrinogen was measured via the Clauss method, and von Willebrand Factor concentration (vWF:Ag) was measured in an ELISA. A paired t-test was utilized to identify differences in factor activity or concentration between FTC FFP and NFTC FFP. No clinically or statistically significant differences (all P>0.05) were identified between FTC FFP and NFTC FFP. Refreezing FFP within 1 hour of initial thawing appeared to have no deleterious effects on the hemostatic protein activity or content of that unit. Transfusion of FTC FFP is expected to provide the recipient with comparable replacement of hemostatic proteins as FFP that has remained frozen. [ABSTRACT FROM AUTHOR]