Retrospective evaluation of the respiratory rate-oxygenation index to predict the outcome of high-flow nasal cannula oxygen therapy in dogs (2018-2021): 81 cases.

OBJECTIVE: To evaluate the respiratory rate-oxygenation index (ROX), modified ROX index (ROX-HR), and the ratio of pulse oximetry saturation (Spo2) to Fio2 (SF) to determine if these indices over time are predictive of outcome in dogs treated with high-flow nasal cannula oxygen therapy (HFNC). DESIGN: Retrospective study. SETTING: Two university teaching hospitals. ANIMALS: Eighty-one client-owned dogs treated with HFNC for hypoxemic respiratory failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The ROX was defined as the SF divided by the respiratory rate (RR), and the ROX-HR was defined as the ROX divided by the heart rate multiplied by 100. The overall success rate of HFNC was 44% (n = 36/81). Dogs weaned from HFNC had a significantly higher ROX (P < 0.0001) at 1-3, 5-10, 12, and 15 hours than dogs that failed HFNC. Both the ROX and SF showed excellent discriminatory power in predicting HFNC failure at 6 hours, with an area under receiver operating curve of 0.85 (95% confidence interval: 0.72-0.99; P < 0.002) and 0.86 (95% confidence interval: 0.73-0.99; P < 0.001), respectively. The optimal cutoff values for predicting HFNC failure at 6 hours were a ROX ≤3.68 (sensitivity 72%, specificity 92%) and an SF ≤143 (sensitivity 79%, specificity 93%). CONCLUSIONS: These results suggest that similar to people, the ROX and SF are useful predictors of HFNC failure. These indices are easy to measure at the bedside and may have clinical use. Future prospective studies are warranted to confirm the findings and to optimize cutoff values in a larger population of dogs undergoing HFNC.

Impact of cytidine diphosphocholine on oxygenation in client-owned dogs with aspiration pneumonia.

BACKGROUND: New drugs for veterinary patients with acute respiratory distress syndrome (ARDS) are urgently needed. Early or late postinfection treatment of influenza-infected mice with the liponucleotide cytidine diphosphocholine (CDP-choline) resulted in decreased hypoxemia, pulmonary edema, lung dysfunction, and inflammation without altering viral replication. These findings suggested CDP-choline could have benefit as adjunctive treatment for ARDS in veterinary patients (VetARDS). OBJECTIVES: Determine if parenterally administered CDP-choline can attenuate mild VetARDS in dogs with aspiration pneumonia. ANIMALS: Dogs admitted to a veterinary intensive care unit (ICU) for aspiration pneumonia. METHODS: Subjects were enrolled in a randomized, double-blinded, placebo-controlled trial of treatment with vehicle (0.1 mL/kg sterile 0.9% saline, IV; n = 8) or CDP-choline (5 mg/kg in 0.1 mL/kg 0.9% saline, IV; n = 9) q12h over the first 48 hours after ICU admission. RESULTS: No significant differences in signalment or clinical findings were found between placebo- and CDP-choline-treated dogs on admission. All dogs exhibited tachycardia, tachypnea, hypertension, hypoxemia, hypocapnia, lymphopenia, and neutrophilia. CDP-choline administration resulted in rapid, progressive, and clinically relevant increases in oxygenation as determined by pulse oximetry and ratios of arterial oxygen partial pressure (Pa O2 mmHg) to fractional inspired oxygen (% Fi O2 ) and decreases in alveolar-arterial (A-a) gradients that did not occur in placebo (saline)-treated animals. Treatment with CDP-choline was also associated with less platelet consumption over the first 48 hours, but had no detectable detrimental effects. CONCLUSIONS AND CLINICAL IMPORTANCE: Ctyidine diphosphcholine acts rapidly to promote gas exchange in dogs with naturally occurring aspiration pneumonia and is a potential adjunctive treatment in VetARDS patients.

Evaluation of geriatric trauma in dogs with moderate to severe injury (6169 cases): A VetCOT registry study.

OBJECTIVE: To examine geriatric classification as a predictor of survival in moderate to severely injured dogs denoted by animal trauma triage (ATT) scores ≥3 or modified Glasgow Coma Scale (mGCS) scores ≤14. DESIGN: Retrospective observational cohort study utilizing data collected between September 2013 and May 2019 with follow-up until death or hospital discharge. SETTING: Thirty-one trauma centers including university teaching hospitals and private referral centers. ANIMALS: A total of 6169 dogs entered into the Veterinary Committee on Trauma Registry with complete data entry including age, weight, outcome, mGCS (≤14), and/or ATT (≥3). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The effect of geriatric classification on survival was estimated using shared-frailty cox proportional hazard models. Model 1 dependent variables: death despite intervention or euthanasia due to grave prognosis. Model 2 dependent variables: death by euthanasia due to financial influence or combined influence of finances and grave prognosis. Model 3 evaluated interactions between geriatric classification and moderate versus severe trauma. The shared-frailty models controlled for contributing site as a random effect and other confounding variables, including trauma severity. Model 1: geriatrics had a significantly increased hazard risk (HR) for death (HR = 1.48, P < 0.0001). Model 2: geriatrics had an insignificant increased HR for death (HR = 1.34, P = 0.08). Model 3: geriatrics demonstrated significantly increased mortality risk with moderate level trauma. Additional Model 1 variables independently associated with mortality include ATT perfusion, neurologic, respiratory subscores, mGCS motor subscore, weight, and spinal trauma. Additional Model 2 variables independently associated with mortality include ATT perfusion subscore and neuter status. In general, statistical differences between cohorts were found with regard to lactate, PCV, total protein, and glucose. CONCLUSIONS: Among moderately injured dogs who experienced death despite intervention or euthanasia due to grave prognosis, mortality risk is significantly higher in geriatrics as compared to nongeriatrics.

Successful management of massive lamotrigine extended-release intoxication in a dog.

A 3-year-old spayed female Siberian Husky presented for evaluation following ingestion of approximately 429 mg/kg of lamotrigine extended-release. She demonstrated severe neurologic and cardiac signs and was treated with lipid emulsion, anticonvulsants, antiarrhythmics and aggressive decontamination and supportive care. She was successfully discharged from the hospital 5 days later.