Retrospective evaluation of the incidence of presumed feline urethral obstruction during a prepandemic year compared to a pandemic year.

OBJECTIVE: To investigate the influence of the coronavirus disease 2019 (COVID-19) pandemic on the incidence of urethral obstruction (UO) in male cats. DESIGN: Retrospective study. SETTING: One veterinary university teaching hospital and 6 private practice veterinary specialty and emergency centers. ANIMALS: A total of 24,937 total feline cases presenting to the emergency room (ER) between March 2019 and March 2021. MEASUREMENTS AND MAIN RESULTS: Out of 24,937 total cases, 1793 male cats met the inclusion criteria for diagnosis of UO. Of those, 327 cases were identified in which an additional diagnosis of either urolithiasis or neoplasia was made and were therefore excluded. The remaining 1466 UO cases were presumed to be idiopathic urethral obstruction (iUO) caused by feline interstitial cystitis (FIC) alone. Of those, 637 cats presented during the prepandemic year and 829 cats presented during the pandemic year. KEY FINDINGS: Incidence of presumptive iUO increased by 30% during the COVID-19 pandemic. Total feline emergency caseload increased by 38%. iUO accounted for 6.08% and 5.73% of total feline emergency cases during the prepandemic and pandemic years, respectively. CLINICAL SIGNIFICANCE: The reported increase in incidence of feline UO is likely due to the increase in overall emergency feline caseload.

Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative small animal CPR registry report 2016-2021.

OBJECTIVE: To introduce the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR registry and report cardiopulmonary arrest (CPA) and CPR event data collected to date. DESIGN: International, multi-institutional veterinary CPR registry data report. SETTING: Veterinary private practice and university teaching hospitals. ANIMALS: Data from 514 dogs and 195 cats undergoing CPR entered in the RECOVER CPR registry between February 2016 and November 2021. INTERVENTIONS: The RECOVER CPR registry is an online medical database created for standardized collection of hospital, animal, arrest, and outcome information on dogs and cats undergoing CPR. Data were collected according to the veterinary Utstein-style guidelines for standardized reporting of in-hospital CPR in dogs and cats. Case records were downloaded, duplicate and incomplete cases were removed, and summary descriptive data were reported. MEASUREMENTS AND MAIN RESULTS: Sixteen hospitals in the United States, Europe, and Australia contributed data on 709 CPR events to the registry. One hundred and forty-two (28%) dogs and 58 (30%) cats attained return of spontaneous circulation (ROSC), 62 (12%) dogs and 25 (13%) cats had ROSC >20 minutes, and 14 (3%) dogs and 4 (2%) cats survived to hospital discharge. The reason for CPR discontinuation was reported as owner choice in 321 cases (63%). The most common suspected causes for CPA were respiratory failure (n = 142, 20%), heart failure (n = 86, 12%), and hemorrhage (n = 76, 11%). CONCLUSION: The RECOVER CPR registry contains the first multicenter data set on small animal CPR. It confirms poor outcomes associated with CPA, emphasizing the need for large-sized studies to gain adequate information on characteristics associated with favorable outcomes.

Fluid Therapy for the Emergent Small Animal Patient: Crystalloids, Colloids, and Albumin Products.

Water is essential for life. Without adequate fluid intake, normal body functioning becomes impaired and ultimately can lead to death. A fluid therapy plan should be considered for any small animal patient that has either inadequate fluid intake, excessive fluid loss, or both. A simplified approach to fluid therapy begins with an understanding of the composition of fluid and its distribution within the body. Next, consideration of electrolyte loss, acid-base disturbances, perfusion impairment, and loss of protein also becomes important when replenishing deficits by using various fluids that are commercially available to small animal practitioners.

Advanced Oxygen Therapy for the Small Animal Patient - High-Flow Oxygen Therapy and Mechanical Ventilation.

High-flow nasal oxygen therapy (HFNT) and positive pressure ventilation (PPV) are interventions used in the management of animals with respiratory failure. The indications for the use of these modalities, clinical application, prognosis, and a review of the current veterinary evidence are provided.

