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.     

Adrenergic and peptidergic innervation of the trachealis muscle in the normal horse: a preliminary report

The tone of respiratory smooth muscle is largely determined by the input from autonomic nerves. The distribution of adrenergic and selected nonadrenergic, non-cholinergic (NANC) nerves in the normal equine trachealis muscle was investigated using immunohistochemistry. The smooth muscle of the trachealis was found to contain numerous nerves immunoreactive for an enzymatic marker of adrenergic nerves, as well as many nerves immunoreactive for a putative NANC neurotransmitter, peptide histidine isoleucine, a potent bronchodilator. The tissues surrounding the respiratory smooth muscle contained numerous nerves immunoreactive for the neuropeptides substance P and calcitonin gene-related peptide, which can cause marked vasodilation and bronchoconstriction. The complex innervation of the equine trachea should be kept in mind when interpreting the results of physiological experiments.     

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.     

A novel approach to studying the effects of temperature on soil biogeochemistry using a thermal gradient bar

The temperature dependence of chemical reaction rates and microbial metabolism mean that temperature is a key factor regulating soil trace gas emissions and hydrochemistry. Here we evaluated a novel approach for studying the thermal response of soils, by examining the effects of temperature on gas emissions and hydrochemistry in (a) peat and (b) soil from a Sitka spruce plantation. A thermal gradient was applied along an aluminium bar, allowing soil to be incubated contemporaneously from 2 to 18 °C. The approach demonstrated clear differences in the biogeochemical responses of the two soil types to warming. The peat showed no significant emission of CH₄ at temperatures below 6 °C, while above 6 °C, a marked increase in the rate of release was apparent up to 15 °C (Q₁₀ = 2.5) with emissions being similar between 15 and 18 °C. Conversely, CH₄ emissions from the forest soil did not respond to warming. Nitrate availability in the peat decreased by 90% between 2 and 18 °C (P < 0.01), whereas concentrations in the forest soil did not respond. Sulphate availability in the peat decreased significantly with warming (60%, P < 0.01), while the forest soil showed the opposite response (a 30% increase, P < 0.01). Conventionally, thermal responses are studied by incubating individual soil samples at different temperatures, involving lengthy preparation and facilities to incubate samples at different temperatures simultaneously. Data collected on a given thermal response is usually limited and thus interpolated or extrapolated. The thermal gradient method overcomes these problems, is simple and flexible, and can be adapted for a wide range of sample types (not confined to soil). Such apparatus may prove useful in the optimization of management practices to mitigate the effects of climate change, as thermal responses will differ depending on land use and soil type.