Table of Contents
IVECCS Abstracts presented
September 14–18, 2018 in New Orleans, LA, USA
IVECCS Small Animal Abstracts
(in alphabetical order of presenter)
p. S2‐S21
IVECCS Large Animal Abstracts
(in alphabetical order of presenter)
p. S21‐S26
EVECC Congress Abstracts presented
June 21–23, 2018 in Venice, Italy
EVECCS Small Animal Abstracts
(in alphabetical order of presenter)
p. S27‐S35
ACVECC VetCOT Abstracts presented
April 6–8, 2018, in Las Vegas, Nevada, USA
At ACVECC VetCOT Veterinary Trauma & Critical
Care Conference
p. S36‐S37
Author Index
p. S38‐S39
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IVECCS Abstracts presented September 14–18, 2018 in New Orleans, LA, USA
Listing of Small Animal IVECCS Abstracts (in alphabetical order of presenter)
Oral Presentations
ACUTE KIDNEY INJURY IN DOGS AFTER HYDROXYETHYL STARCH 130/0.4 OR HARTMANN'S SOLUTION:
PROTOCOL AND FEASIBILITY ANALYSIS*
Boyd, CJ, Claus, MA, Sharp, CR, Raisis, AR, Hosgood, G, Smart, L
Murdoch University, Perth, WA, Australia
*Winner of the Veterinary Emergency and Critical Care Foundation Research Grant.
Introduction: Hydroxyethyl starch (HES) has been associated with acute kidney injury
(AKI) in people, but there is limited evidence in dogs. We present the protocol and
feasibility analysis of an ongoing prospective randomized blinded phase II clinical
trial.
Methods: Dogs at a university hospital prescribed a fluid bolus for clinical reasons
were randomized to receive at least 10 mL/kg of HES 130/0.4 or Hartmann's solution.
After 40 mL/kg of study fluid further fluid administration was open‐label. Urine for
neutrophil gelatinase‐associated lipocalin and cystatin C was collected prior to and
6, 12, and 24 hours after the first study fluid bolus. Serum creatinine was measured
daily for 7 days or until discharge. Target sample size was 20 per group. Screening
and enrolment targets were 7 and 2 per week, respectively. Population characteristics
and feasibility outcomes for the first 17 weeks of enrolment are reported.
Results: Thirty‐six dogs were logged as screened (2.1 per week) with 15 enrolled (0.9
per week). Reasons for exclusion included dehydration (4/21), transfusion required
(4/21), consent declined (3/21), insufficient time to enroll (2/21), and predicted
hospitalization < 24 hours (2/21). Twelve out of 15 dogs that were enrolled were administered
the intervention. One was taken home against medical advice, one was administered
a transfusion in place of the intervention, and one no longer required the intervention.
For the 12 dogs administered the intervention, median (range) APPLEfast score was
23.5 (20–38) and 4 were septic. Median (range) volume of intervention fluid was 22.9
mL/kg (10.0–57.1 mL/kg). There were four major protocol violations, all relating to
volume of intervention fluid administered. Nine of 12 dogs completed blood and urine
sampling for all time points. Two out of 12 dogs developed AKI during hospitalization
based on Veterinary Acute Kidney Injury scoring (one stage 1, one stage 2). Nine out
of 12 dogs survived to discharge (2 died, 1 euthanized due to prognosis).
Conclusion: Recruitment rate was lower than projected, mainly due to lower number
of dogs screened. The investigators are satisfied that the enrolled cases are representative
of the population of clinical interest. Drop‐out after enrolment and protocol violations
highlight the challenges of performing clinical interventional studies in emergency
medicine.
PLATELET NUMBER AND FUNCTION IN RESPONSE TO A SINGLE DOSE OF INTRAVENOUS VINCRISTINE
AS ASSESSED BY FLOW CYTOMETRY
Allen, EC
1, Tarigo, JL1, Brainard, BM1, Barber, JP1, LeVine, DN2
1University of Georgia, Athens, GA, USA
2Iowa State University, Ames, IA, USA
Introduction: Immune thrombocytopenia (ITP) causes severe thrombocytopenia in dogs.