Tissue oxygen saturation in dogs with acute hemorrhage.

OBJECTIVE: To evaluate initial tissue hemoglobin oxygen saturation (StO2 ) in dogs presenting to an emergency room (ER) for acute hemorrhage. DESIGN: Prospective, observational study. SETTING: University veterinary teaching hospital. ANIMALS: Thirty-eight dogs with acute hemorrhage were enrolled between July 2009 and October 2010. Seventy-eight normal dogs from a previous observational study were included to represent healthy controls ("no shock"). INTERVENTIONS: Tissue oxygen saturation measurement was obtained at enrollment on dogs presented to the ER for acute hemorrhage. Baseline clinicopathologic (CBC, serum biochemical profile, prothrombin time, and activated partial thromboplastin time) and physiologic (plasma lactate concentration, venous blood gas, blood pressure, and hemoglobin oxygen saturation by pulse oximetry) data were recorded from all patients with hemorrhage. An ER clinician blinded to the StO2 value guided patient management. Patient survival to discharge from the hospital in the study group was recorded. Once data collection was complete, 3 emergency and critical care clinicians blinded to the StO2 data retrospectively classified patients into 1 of 4 shock categories (no shock, mild, moderate, or severe shock). MEASUREMENTS AND MAIN RESULTS: The historical group of healthy dogs had higher StO2 concentrations compared to the dogs classified with shock at all 3 levels (mild, moderate, and severe, P = 0.0006, <0.0001, and 0.0018, respectively); however, there was no statistical difference in StO2 between the levels of shock. A cut-off StO2 value of 87.6% identified a patient as having shock (area under the curve: 0.824, 95% confidence interval 0.749, 0.899). CONCLUSIONS: Dogs with hemorrhagic shock have lower StO2 than a population of healthy dogs.

Pneumatosis of the intestines, colon and liver in a young cat.

To describe a case of naturally occurring pneumatosis intestinalis, pneumatosis coli and emphysematous hepatitis in a cat. A 9-month-old, indoors-only, female spayed, domestic medium hair cat presented for vomiting, open-mouth breathing and acute collapse. The initial physical examination identified moderate to severe hypothermia [35°C (95°F)], obtunded mentation, weak femoral pulses, tachycardia (heart rate 240 beats per min), pale pink mucous membranes and significant splenomegaly on abdominal palpation. Immediate diagnostics performed [packed cell volume and total solids (PCV, TS), venous blood gas and electrolytes] revealed severe anaemia (PCV 12%), hypoproteinaemia (TS = 2.2 g/dl), and severe metabolic acidosis (pH 6.956). Additional diagnostics performed included Feline Leukaemia Virus and Feline Immunodeficiency Virus testing (FeLV/FIV), complete blood count (CBC) with pathology review, serum biochemistry profile, prothrombin time (PT) and partial thromboplastin time (PTT), urinalysis, and abdominal radiographs. Abdominal radiographs were consistent with gas within hepatic and splenic veins and parenchyma, small intestinal walls and colonic wall. Due to the guarded prognosis, euthanasia was elected. Necropsy was performed and the most significant gross and histopathological findings included intra-luminal and intra-mural intestinal haemorrhage and vascular congestion with mild neutrophilic hepatitis, and marked hepatic periportal emphysema. Clostridium perfrigens and Escherichia coli were cultured from the bowel wall; no bacterial growth from the liver or spleen was identified. This case report describes idiopathic emphysematous hepatitis, with concurrent emphysema of the spleen and intestinal wall and intestinal haemorrhage. To the authors' knowledge, this type of pathology in a feline patient has not been previously described.

Parvoviral myocarditis in a 5-week-old Dachshund.

