Abstract Objective To discuss the definitions of sepsis in human and veterinary medicine. Design International, multicenter position statement on the need for consensus definitions of sepsis in veterinary medicine. Setting Veterinary private practice and university teaching hospitals. Animals Dogs and cats. Interventions None. Measurements and Main Results Sepsis is a life‐threatening condition associated with the body's response to an infection. In human medicine, sepsis has been defined by consensus on 3 occasions, most recently in 2016. In veterinary medicine, there is little uniformity in how sepsis is defined and no consensus on how to identify it clinically. Most publications rely on modified criteria derived from the 1991 and 2001 human consensus definitions. There is a divergence between the human and veterinary descriptions of sepsis and no consensus on how to diagnose the syndrome. This impedes research, hampers the translation of pathophysiology insights to the clinic, and limits our abilities to optimize patient care. It may be time to formally define sepsis in veterinary medicine to help the field move forward. In this narrative review, we present a synopsis of prior attempts to define sepsis in human and veterinary medicine, discuss developments in our understanding, and highlight some criticisms and shortcomings of existing schemes. Conclusions This review is intended to serve as the foundation of current efforts to establish a consensus definition for sepsis in small animals and ultimately generate evidence‐based criteria for its recognition in veterinary clinical practice.
Abstract 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.
Abstract OBJECTIVE The primary goal was to compare the efficacy of administration of apomorphine (APO) administered by intranasal (IN), transconjunctival (TC), SC and IV routes with ropinirole eye drops for induction of emesis in dogs with a secondary goal to evaluate the time of emesis as well as difficulty in administration. ANIMALS 125 client-owned dogs. METHODS Dogs were randomly enrolled between October 1, 2021, and March 30, 2022, into groups of 25: IV APO, IN APO, TC APO, SC APO, and ropinirole eye drops. The IV, SC, and TC groups were dosed at 0.03 mg/kg, the IN group was dosed at 0.06 mg/kg, and the ropinirole group was dosed according to manufacturer guidelines. Data collected included success rate of emesis within 600 seconds, time to emesis, time to administer, and difficulty score. Results were compared to IV with P values and CIs being adjusted for multiple comparisons. RESULTS Emesis was successful within 600 seconds using IV APO in 22 of 25 dogs. By comparison, IN APO induced emesis in 18 of 25 dogs ( P = .63). Ropinirole (14/25), SC APO (6/25), and TC APO (4/25) were significantly less successful ( P = .047, P = < .001, and P < 0.001, respectively). When emesis was successful, it occurred most rapidly with TC APO, followed by IN APO and then ropinirole. It was most difficult to administer IV APO and TC APO. CLINICAL RELEVANCE Similar to IV APO, IN APO was a rapid, easy, and effective method of inducing emesis in dogs and should be considered when IV administration is not possible. Ropinirole was easy to administer but successfully induced emesis less reliably within a 10-minute timeframe. APO administered TC using the commercially compounded injectable formulation was ineffective.
Down-regulated gene expression, encoding sarcoplasmic reticulum (SR) Ca 2 + -ATPase and its regulatory proteins such as SR Ca 2 + -ATPase isoform 2a (SERCA2a) and phospholamban (PLN), plays a crucial role in myocardial decompensation due to the impairment of intracellular Ca 2+ cycling.It has been reported that SERCA2a and PLN expressed in peripheral blood mononuclear cells (PBMC) not only are translatable to the myocardial setting, but also significantly decrease in dogs with degenerative mitral valve disease.The aim of this study is to clarify how effectively the target genes reflect hemodynamic overload, a primary determinant of myocardial distress.Healthy laboratory beagles (n = 24), very young dogs with patent ductus of arteriosus (PDA; n = 8) and with pulmonic stenosis (PS; n = 5) were enrolled in this study.None of patients have been treated previously with cardiovascular medication.All PDA patients were in subclinical stage, whereas PS patients had severe stenosis.The mRNA levels of SERCA2a and PLN in PBMC were evaluated before and one week after surgical intervention with using quantitative real-time PCR.Plasma concentration of NT-proBNP was also measured as a reference of cardiac biomarkers.Compared with control group, the fold-changes of the both target genes were significantly low in PDA (0.50 AE 0.17 for SER-CA2a and 0.41 AE 0.21 for PLN) as well as in PS (0.47 AE 0.20 for SERCA2a and 0.35 AE 0.10 for PLN).In paired comparison between pre-and post-operation, their expression levels significantly increased one week after surgical correction in both PDA (0.74 AE 0.22 for SERCA2a and 0.68 AE 0.24 for PLN) and PS (0.74 AE 0.18 for SERCA2a and 0.65 AE 0.20 for PLN).Meanwhile, plasma levels of NT-proBNP between before and after surgery were not different in both PDA (before surgery, 761.0 AE 579.2 pmol/L; one week after surgery, 679.9 AE 437.2 pmol/L) and PS (before surgery, 867.2 AE 560.2 pmol/L; one week after surgery, 863.4 AE 523.1 pmol/L).Additionally, the expression levels of SER-CA2a and PLN were significantly correlated to hemodynamic indices, such as fractional shortening and LA/Ao ratio in PDA, and peak pressure gradient in PS (P < 0.05).Furthermore, receiveroperating characteristic analysis showed high values of the area under the curve in SERCA2a (0.95 AE 0.04 in PDA; 0.95 AE 0.04 in PS) and PLN (1.00 AE 0.0 in PDA; 0.98 AE 0.03 in PS).To conclude, SERCA2a and PLN expressed in the PBMC may be effectively able to reflect myocardial distress determined by hemodynamic change as cardiac biomarkers.
