A retrospective case control study, which aimed to evaluate potential clinical, laboratory and imaging predictors of fatal pulmonary haemorrhage in dogs with Leptospirosis submitted to haemodialysis. The study population was divided in two groups according to the presence (PH) or absence (nPH) of pulmonary haemorrhage. A statistical comparison was performed at hospital admission for clinical (spontaneous bleeding, icterus, and respiratory distress), laboratory (serum creatinine, urea, phosphate, calcium, bicarbonate, bilirubin, AST, ALT, ALKP, GGT, total protein, albumin, glycaemia, sodium, potassium, CRP, RBC, HCT, HGB, WBC, PLT, PT, aPTT, fibrinogen), and pulmonary radiographic findings between the two groups of dogs. At hospital admission, dogs developing pulmonary haemorrhage were more likely to have respiratory distress (p = 0.002), severely elevated serum bilirubin (p = 0.002), AST (p = 0.04), ALT (p = 0.012), ALKP (p = 0.002), reduced serum glycaemia (p = 0.014), and thrombocytopenia (p = 0.04). Respiratory distress and elevated serum bilirubin (≥11.5 mg/dL) were independently associated with increased risk of pulmonary haemorrhage. In conclusion, the presence of respiratory distress at hospital admission is strongly associated (OR 40.9) with increased risk of pulmonary haemorrhage, even though no abnormalities are found at chest radiography.
Abstract Objective To investigate prognostic models in a cohort of dogs with acute kidney injury (AKI) and acute on chronic kidney disease (AKI/CKD) managed by hemodialysis. Design Retrospective study from July 2011 to November 2014. Setting University Veterinary Teaching Hospital. Animals Forty dogs with historical, clinical, imaging, and laboratory findings consistent with AKI or AKI/CKD managed with intermittent hemodialysis were included. Interventions Scoring system models previously established by Segev et al for outcome prediction in dogs with AKI were applied to all dogs. Results Models A, B, and C correctly classified outcomes in 68%, 83%, and 85% of cases, respectively. In our cohort Model A showed sensitivity of 58% and specificity of 86%, Model B showed sensitivity of 79% and specificity of 87%, Model C showed sensitivity of 86% and specificity of 84%. The presence of anuria ( P < 0.0002), respiratory complications ( P < 0.0001), disseminated intravascular coagulation (DIC) ( P = 0.0004), grade of AKI ( P = 0.0023), pancreatitis ( P = 0.0001), and systemic inflammatory response syndrome (SIRS) ( P = 0.0001) was significantly higher in nonsurvivors compared with survivors. Conclusions In our cohort of patients, Segev's model C showed the best sensitivity and specificity for predicting prognosis, while model A had lower sensitivity. In our cohort of dialysis patients, the presence of respiratory complications, DIC, SIRS, and pancreatitis at hospitalization, were correlated with a poor prognosis.
Non-permanent central venous catheters (CVCs), are the most commonly used vascular access in veterinary patients undergoing hemodialysis. In human dialysis patients, CVC infection represents a common cause of morbidity and mortality. The aim of this retrospective observational study was to evaluate the prevalence of bacterial colonization of CVCs in dogs submitted to hemodialysis treatment at time of CVC removal. The CVCs of all dogs submitted to hemodialysis (n = 23) at the Veterinary Teaching Hospital ''Mario Modenato'' of the University of Pisa between January 2015 and December 2016 were considered. For all dogs, data regarding signalment, reason for hemodialysis treatment, duration of catheterization (≤15 or >15 days), CVC complications, and 30-day survival were considered. Statistical analysis was performed using Graph Pad Prism™. Five over 23 dogs (22%) showed positive bacterial culture of CVC (+), and 18/23 dogs (78%) negative culture of CVC (-). The most prevalent microorganism was Staphylococcus Spp (3/5; 60%). No significant difference was found in the prevalence of CVC infection according to age, gender, reason for hemodialysis, CVC complications, duration of catheterization, and outcome. No statistically significant difference (p = 0.64) in survival curves was reported at log rank analysis between dogs with CVC - and CVC +. The prevalence of bacterial CVC contamination in our dialysis dogs showed relatively low. Exclusive use of CVC for hemodialysis, good hygiene practice during CVC management, and use of chlorhexidine as an antiseptic should be strongly encouraged.