OBJECTIVE: To describe a case of myocarditis associated with naturally occurring canine parvovirus type 2 (CPV-2). CASE SUMMARY: A 5-week-old male intact Dachshund dog presented for acute respiratory distress. Limited diagnostic tests prior to the dog experiencing cardiopulmonary arrest included a lateral thoracic radiograph, which indicated cardiomegaly and diffuse unstructured pulmonary infiltrate. Necropsy was performed and results identified a lymphoplasmacytic myocarditis with positive CPV-2 immunohistochemistry within the myocardium. UNIQUE INFORMATION PROVIDED: This report describes the natural occurrence of CPV-2-associated myocarditis. In addition to highlighting this rare form of canine parvovirus, cardiomyopathy in survivors of the acute viral myocarditis phase is reviewed.

A retrospective analysis of 25% human serum albumin supplementation in hypoalbuminemic dogs with septic peritonitis.

This study describes the influence of 25% human serum albumin (HSA) supplementation on serum albumin level, total protein (TP), colloid osmotic pressure (COP), hospital stay, and survival in dogs with septic peritonitis. Records of 39 dogs with septic peritonitis were evaluated. In the HSA group, initial and post-transfusion TP, albumin, COP, and HSA dose were recorded. In the non-supplemented group, repeated values of TP, albumin, and COP were recorded over their hospitalization. Eighteen dogs survived (53.8% mortality). Repeat albumin values were higher in survivors (mean 23.9 g/L) and elevated repeat albumin values were associated with HSA supplementation. Repeat albumin and TP were higher in the HSA supplemented group (mean 24 g/L and 51.9 g/L, respectively) and their COP increased by 5.8 mmHg. Length of hospitalization was not affected. Twenty-five percent HSA increases albumin, TP, and COP in canine patients with septic peritonitis. Higher postoperative albumin levels are associated with survival.

Analyse rétrospective d'un supplément de 25 % d'albumine sérique humaine chez les chiens hypoalbuméniques souffrant d'une péritonite septique. Cette étude décrit l'influence d'un supplément de 25 % d'albunine sérique humaine (ASH) sur le niveau d'albumine sérique, de protéines totales (PT), sur la pression osmotique colloïdale (POC), la durée du séjour à l'hôpital et la survie des chiens souffrant de péritonite septique. Les dossiers de 39 chiens souffrant de péritonite septique ont été évalués. Dans le groupe ASH, la PT, l'albumine, le POC et l'ASH initiaux et post-transfusion ont été consignés. Dans le groupe sans supplément, des valeurs répétées de PT, d'albumine et de POC ont été notées pendant l'hospitalisation. Dix-huit chiens ont survécu (mortalité de 53,8 %). Les nouvelles valeurs d'albumine étaient supérieures chez les survivants (moyenne de 23,9 g/L) et les nouvelles valeurs d'albumine élevées étaient associées à un supplément d'ASH. Les nouvelles valeurs d'albumine et de PT étaient supérieures dans le groupe ayant reçu le supplément d'ASH (moyenne de 24 g/L et 51,9 g/L, respectivement) et leur POC a augmenté de 5,8 mmHg. La durée de l'hospitalisation n'était pas affectée. Le 25 % d'ASH augmente l'albumine, la PT et le POC chez les patients canins atteints de péritonite septique. Des niveaux d'albumine postopératoire supérieurs étaient associés à la survie.(Traduit par Isabelle Vallières).

Outcome of male cats managed for urethral obstruction with decompressive cystocentesis and urinary catheterization: 47 cats (2009-2012).

OBJECTIVE: To characterize the duration of urinary catheterization, length of hospitalization, complications and clinical outcome in cats with urethral obstruction managed with decompressive cystocentesis and subsequent urinary catheterization. DESIGN: Retrospective, observational, descriptive study. SETTING: University teaching hospital. ANIMALS: Forty-seven client-owned male cats diagnosed with urethral obstruction. MEASUREMENTS AND MAIN RESULTS: The medical records of 47 cats diagnosed with urethral obstruction were reviewed. Treatment of all cats included decompressive cystocentesis, placement of an indwelling urinary catheter and hospitalization for a minimum of 6 hours. Collected data included signalment, body weight, body condition score, owner-reported clinical signs, duration of clinical signs, vital signs, and venous blood gas or chemistry values. Mean duration of urinary catheterization was 27.9 hours, median length of hospitalization was 40 hours, and survival to discharge was 91%. Of 34 cats that had survey abdominal radiographs, 56% (19/34) had loss of peritoneal detail consistent with abdominal effusion. No cat was diagnosed with a ruptured bladder during hospitalization. CONCLUSIONS: Decompressive cystocentesis, in cats with urethral obstruction, followed by placement of an indwelling urinary catheter, did not result in a diagnosis of bladder rupture in any cat. The source of and clinical significance of the reported abdominal effusion is not known. Survival to discharge, duration of catheterization, and length of hospitalization were similar to previously reported populations.