Abstract OBJECTIVE To describe the clinical outcome of dogs that developed pneumothorax after an encounter with a porcupine. ANIMALS 25 client-owned dogs from 2 practices in New England. PROCEDURES The medical records were searched for those of dogs that underwent care for porcupine quilling–associated pneumothorax (PQAP) between August 1, 2001, and October 15, 2023. Dogs were all large-breed dogs or large mixed-breed dogs and most frequently had clinical signs associated with pneumothorax, including labored breathing and tachypnea. RESULTS No cases occurred in winter months. Diagnostic imaging was useful for identifying pneumothorax, but not for localizing quills. Twenty-one of the 25 dogs underwent median sternotomy for quill removal, with quills found in lung tissue of 19 dogs. Two dogs had no intrathoracic quills identified at thoracotomy, but residual quills were identified in the intercostal muscles. Four dogs were discharged without surgery after apparent resolution of the pneumothorax. All dogs survived to hospital discharge; however, 5 dogs required subsequent quill removal from ongoing quill migration. CLINICAL RELEVANCE Porcupine quillings may result in traumatic pneumothorax associated with quill migration. Following quill removal, monitoring for the development of a pneumothorax is advised. Surgical removal of quills from the lungs has a good prognosis.
The purpose of this study was to evaluate the clinical response and side effects of tissue plasminogen activator (tPA) for the treatment of feline arterial thromboembolism (ATE). Previous reports of conservative and thrombolytic therapy were used to provide a historical control group of cats with ATE. The study was terminated due to a high frequency of adverse outcomes. tPA was administered to 11 cats with clinical signs of ATE for a median duration of 4.0 h (range 2–12 h) prior to treatment. Pulses were restored in 40% of limbs within 4 h and 53% within 24 h. Motor function was restored to 33% of limbs within 24 h. Adverse effects were seen in 11/11 cats following administration of tPA including azotemia ( n=5), neurological signs ( n=5), cardiac arrhythmias ( n=5), hyperkalemia ( n=4), acidosis ( n=2) and sudden death in one cat. Ultimately, three cats (27%) were discharged alive from the hospital. While signs compatible with thrombolysis were noted in many cats following tPA administration, a high rate of side effects and low rate of hospital discharge were noted in this study.
Abstract Objective To retrospectively evaluate and stratify the differences in signalment, mechanisms, and severity of injury between toy and giant breed dogs. Design Retrospective, observational cohort study. Setting Multicenter, university veterinary teaching hospital, and private referral hospitals contributing to Veterinary Committee on Trauma (VetCOT) patient registry. Animals Two thousand seven hundred and five (2589 toy and 116 giant breed) dogs presented for trauma with complete data entries recruited into the Veterinary Committee on Trauma registry from September 1, 2013 through December 31, 2017. Interventions None. Measurements and Main Results Injury etiology in toy breeds was predominantly blunt trauma (1532/2587 [59.2%]), commonly falling from a height or motor vehicle accident, whereas in giant breeds penetrating trauma was more common (71/116 [61.2%]). Eighty‐seven percent (2231/2558) of toy breeds and 94.7% (108/114) giant breeds survived to discharge. When stratified by severity of injury (animal trauma triage [ATT] ≥ 5), mortality increased. Severely injured toy breeds had a 45.6% (200/438) survival rate, and severely injured giant breeds had a 62.5% (5/8) survival rate. Patient size did not impact survival in a logistic regression model; however, ATT score (odd ratio, 0.55; 95% CI, 0.52–0.58; P < 0.001), modified Glasgow Coma Scale (mGCS; odds ratio, 1.2; 95% CI, 1.11–1.32; P < 0.001), and base excess (odds ratio, 1.15; 95% CI, 1.09–1.22; P < 0.001) were predictive of nonsurvival. Surgical intervention was required in 743 of 2587 (29%) toy breeds and 65 of 116 (56%) giant breeds. Surgery was associated with an increased survival rate (odds ratio, 4.43; 95% CI, 2.45–8.83; P < 0.0001). Conclusions Evaluation of a large, multicenter dataset showed that ATT score along with base excess, plasma lactate, and mGCS were predictors of mortality independent of patient size. Severely injured dogs, as defined by an ATT score ≥ 5, were less likely to survive, and toy breed dogs had a higher mortality rate than giant breeds in the subcategory.
A 7-year-old male neutered domestic shorthair cat was presented with a 3-month history of dyspnea when exercising and increased respiratory noise when purring. Initial radiographs identified a suspected laryngeal mass. Point-of-care ultrasound found a fluid-filled structure on the larynx, which was drained percutaneously. The cat initially recovered well but, due to recurrence of clinical signs, a CT scan was performed, which confirmed the presence of a laryngeal cyst that was subsequently surgically resected. Histopathological analysis was consistent with a suspected thyroglossal cyst.This is only the second report of a laryngeal cyst in the cat. While malignant laryngeal disease may be more prevalent in the cat, benign differentials should be considered as treatment could be curative, as was observed in this case.
