PRACTICALITY, USEFULNESS, AND LIMITS OF END-TIDAL CARBON DIOXIDE MONITORING IN CRITICAL SMALL ANIMAL PATIENTS

End-tidal monitors for measuring carbon dioxide (CO₂) have become widely available for clinical use in the last two decades. This non-invasive technology has been previously evaluated in anesthetized veterinary patients, but its accuracy has not been assessed in critical patients. We investigated the usefulness and limits of end-tidal CO₂ monitoring in two populations of critical small animal patients: spontaneously breathing dogs and mechanically ventilated patients with healthy and damaged lungs. In analyzing samples from 43 spontaneously breathing dogs and 34 ventilated patients (28 dogs and six cats), the end-tidal CO₂ was generally lower than pCO₂. The predictive value for hypoventilation was excellent in both populations (100%). The linear correlation of the end-tidal CO₂ and arterial pCO₂ in non-panting dogs with healthy lungs was 0.84 (p<0.0001), and the 95% confidence interval (CI) of the difference was ± 3.2 mm Hg. However, the measures were uncorrelated in panting dogs (r=0.37, p=0.27), and the 95% CI was ± 13.37 mm Hg. Furthermore, where multiple samples could be obtained in individual patients, the r values and differences of end-tidal compared to arterial pCO₂ varied unpredictably. These variations did not appear to be predicted by patient factors such as lung disease. We conclude that the end-tidal CO₂ monitor is clinically useful for detecting hypoventilation and monitoring apnea, but it should be supplemented with arterial pCO₂ determinations if it is important to obtain accurate pCO₂ measures.     

Cytomegalovirus-associated discrete gastrointestinal masses in macaques infected with the simian immunodeficiency virus

Cytomegalovirus (CMV)-associated gastrointestinal masses have been reported in human acquired immune deficiency syndrome patients. This is the first report on CMV-associated gastrointestinal masses in simian immunodeficiency virus (SIV)-infected macaques. Two SIV-infected macaques presented at necropsy with multiple nodular or umbilicated masses within the gastrointestinal tract. In one animal, the masses were located throughout the gastrointestinal tract, whereas in the other, the masses were restricted to the proximal small intestine. Grossly, the masses were indistinguishable from those caused by neoplastic conditions such as lymphoma and, histologically, were composed of hyperplastic glandular tissue, dense neutrophilic infiltrates within the lamina propria, and multifocal proprial hemorrhage. Frequent cytomegalic cells with basophilic intranuclear inclusions were found in affected regions. Immunohistochemistry for CMV demonstrated frequent immunopositive cells within affected areas. Furthermore, immunohistochemistry for the proliferation marker Ki-67 demonstrated increased proliferation in hyperplastic glands and crypts. CMV should be considered a cause of discrete mass lesions in the gastrointestinal tract of SIV-infected macaques.     

Respiratory conditions in critical patients

The support and diagnosis of respiratory distress requires an efficient approach and a solid understanding of pathophysiology.     

Visceral leishmaniasis in the German shepherd dog. I. Infection, clinical disease, and clinical pathology

Two groups of three German shepherd dogs each were inoculated with Leishmania chagasi or Leishmania donovani amastigotes and the infection was followed for 82 days. The dogs developed a persistent infection, became thin, and developed splenomegaly and lymphadenomegaly by 55 days after inoculation. All dogs developed a normocytic, normochromic anemia of increasing severity. Thrombocytopenia and leukopenia occasionally occurred. Blood tryptophan levels were decreased significantly in infected dogs. Increased total serum protein, with hypergammaglobulinemia and hypoalbuminemia, was present in all dogs to various degrees. There was a marked increase in gamma globulins, with smaller increases in alpha and beta globulins. Many of the clinicopathologic changes observed in these dogs were similar to the disease as it occurs in man. The German shepherd dog may be a useful laboratory model for the study of visceral leishmaniasis.     

Static thoracic compliance as a measurement of pulmonary function in dogs.

Thoracic compliance measurements by use of readily available equipment were determined to be practical and safe in dogs. Twenty healthy dogs (age 1 to 16 years, weight 2.3 to 49.5 kg) were anesthesized for routine procedures such as dentistry or neutering. The animals were first hyperventilated to reduce pulmonary atelectasis, to check for leakage at the endotracheal tube cuff, and to induce mild hypocarbia, thus minimizing voluntary respiratory efforts. Total thoracic compliance measurements were calculated as the difference between exhaled volumes at static inspiratory pressures of 15 and 20 cm of H2O, divided by the pressure difference, and expressed as a function of body weight. The procedure was easy, took 5 to 10 minutes, and caused no recognizable ill effects in any of the dogs studied. Mean total thoracic compliance was 42.25 +/- 32 ml/cm of H2O. There was a significant correlation with weight, but no significant relationship was seen between compliance and age, or gender. The mean weight-adjusted total thoracic compliance was 1.85 +/- 0.56 ml/cm of H2O/kg. In studies in a small group of dogs with documented respiratory tract disease, 4 of 7 had a mean compliance greater than 2 SD below the normal range. Thus, this test may become part of the routine workup of any animal being anesthetized for procedures such as bronchoscopy to evaluate respiratory tract disease. Routine monitoring of animals on ventilators could provide early warning of complications such as pneumonia, pleural effusion, or pulmonary edema.     

ACTIVITY RHYTHM IN PEROMYSCUS: ITS INFLUENCE ON RATES OF RECOVERY FROM NEMBUTAL

Injection of sublethal doses of Nembutal (sodium pentobarbital) into deer mice, Peromyscus maniculatus rufinus (Merriam), at diflerent times in their daily activity cycle revealed large differences in rates of recovery. By taking the phase of the circadian rhythm into account, the accuracy obtained in pharmaceutical and physiological bioassays could be increased.     

Movement disorders during sleep in cats and dogs

Spontaneous sleep movement disorders in 5 cats and 3 dogs were studied. Objective abnormalities during sleep were confirmed by electrographic or behavioral monitoring techniques in all animals. The cause of the disorder was CNS disease in 3 animals. A cause was not discovered in the other 5 animals, although at necropsy, 2 were found to have thyroid tumors. Many pharmacologic treatments were ineffectual, but trials with the benzodiazepine tranquilizer, clonazepam, suggested it will prove useful in controlling violent movements during rapid-eye-movement sleep.     

Treatment of cataplexy in a dog with narcolepsy

A 1-year-old female Rottweiler with a history of narcolepsy and cataplexy lost weight and became worse when given cholinergic agents and/or prednisolone over a 12-day period. The dog was then treated with imipramine HCl, and has been almost clinically normal for 2 years.