Fluid therapy for the emergent small animal patient: crystalloids, colloids, and albumin products.

Fluid therapy is essential in the treatment of emergent veterinary patients. Many different types of intravenous fluids are available, including crystalloids, artificial colloids, and natural colloids. The type, dose, and administration rate can determine the outcome in a critically ill patient. This article discusses the various types of fluids and their indication for use.

Basics of mechanical ventilation for dogs and cats.

Respiratory failure may occur due to hypoventilation or hypoxemia. Regardless of the cause, emergent anesthesia and intubation, accompanied by positive pressure ventilation, may be necessary and life saving. Long-term mechanical ventilation requires some specialized equipment and knowledge; however, short-term ventilation can be accomplished without the use of an intensive care unit ventilator, and can provide oxygen supplementation and carbon dioxide removal in critical patients.

The use of canine-specific albumin in dogs with septic peritonitis.

OBJECTIVE: To assess changes in serum albumin concentration (ALB), colloid osmotic pressure (COP), and Doppler blood pressure (DBP) following transfusion of 5% lyophilized canine-specific albumin (CSA) in hypoalbuminemic dogs following surgical source control for septic peritonitis. DESIGN: Prospective randomized clinical trial November 2009 - November 2010. SETTING: University teaching hospital. ANIMALS: Fourteen client-owned dogs with hypoalbuminemia (<27 g/L [2.7 g/dL]) following surgical source control for septic peritonitis. INTERVENTIONS: Dogs were randomized to clinician-directed therapy (CDT) and CSA groups. Dogs enrolled in the CSA group received 800 mg/kg of CSA within 24 hours following surgical intervention. MEASUREMENTS AND MAIN RESULTS: At enrollment, ALB, COP, and DBP were not different between groups. ALB, COP, and DBP were significantly increased in the CSA group 2 hours following completion of the transfusion compared with the CDT group (P = 0.0234, 0.0078, 0.0156, respectively). In comparison to the CDT group, there was a significant change in ALB in the CSA group 24 hours after transfusion (P = 0.0039), but no difference in COP (P = 0.3914) or DBP (P = 0.5145). ALB was significantly higher in the CSA group at 24 hours compared with the CDT group (P = 0.0367) At the time of death or discharge, there was no difference between groups regarding ALB, COP, or DBP, but an association between ALB and survival was identified (P = 0.0273). One dog experienced tachypnea during transfusion of CSA; this dog died of unknown respiratory causes 120 hours after transfusion. CONCLUSIONS: The administration of CSA in dogs with septic peritonitis results in an increase in ALB, COP, and DBP 2 hours after administration. An increase in ALB persisted at 24 hours compared with a CDT group. Administration of this product was not associated with owner-reported delayed adverse events in this population of dogs.

4-Methylpyrazole as a treatment in naturally occurring ethylene glycol intoxication in cats.

OBJECTIVE: To describe the clinical experience and therapeutic use of fomepizole (4-methylpyrazole [4-MP]) in 3 cats with naturally occurring ethylene glycol (EG) toxicity. CASE OR SERIES SUMMARY: All cats were documented to be EG positive by an ethylene glycol test kit. This report describes the dose of 4-MP used, available clinicopathological data, and clinical progression during hospitalization. All patients survived to discharge. NEW OR UNIQUE INFORMATION PROVIDED: IV use of 4-MP at 125 mg/kg as an initial dose and 31.25 mg/kg at 12, 24, and 36 hours is safe and effective for treatment of naturally occurring EG toxicity in cats. Increased HCO3 concentrations were noted after IV use of 4-MP. This is the first report documenting the successful treatment of naturally occurring EG intoxication in cats with 4-MP.