Emergency therapy can include the administration of vincristine to increase platelet
numbers, but it is unknown if the newly released platelets are fully functional. The
objective of this study was to evaluate the functionality of immature (reticulated)
platelets released following a single intravenous dose of vincristine to healthy adult
dogs.
Methods: Ten healthy research dogs received either a single IV injection of 0.02 mg/kg
vincristine, or a similar volume of saline. Prior to and after treatment, platelet
P‐selectin (CD62P) expression and fibrinogen binding (CAP1 antibody) were assessed,
with and without activation with human gamma thrombin (HGT). Mature and immature platelets
were distinguished on the basis of thiazole orange (TO) staining.
Results: Vincristine administration increased platelet concentration relative to saline
from day 0 to day 7 (225 ± 58 vs 273 ± 65 × 103/μL, P = 0.0148). Baseline (unstimulated)
expression of CAP1 and CD62P was greater in the reticulated (TO+) platelets than the
mature (TO‐) platelets (P < 0.003). Following HGT stimulation, TO+ platelets did not
have significantly different CAP1 and CD62P expression relative to TO‐ platelets with
the exception of day 0, when they had greater CD62P expression (P = 0.049).
Conclusion: Reticulated platelets appear to have a higher resting activation state
than mature platelets, but demonstrate similar P‐selectin expression and fibrinogen
binding to mature platelets following HGT stimulation, suggesting that these platelets
function similarly to mature platelets.
EFFECTS OF POSITIVE FLUID BALANCE ON MORBIDITY AND MORTALITY IN CANINE SEPTIC PERITONITIS
Binagia, EM, Levy, NA, Koenigshof, A
Michigan State University, East Lansing, MI, USA
Introduction: Several studies in people have shown that septic patients with a positive
fluid balance after day 1 have a worse prognosis. The purpose of this study was to
evaluate the daily and cumulative fluid balance in canine septic peritonitis patients.
Methods: Medical records were searched for all dogs with the diagnosis of septic peritonitis
from 2007 to 2017. Patients were excluded if no urinary catheter was placed within
12 hours or if the patient was hospitalized less than 24 hours. Daily and cumulative
fluid balances were determined at 6, 12, 24, 48, and 72 hours. Fluid balance was calculated
by total fluid intake (intravenous fluids, blood products, enteral, and parenteral
nutrition) minus total fluid output (urine measured via urinary catheter, abdominal
drain production, and nasogastric tube aspiration).
Results: Seventy‐four patients met inclusion criteria (43 survivors, 31 nonsurvivors).
There was no difference in fluid balance at 6, 12, and 24 hours between survivors
and nonsurvivors. Seventy‐three patients had a positive fluid balance after 24 hours.
Daily fluid balance was significantly lower in survivors on day 2 compared to nonsurvivors
(11.1 mL/kg (–91.4 to 136.3), 59.9 mL/kg (–90.1 to 187.9), respectively; P = 0.01).
Day 3 daily fluid balance was also significantly lower in survivors compared to nonsurvivors
(2.9 mL/kg (–140.5 to 63.0), 40.1 mL/kg (–69.8 to 296.4), respectively; P = 0.04).
Cumulative fluid balance at day 3 was significantly lower in survivors compared to
nonsurvivors (149.2 mL/kg (–36.9 to 357.0), 254.8 mL/kg (30.9–578.2), respectively;
P = 0.001), but there was no difference in cumulative fluid balance on day 2 between
the groups. Length of hospitalization of survivors was positively correlated with
fluid balance on day 1 (r = 0.35, P = 0.018) and cumulative fluid balance on day 2
(r = 0.39, P = 0.018).
Conclusion: In canine septic peritonitis patients, nonsurvivors had a significantly
higher daily fluid balance on days 2 and 3, and a higher cumulative balance at day
3. Future studies are needed to evaluate the effects of a positive fluid balance on
outcome in dogs with septic peritonitis.