Abstract Objective To evaluate arterial blood gas parameters and pulmonary radiography, before and after provision of continuous positive airway pressure (CPAP) via a pediatric helmet in dogs with acute hypoxemic respiratory failure. Design Single‐center, observational study conducted from 2016 to 2017. Setting University teaching hospital. Animals Seventeen dogs presenting with clinical signs compatible with respiratory failure, confirmed by arterial blood gas analyses. Interventions For each animal arterial blood samples and thoracic radiographs were performed at arrival (T 0 ). Hypoxemic dogs (PaO 2 <80 mm Hg), without evidence of pneumothorax or pleural effusion, received CPAP ventilation via a pediatric Helmet for at least 1 hour. At the end of CPAP ventilation, a second arterial blood gas analysis was performed at room air (T 1 ). The F‐shunt was also calculated. Measurement and Main Results Respiratory rate, heart rate and rhythm, mean blood pressure, mucosal membrane color, and rectal temperature were recorded. Tolerance to the helmet was evaluated using a predetermined scoring system. Two dogs were excluded from the study for low tolerance to the helmet. In 15 of 17 dogs, a significant difference between T 0 and T 1 was noted for PaO 2 (60.84 ± 3 mm Hg vs 80.2 ± 5.5 mm Hg), P(A‐a)O 2 (52.4 ± 4.4 mm Hg vs 35.2 ± 6 mm Hg), PaO 2 /FiO 2 (289.7 ± 14.3 vs 371 ± 21), and %SO 2 (91.3 vs 98.8). In 15 of 17 dogs, the helmet was well tolerated. F‐shunt significantly decreased following provision of CPAP (37%; range, 8.4–68% vs 6%; range, −5.6–64.3%). Conclusion The use of a pediatric helmet appears to be a suitable device for delivery of CPAP in dogs with hypoxemic acute respiratory failure. The device appears to be reasonably tolerated and improved oxygenation in most dogs.
Three dogs were evaluated for severe hyperproteinemia and hyperglobulinemia secondary to Leishmania infantum. Double filtration plasmapheresis (DFPP) was performed in two dogs at days 1, 2, and 6 after presentation. The third dog received DFPP at days 1 and 3 after presentation and eleven hemodialysis treatments. Significant reduction in serum total protein (p ＜ 0.0001), alpha-1 (p = 0.023), alpha-2 (p = 0.018), gamma globulins (p = 0.0105), and a significant increase in albumin/globulin ratio (p = 0.0018) were found. DFPP may be a promising therapeutic technique for rapid resolution of signs of hyperproteinemia in dogs affected by L. infantum.
Abstract Background In humans, respiratory complications in patients with acute pancreatitis (AP) are a common life-threatening comorbidity. Since possible lung impairment has not been individually evaluated in canine AP, the aims of the present study were to: (1) describe the prevalence, types and severity of pulmonary complications in dogs with acute presentation of AP, and (2) evaluate their association with mortality. AP diagnosis was based on compatible clinical and laboratory parameters, abnormal canine pancreatic-lipase test, and positive abdominal ultrasound within 48 h from admission. The canine acute pancreatitis severity score (CAPS) was calculated for each dog at admission. Arterial blood gas analysis and thoracic radiography were performed at admission. Thoracic radiography was classified on the basis of pulmonary pattern (normal, interstitial or alveolar) and a modified lung injury score (mLIS) was applied to the ventrodorsal projections for each dog. VetALI/VetARDS were diagnosed using current veterinary consensus. Dogs were divided into non-survivors or survivors (hospital discharge). Clinical, radiological and blood gas parameters collected at presentation were compared between survivors and non-survivors and associated with mortality. Results This prospective cohort study included twenty-six client-owned dogs with AP. Twelve out of twenty-six dogs (46%) died or were euthanized. At admission, thirteen dogs showed respiratory distress at physical examination, which was associated with death ( P < 0.001). Radiographic abnormalities were found in twenty-one dogs: alveolar ( n = 11) and interstitial pattern ( n = 10). Radiographic alterations and mLIS score were both associated with death ( P = 0.02 and P = 0.0023). The results of the arterial blood-gas evaluation showed that non-survivors had lower PaCO 2 and HCO 3 − levels, and higher A-a gradient than survivors ( P = 0.0014, P = 0.019 and P = 0.004, respectively). Specifically, three dogs had aspiration pneumonia, and VetALI was diagnosed in nine dogs (34.6%), and no dogs met the criteria for VetARDS. The presence of VetALI was associated with mortality ( P < 0.001). Conclusions As with humans, possible lung impairments, such as VetALI, should be investigated in dogs with acute presentation of pancreatitis.