Outcome and medical management in dogs with lower motor neuron disease undergoing mechanical ventilation: 14 cases (2003-2009).

OBJECTIVE: To describe the application of intermittent positive pressure ventilation (IIPV) in dogs with lower motor neuron disease (LMND). DESIGN: Multi-institutional, retrospective study (2003-2009). SETTING: Intensive care units at multiple university teaching hospitals. ANIMALS: Fourteen dogs with LMND that underwent IIPV. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The ventilatory logs of 4 teaching hospitals were searched for dogs undergoing IIPV in association with a diagnosis of acute LMND. The medical records were evaluated for signalment, specific LMND, ventilatory management and duration, complications associated with ventilation, duration of hospitalization, and outcome. Descriptive statistics were used as indicated. Fifteen records were evaluated, 1 dog was excluded since it experienced cardiopulmonary arrest (CPA) before commencement of IIPV. The median age was 7.0 years (range 10 mo to 12 y). There were 5 Labrador retrievers, 4 mixed breeds, and 5 other breeds were each represented once. Five dogs were diagnosed with myasthenia gravis, 4 dogs with polyradiculoneuritis, and 5 dogs had an undetermined LMND. Clinical signs of weakness before ventilation were present for a median of 36 hours (range 6 h to 14 d). Dogs were ventilated for a median of 109 hours (range 5-261 h). Nine dogs had temporary tracheostomies performed, and 8 dogs received nutritional support. Five dogs developed ventilator associated pneumonia. Six dogs were successfully weaned from the ventilator with a median ventilatory time of 49 hours (range 25-192 h). Three dogs survived to discharge. No single LMND was associated with a better outcome. CONCLUSIONS: High euthanasia rates and iatrogenic complications limit the ability to accurately prognosticate for affected dogs in this retrospective study, but in dogs with LMND that is severe enough to require IIPV, support may be required days to weeks.

Causes of respiratory failure.

There are many causes of respiratory failure in veterinary patients. Assessment of oxygenation is imperative for the diagnosis and monitoring of these patients. Oxygen therapy should be instituted when hypoxemia is diagnosed to prevent tissue hypoxia, end-organ damage, and death. Methods of administering oxygen include commercial oxygen cages, mask oxygen, nasal cannulation (for dogs), and intubation. Mechanical ventilation is an option in many referral hospitals for patients who are severely hypoxemic and are not responding to inspired oxygen concentrations achieved with other methods of oxygen administration. One rule of thumb used to assess need for mechanical ventilation is a PaO2 of less than 50 mm Hg despite aggressive oxygen therapy, or a PaCO2 of greater than 50 mm Hg despite treatment for causes of hypoventilation. A mechanical ventilator has the ability to vary the FiO2 by increments of one, from 21% to 100% (0.21-1) oxygen in inspired gas. Positive end-expiratory pressure (PEEP) is also available on most ventilators. PEEP allows the alveoli to remain open on expiration, allowing gas exchange to occur in both inspiration and expiration. PEEP also helps diseased alveoli to inflate, increasing the available surface area for gas exchange and improving arterial blood oxygen tension. Because patients requiring mechanical ventilation have severe respiratory failure that did not respond to conventional oxygen therapy, the prognosis is guarded for most of these patients unless ventilation is instituted due to primary hypoventilation and lung parenchyma is normal. Hypoxemia caused by respiratory failure is a common problem in small animal veterinary patients. Assessment of blood oxygenation and continual monitoring of respiratory rate and effort are essential in management of these patients. Oxygen therapy should be instituted if hypoxemia is diagnosed. The prognosis depends on the underlying disease process and response to treatment with an enriched oxygen environment.