Abstract Objective —To identify breed disposition, postoperative complications, and outcome in dogs with lung lobe torsion. Design —Retrospective study. Animals —22 client-owned dogs. Procedure —Information on signalment; history; clinical findings; results of clinicopathologic testing, diagnostic imaging, and pleural fluid analysis; surgical treatment; intra- and postoperative complications; histologic findings; and outcome were obtained from medical records. Results —All 22 dogs had pleural effusion; dyspnea was the most common reason for examination. Fifteen dogs were large deep-chested breeds; 5 were toy breeds. Afghan Hounds were overrepresented, compared with the hospital population. One dog was euthanatized without treatment; the remaining dogs underwent exploratory thoracotomy and lung lobectomy. Eleven dogs recovered from surgery without complications, but 3 of these later died of thoracic disease. Four dogs survived to discharge but had clinically important complications within 2 months, including chylothorax, mediastinal mesothelioma, gastric dilatation, and a second lung lobe torsion. Six dogs died or were euthanatized within 2 weeks after surgery because of acute respiratory distress syndrome, pneumonia, septic shock, pneumothorax, or chylothorax. Chylothorax was diagnosed in 8 of the 22 dogs, including 4 Afghan Hounds. Conclusion and Clinical Relevance —Results suggest that lung lobe torsion is rare in dogs and develops most frequently in large deep-chested dogs, particularly Afghan Hounds. Other predisposing causes were not identified, but an association with chylothorax was evident, especially in Afghan Hounds. Prognosis for dogs with lung lobe torsion was fair to guarded. ( J Am Vet Med Assoc 2000;217:1041–1044)
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Respiratory distress is a common presentation in veterinary medicine, and prompt, effective management is paramount. Treating these animals can be challenging, as many are too distressed to be handled extensively. Excessive manipulation can result in exacerbation of respiratory distress, haemoglobin desaturation and respiratory arrest. Thus, in unstable animals, it is very important to limit diagnostic testing. Instead, initial efforts should be focused on stabilization and application of non-specific respiratory support modalities, such as oxygen supplementation. The history and signalment, observation of the pattern of respiration, and a brief physical examination are all used to make a clinical estimate of the anatomical location of disease within the respiratory tract, thereby directing effective emergency therapy to stabilize the patient prior to diagnostic testing. Depending on the cause of respiratory distress, a variety of emergency interventions may be necessary, including drug therapy, tracheostomy, thoracocentesis or thoracostomy tube placement, and positive pressure ventilation. This chapter looks at Physiology; History; Initial observation; Physical examination; Initial stabilization; Initial management based on disease location; and Initial diagnostic tests.
Abstract Objective – Describe antimicrobial therapy and aerobic bacteriologic culture patterns in canine intensive care unit (ICU) patients in a university hospital. Design – Retrospective descriptive. Setting – A tertiary university referral hospital. Animals – Seventy‐four canine ICU patients. Interventions – From January to June 2006 patient antimicrobial use, minimum inhibitory concentration (MIC) results, and clinical data were recorded. Appropriate antimicrobial use was analyzed relative to the time of culture submission and MIC results. Measurements and Main Results – Mean±SD age was 7.2±4.2 years. Median (range) length of ICU and hospital stays were 3 days (1–25 d) and 4 days (1–27 d), respectively. A total of 106 cultures were submitted; 47 of 106 (44%) cultures were positive for 70 isolates, including Escherichia coli (16/70 [23%]), Staphylococcus intermedius (7/70 [10%]), and Acinetobacter baumannii (5/70 [7%]). A multidrug resistant pattern occurred in 19 of 70 (27%) isolates, and was significantly more likely after 48 hours of hospitalization ( P <0.001). Antimicrobials were administered before culture submission in 42 of 74 dogs (57%) and included enrofloxacin (23/42 [55%]), ampicillin (20/42 [48%]), and amoxicillin/clavulanic acid (8/42 [19%]). Antimicrobial choices were appropriate 19% of the time. While pending culture results, antimicrobials were administered to 67 of 72 (94%) dogs remaining alive, and were appropriate 75% of the time. The most common antimicrobials administered while awaiting culture results were ampicillin (52/67 [78%]), enrofloxacin (49/67 [73%]), and amikacin (9/67 [13%]). Post‐MIC antimicrobials were appropriate 89% of the time. Of 45 dogs remaining alive, 17 (37%) continued to receive antimicrobials despite negative cultures. Conclusions – Antimicrobial use was extensive in this patient population, but when available, MIC results were used to guide antimicrobial therapy. Many patients with negative cultures continued to receive antimicrobial therapy. Multidrug resistant bacteria were more likely in cultures taken after 48 hours of hospitalization.