UTILITY OF BLOOD LACTATE PARAMETERS IN OUTCOME ASSESSMENT IN HOSPITALIZED CRITICALLY
ILL CANINE PATIENTS
Blutinger, L, Zollo, AM, Weltman, J, Prittie, J
The Animal Medical Center, New York, NY, USA
Introduction: Various lactate variables and illness severity scoring systems have
shown utility in predicting outcome in critically ill human and veterinary patients.
We aimed to determine whether lactate variables and/or the Acute Patient Physiologic
and Laboratory Evaluation Score (APPLEfast) could discriminate hospital survivors
from non‐survivors in dogs with noncardiogenic shock.
Methods: Seventy‐one dogs with noncardiogenic shock presenting for emergent care were
prospectively enrolled. Primary outcome was survival to discharge; secondary outcome
was the need for blood product administration. APPLEfast was calculated at admission
and venous lactate concentrations were measured at predetermined time points. Admission
lactate, lactate variables (lactime, lactate clearance, LACAREA) and APPLEfast were
compared between survivors and nonsurvivors. APPLEfast was assessed for correlation
with lactime, LACAREA, and lactate clearance.
Results: Neither admission lactate nor APPLEfast were predictive of outcome. Lactime
was shorter in survivors (P = 0.026). Lactate clearance at hours (h) 1 (P = 0.007),
4 (P = 0.029), and 10 (P = 0.048) was greater in survivors. LACAREA at time intervals
1–4 hours (P = 0.005), 4–10 hours (P = 0.001), 10–16 hours (P = 0.002), and 16–24
hours (P = 0.003) was larger in nonsurvivors. Total LACAREA was not different between
groups. APPLEfast was significantly correlated with admission lactate (P = 0.0001)
and LACAREA at time 0–1 hours (P = 0.004). LACAREA at time interval 1–4 hours (P = 0.001)
and APPLEfast (P = 0.01) were predictive of the need for blood products.
Conclusion: While admission venous blood lactate concentration and APPLEfast failed
to discriminate hospital survivors from nonsurvivors in this population, serial lactate
measures predicted outcome in dogs with clinical evidence of shock. Additionally,
APPLEfast and LACAREA 0–1 hours predicted the need for blood product transfusion.
This study suggests that serial biomarker measurements may be more useful in predicting
outcome in critically ill patients when compared to individual measurements.
ACCURACY OF ABDOMINAL ULTRASONOGRAPHY IN DOGS WITH NONTRAUMATIC SPONTANEOUS HEMOABDOMEN:
95 CASES (2014–2017)
Cudney, SE, Wayne, AS, Rozanski, EA
Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
Introduction: Spontaneous hemoabdomen is a common emergent presentation in dogs, with
the majority of the cases due to splenic or hepatic neoplasia. Abdominal ultrasonography
(AUS) is often recommended prior to surgery to evaluate for the location of a primary
mass and for evidence of metastatic disease although the evidence for the accuracy
of imaging is unknown. The goal of this study was to evaluate the accuracy of AUS
in predicting gross evidence of lesions at either exploratory surgery or necropsy,
with the hypothesis that AUS has a high specificity but low sensitivity for identification
of lesions.
Methods: Dogs that presented between 1/1/2014 and 10/30/2017 with a nontraumatic spontaneous
hemoabdomen that were evaluated by abdominal ultrasound and had either surgical exploration
or necropsy within 24 hours of presentation were eligible for inclusion. Dogs that
were euthanized prior to further diagnostics and treatment or were evaluated only
by point‐of‐care ultrasound were also excluded. The ability of AUS to accurately predict
splenic lesions, liver masses, liver nodules, and diffuse nodular metastatic lesions
was evaluated.
Results: Two hundred forty‐three dogs presented for spontaneous hemoabdomen in the
time frame evaluated, and 95 met the inclusion criteria. Overall, 50.5% (48/95) of
the dogs had grossly detected lesions that were not visualized on abdominal ultrasound.
