Application of Airway Pressure Therapy in Veterinary Critical Care: Part I: Respiratory Mechanics and Hypoxemia

Over the past several decades, recognition of acute respiratory failure as the cause of death in patients suffering from various clinical conditions has prompted aggressiv investigation into the area of respiratory physiology and supportive respiratory care. With the evolution of emergency medicine and critical care services in both human and veterinary medicine, many patients previously considered unsalvageable due to the severity of their underlying disease are now being resuscitated and successfully supported, creating a new population of critically ill patients. Where only a decade ago these patients would have succumbed to their underlying disease, they now survive long enough to manifest the complications of shock and tissue injury in the form of acute respiratory failure. Investigation into the pathophysiology and treatment of this acute respiratory distress syndrom (ARDS) has facilitated increased clinical application of respiratory theerapy and machanical ventilation.¹ The purpose of this paper is to provide a basic review of respiratory mechanics and the pathophysiology of hypoxemia as they relate to airway pressure therapy in veterinary patients and to review the use of airway pressure therapy in veterinary patients This paper is divided into two parts; part I reviews respiratory mechanics and hypoxemia as they apply to respiratory therapy, while part II deals specifically with airway pressure therapy andits use in clinical cases.     

USE OF 123IODINE METAIODOBENZYLGUANIDINE SCINTIGRAPHY FOR THE DIAGNOSIS OF A PHEOCHROMOCYTOMA IN A DOG

A 13-year-old neutered female Yorkshire terrier presented with a history of progressive episodic weakness and disorientation of 4 months duration. Physical and neurologic examinations were normal at presentation. Abdominal ultrasound revealed a mass involving the right adrenal gland. Standard planar scintigraphy was performed at 4, 18, and 24 hours after intravenous injection 185 MBq (5mCi) of ¹²³I-labeled metaiodobenzylguanidine (¹²³I-MIBG). An area of focal intense uptake was identified in the area of the right adrenal gland. A pheochromocytoma was confirmed histologically after surgical excision.     

GI PiCO2: Tissue Specific Monitoring For Improving Patient Outcomes

Improvements in human patient monitoring despite their development in animals, do not always find their way into veterinary clinical use due to financial constraints. Gastrointestinal intraluminal CO₂ partial pressure (Gip₁CO₂) monitoring, however, is not only proving very beneficial in human trauma and critical patient care but is also very likely to become relatively inexpensive. By providing information on the perfusion adequacy of a high risk, critically important tissue, the GI mucosa, GI P₁CO₂ monitoring offers an easily accesible indicator of the efficacy and adequacy of resuscitative interventions. The potential for decreasing morbidity and mortality is enormous. Therefore, the practicing veterinarian should become familiar with GI P₁CO₂ monitoring theory and technology so he or she can be better prepared to incorporate it into practice when in becomes available.     

A Prospective Study Of Intravenous Catheter Contamination

A one year prospective study was conducted to determine the association between intravenous catheter contamination and increased dwell time, and to identify any related risk factors. Intravenous catheters obtained from 23 cats and 98 dogs in the Intensive Care Unit at the Ontario Veterinary College with dwell times > 72 hours for the test group (n=58) and < 72 hours for a corresponding control group (n=63) were cultured between April 1991 and March 1992. One hundred and twenty one catheters were cultured, 16 jugular, 99 cephalic, and 6 saphenous. The overall contamination rate was 13 out of 121 catheters cultured (10.7%); 9/63 (14.3%) control and 4/58 (6.9%) test catheters. The bacteria isolated were E.aerogenes, S.aureus (3), P.aeruginosa, P.multocida, and Bacillus sp (7). The Bacillus sp positive catheters (5 control and 2 test) were placed during a five day period, and contaminated gauze squares were identified as the source of infection in these catheters. After these were removed from the study, the group infection rate was 6.9% control and 3.6% test. There was no significant difference between groups and no associated risk factors were identified. We conclude that intravenous dwell time need not be restricted to <72 hours.     

Application of Airway Pressure Therapy in Veterinary Critical Care: Part II: Airway Pressure Therapy

As the specialties of emergency medicine and critical care have grown and evolved in both human and veterinary medicine, so has the need for more advanced care of patients with primary lung disease. Treatment of acute respiratory failure has been the focus of several articles in the human medical literature of the past few years.^1,8 This paper deals with airway pressure therapy and its application in cases of acute respiratory failure in veterinary medicine. The reader is referred to part I of this paper for a reveiw of respiratory mechanics and hypoxemia as they apply to respiratory therapy.     

Pasteurella haemolytica A1 and Bovine Respiratory Disease: Pathogenesis

The severe fibrinonecrotic pneumonia associated with pneumonic pasteurellosis usually results from colonization of the lower respiratory tract by Pasteurella haemolytica biotype A, serotype 1(A1). Despite recent research efforts, the authors lack a detailed understanding of the interactions and host response to P. haemolytica in the respiratory tract. The authors hypothesize that management and environmental stress factors or viral infection alters the upper respiratory tract (URT) epithelium allowing P. haemolytica to colonize the epithelium. Once the URT is colonized, large numbers of organisms enter the lung where they interact with alveolar macrophages. Endotoxin, released from the bacteria, crosses the alveolar wall where it activates pulmonary intravascular macrophages, endothelium, neutrophils, lymphocytes, platelets, complement, and Hageman factor leading to complex interactions of cells and mediators. It is the progression of this inflammatory response with neutrophil influx that is ultimately responsible for the pulmonary injury. Leukotoxin is a major virulence factor of P. haemolytica that allows it to survive by destroying phagocytic cells. At subcytolytic concentrations it may also enhance the inflammatory response by activating cells to produce mediators and release reactive oxygen metabolites and proteases.     

Long-term Outcome of Tooth Repulsion in Horses A Retrospective Study of 61 Cases

The records of 61 horses undergoing tooth repulsion for treatment of alveolar periostitis were reviewed. Seventeen of 36 horses (47%) in which maxillary teeth were removed had serious postoperative complications, such as infection of a second tooth, bone sequestration, chronic sinusitis, draining tracts, retained dental packing, feed impaction of the alveolus or sinus, suture-line dehiscence, or skin-flap sloughs. Eight horses required at least one additional surgical procedure. Eight of 25 horses (32%) in which mandibular teeth were removed had serious postoperative complications, and four horses required an additional surgical procedure. Hospitalization lasted 2 to 61 days (median, 22 days) for maxillary teeth and 3 to 35 days (median, 8 days) for mandibular teeth. Long-term follow-up (at least 5 months) was possible in 47 horses. Twenty-four of 30 horses (80%) with maxillary tooth repulsion healed without further problems; six horses had persistent nasal discharge. Fourteen of 17 horses (82%) with mandibular tooth repulsion healed with no further problems or with only minor complications; three horses had a chronic draining tract.