Multiple organ dysfunction syndrome in humans and dogs

Objective: To describe the clinical appearance and theories on the pathogenesis of multiple organ dysfunction syndrome (MODS) in humans, and to review the evidence suggesting that a similar syndrome occurs in critically ill dogs. Human‐based studies: Currently, there are a multitude of publications describing the pathogenesis and clinical course of MODS in humans. Providing much of the basis for on‐going research and the development of clinical applications, a consensus statement made by the American College of Chest Physicians and Society of Critical Care Medicine defined parameters that had guided and shaped much of what is known about MODS. Veterinary‐based studies: To date, there are few publications describing MODS in dogs and much of what is known has been derived from case reports and reviews of various critical illnesses in dogs. While a similar syndrome of multiple organ dysfunction likely exists in dogs, a consensus statement defining clinical parameters has not been made. Data sources: Veterinary and human literature review. Conclusions: The development of MODS in human critical illness is widely recognized and major strides have been made in the understanding of this complex syndrome. Scoring schemes applied to human MODS patients have established that with increasing numbers of failing organs, there is a worse prognosis. As a similar finding likely exists in dogs, an awareness of MODS is vital to veterinary critical care clinicians and a consensus definition of MODS in dogs is warranted.     

Successful management of saltwater submersion injury in a dog using mechanical ventilation

Objective– To describe successful management of saltwater near-drowning in a dog using mechanical ventilation. Case Summary– A 7-year-old spayed female Golden Retriever weighing 37 kg was referred for mechanical ventilation after saltwater submersion injury. The dog had a history of rare seizures characterized by pre-ictal agitation. On the morning of the event, the dog became agitated and ran toward Puget Sound. The owners discovered the dog unconscious in approximately 25.4 cm (10 in) of water, with her head submerged. The owners estimated that the dog was submerged for approximately 30 seconds. The dog was presented immediately to the nearest emergency facility where initial diagnostic testing and treatment included venous blood gases, nasal oxygen, and IV fluids. The dog was dyspneic despite nasal oxygen administration and was referred for mechanical ventilation. Upon arrival the patient was cyanotic with an arterial partial pressure of oxygen of 38 mm Hg (reference interval 85–100 mm Hg) and oxygenation saturation of 62% (reference interval >95%). Thoracic radiographs were taken and revealed severe, bilateral pulmonary infiltrates. The patient was ventilated for 70 hours and was discharged 4 days later. Complications included pneumonia and phlebitis at the site of a cephalic IV catheter. Follow up thoracic radiographs 10 days after discharge were within normal limits and the owners report a full recovery at 1 year. New or Unique Information Provided– Submersion injury can result in acute respiratory distress syndrome in dogs. Mechanical ventilation provided critical support during pulmonary recovery in this dog.     

IMAGING DIAGNOSIS: ACUTE LUNG INJURY FOLLOWING MASSIVE BEE ENVENOMATION IN A DOG

A 5-year-old neutered male mixed breed dog presented for increased respiratory effort after being stung by over 100 bees and developing anaphylactic shock. Given the history, clinical signs and thoracic radiographic findings of a mild bilateral interstitial pattern, acute lung injury/acute respiratory distress syndrome (ALI/ARDS) was suspected. Further testing was performed to support this diagnosis. On computed tomographic images, there was a diffuse bilateral opacification of the lungs, with preservation of bronchial and vascular margins. Pulmonary function testing indicated decreased pulmonary compliance, decreased diffusion capacity and decreased functional residual capacity. These results supported the diagnosis of ALI/ARDS secondary to bee sting envenomation and development of anaphylactic shock. After 8 days of treatment with oxygen, steroids, antibiotics, and bronchodilators the dog improved. This case demonstrates the usefulness of computed tomography and pulmonary function testing in the diagnosis of ALI/ARDS.     

肺表面活性物质相关蛋白A的研究进展

肺表面活性物质相关蛋白A（pulmonary surfactant-associated protein A,SP-A）是肺表面活性物质（pulmonary surfactant,PS）中含量最丰富的蛋白成分,主要分布于支气管表面和肺泡气液界面上,属C-型胶凝素家族的重要成员,在维持PS的正常生物学功能和调节局部免疫及炎症反应方面发挥重要作用。研究结果表明,SP-A质和量的改变与哺乳动物的肺部疾病密切相关,以SP-A作为肺疾病严重程度的指标已日益受到重视。此外,在急性肺损伤/急性呼吸窘迫综合症（ALI/ARDS）的治疗方面,PS替代治疗虽已获得了一定成功,但是,因现有外源性PS制剂中缺乏SP-A,使其疗效大受限制。因此,运用分子生物学手段,研究SP-A的表达调控,大量获取SP-A,将成为PS制剂研发的一个主要方向。