Based upon surgical or necropsy findings, AUS had a 95.6% sensitivity and a 100% specificity
for identifying splenic masses (n = 87), a 75% sensitivity and 100% specificity for
liver masses (n = 20), a 65.4% sensitivity and 100% specificity for identifying liver
nodules (n = 52), and a 40% sensitivity and 98.7% specificity for identifying diffuse
nodular metastatic disease (n = 20).
Conclusion: Abdominal ultrasonography has a high specificity but a low sensitivity
for detecting disease of the liver, spleen, and diffuse nodular metastasis in dogs
that present with a nontraumatic spontaneous hemoabdomen. The utility of AUS, including
benefits and potential limitations, should be considered prior to performing this
test in a clinical setting.
A COMPARISON OF ACUTE TRANSFUSION REACTIONS IN 766 DOGS RECEIVING EITHER LEUKOREDUCED
OR NONLEUKOREDUCED PACKED RED BLOOD CELLS
Davidow, EB
1, Montgomery, HB2, Mensing, M3
1Self employed, Seattle, WA, USA
2Maple Leaf Pet Corner, Seattle, WA, USA
3BluePearl Veterinary Partners, Seattle, WA, USA
Introduction: Leukoreduction (LR) of packed red blood cells (pRBCs) decreases the
incidence of nonhemolytic febrile transfusion reactions (FNHTR) and potentially improves
outcome in people. In dogs, LR decreases the presence of inflammatory mediators after
transfusion. There are no studies in dogs comparing reaction rates between non‐LR
and LR pRBCs transfusions.
Methods: All transfusions administered at 2 multispecialty hospitals were tracked
beginning in January 2014. Transfusion events involving dogs receiving pRBCs from
2014 to July 2017 were retrospectively reviewed to record data about the patient,
donor, unit, transfusion event, and subsequent reactions. Hospital discharge and cause
of death was also recorded.
Results: A total of 801 transfusion events were identified. Thirty‐five events were
excluded due to lack of data posttransfusion or use of an outside blood unit. Of the
remaining 766 events in 474 patients, 301 used LR pRBC and 465 used nLR pRBC. Blood
was donated from 171 dogs and processed by an in‐house blood bank. Note that 35.6%
of patients had >1 transfusion. There was a 19% (149/766) overall rate of reactions.
One hundred twenty‐three were nonsevere, 20 were severe, and 6 were life‐threatening.
The 2 most common reactions were hemolysis only in 5% and FNHTR in 4% of events. There
was a 5.4% higher rate of mortality and a 2.4% higher rate of FNHTR after nLR pRBC
events. However, this difference was not statistically significant. The odds ratio
estimate for the effect of LR on the odds of death or euthanasia was 0.66 (0.43–1.02)
and on the odds of a FNHTR was 0.48 (0.2–1.18). The type of anemia did not affect
the risk of any reaction. Older age of pRBC significantly increased the odds of a
hemolysis only, more severe, and multiple clinical sign transfusion reaction. Increasing
pRBC unit age did not increase mortality. The odds of a respiratory type reaction
were increased with a greater number of previous transfusions.
Conclusion: In this study, age of unit was more influential on transfusion reaction
rate than LR but did not affect mortality. Future studies would be needed to conclusively
prove or disprove any effect of LR on outcome or FNHTR.
EVALUATION OF COCCYGEAL AND RADIAL ARTERY DOPPLER BLOOD PRESSURE MEASUREMENTS IN SICK
CATS WITH AND WITHOUT ABNORMALITIES IN TISSUE PERFUSION
De Rosa, SM, Drobatz, KJ, Reineke, EL
University of Pennsylvania, Philadelphia, PA, USA
Introduction: To determine if there is a difference between Doppler blood pressure
(SBP) measurements taken from the coccygeal artery compared to the common digital
branch of the radial artery in sick cats presenting to an emergency service with and
without abnormalities in tissue perfusion. A secondary objective was to determine
if there were site differences in SBP in cats that were hypotensive, normotensive,
and hypertensive.
