Acute lung injury and acute respiratory distress syndromes in veterinary medicine: consensus definitions: The Dorothy Russell Havemeyer Working Group on ALI and ARDS in Veterinary Medicine |
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Authors: | Pamela A Wilkins DVM PhD DACVIM DACVECC Cynthia M Otto DVM PhD DACVECC James E Baumgardner MD PhD Bettina Dunkel DVM DACVIM DACVECC Daniela Bedenice DVM DACVIM DACVECC Mary Rose Paradis DVM DACVIM Francesco Staffieri DVM PhD Rebecca S Syring DVM DACVECC Joanne Slack DVM DACVIM Salvatore Grasso MD Gene Pranzo Esq |
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Institution: | Department(s) of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Kennett Square, PA,;Department(s) of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA,;Department of Anesthesiology and Critical Care, School of Medicine, University of Pennsylvania,;Department of Clinical Studies, Tufts Cummings School of Veterinary Medicine, North Grafton, MA,;Department of Physiology, Royal Veterinary College, London, UK,;Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy, and;The Dorothy Russell Havemeyer Foundation, New York, NY. |
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Abstract: | Background: As veterinary medicine has become more sophisticated, with greater numbers of veterinary patients receiving intensive care, more patients with an acute respiratory distress (ARDS)‐like syndrome have been recognized. Methods: A consensus definition meeting was held for the purpose of developing veterinary‐specific definitions for acute lung injury (ALI) and ARDS. Results/conclusions: Three clinically based definitions for acute lung injury and acute respiratory distress‐like syndromes occurring in veterinary patients were described. Neonatal equine respiratory distress syndrome (NERDS) was defined separately due to the specific requirement for primary developmental surfactant dysfunction and lack of an inflammatory component. Five diagnostic criteria categories were established for Veterinary ALI/ARDS (Vet ALI/ARDS) with 4 required and a fifth highly recommended criteria. A strong consensus was reached that onset of respiratory distress must have been acute and that known risk factors must be present. Additional criteria included evidence of pulmonary capillary leak with no evidence of increased pulmonary capillary pressure, evidence of inefficient gas exchange and, finally, evidence of inflammation. Some features of ALI/ARDS in the neonatal horse were recognized as unique, therefore, equine neonatal ALI/ARDS (EqNALI/EqNARDS) was similarly defined but with a graded gas exchange inefficiency table to allow for normal developmental changes in gas exchange. Use of these definitions in planning prospective studies of these problems in veterinary patients should allow for more direct comparisons of studies and clinical trials, with a larger goal of improving outcome in veterinary patients. |
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Keywords: | consensus statement hypoxemia inflammation lung injury pulmonary |
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