Methods: Sixty‐two cats were prospectively enrolled during triage assessment and prior
to therapeutic interventions. Two or three SBP measurements were taken from each site
(coccygeal and radial) and the order of the sites was randomized. Cats were classified
as having hypoperfusion if at least two of the following physical examination parameters
were abnormal: capillary refill time, mucous membrane color, heart rate, pulse quality,
and rectal temperature. Cats were classified as hypertensive (SBP > 160 mm Hg), normotensive
(SBP ≥ 90, ≤ 160 mm Hg), or hypotensive (SBP < 90 mm Hg) based on the average SBP
obtained from both sites.
Results: The mean coccygeal SBP was significantly greater than the mean radial SBP
when all cats were evaluated together (n = 62, 141.66 ± 46.66 vs 126.46 ± 43.48, P = 0.0007).
Mean coccygeal SBP was also significantly higher in cats with normal perfusion (n = 40,
151.22 ± 41.05 vs 138.15 ± 37.46, P = 0.0093), in hypoperfused cats (n = 22, 124.27
± 51.99 vs 105.20 ± 46.38, P = 0.0328), and in normotensive cats (n = 36, 138.44 ±
22.05 vs 119.50 ± 21.49, P = 0.0003). There was no significant difference between
coccygeal SBP and radial SBP in hypertensive cats (n = 16, 192.60 ± 38.45 vs 178.20
± 29.47, P = 0.1449) and hypotensive cats (n = 10, 71.72 ± 17.58 vs 68.72 ± 30.18,
P = 0.8342).
Conclusion: Coccygeal SBP was significantly greater than radial SBP in cats with normal
perfusion, hypoperfusion, and in cats with a normal SBP. There was no difference in
SBP between these sites in cats that were hypertensive or hypotensive although the
number of cats in these groups was small. Larger studies are needed to further evaluate
SBP in cats with abnormal blood pressure as well as compare these measurements to
direct arterial pressure in conscious cats.
QUALITY OF LIFE FOLLOWING MECHANICAL VENTILATION IN CANINE AND FELINE PATIENTS
Donaldson, RE, Barfield, D
The Royal Veterinary College, London, United Kingdom
Introduction: Mechanical ventilation (MV) is routinely performed in dogs and cats
to support respiratory function during severe hypoxemia, hypercapnia, or respiratory
fatigue. It is unknown whether dogs and cats receiving MV experience long‐term effects
or complications of MV, or if their quality of life is affected.
Methods: Medical records were reviewed using a database for the term “MV” within the
medical history or discharge report from January 2004 to February 2018. Cases were
included in the study if they had received MV in the intensive care unit (ICU) and
were subsequently weaned from ventilation and discharged from hospital. Referring
veterinarians were contacted to learn if the patient was alive and to obtain relevant
clinical history. Owners were contacted to respond to a telephone survey.
Results: A total of 507 records were retrieved from the initial search. Six equine
records were excluded. Of the remaining 501, only 196 patients were mechanically ventilated
in the ICU. Sixty patients (30.6%) were weaned from ventilation, and 50 patients (25.5%)
were discharged from hospital. There were three exclusions (incomplete contact details
and medically unfit owner). There were 27 respondents to the survey (the owners of
25 dogs and 2 cats). All respondents rated their pet's quality of life prior to the
illness necessitating ventilation as good to excellent (8/10–10/10). Perceived recovery
periods ranged from 0 days to 6 months (the most common response being 2–3 weeks).
Fourteen owners stated that their pets’ quality of life was as good or better than
previously. Patients with persistent quality of life concerns (n = 3) had been ventilated
with neurological disease. Four owners reported changed behaviors such as startling
easily or being excessively responsive to noise. One cat became deaf and at time of
survey had not regained hearing. Commonly reported problems included decreased exercise
tolerance (n = 7). All respondents stated that they would ventilate their pet again.
Conclusion: The majority of patients discharged from hospital following MV have a
similar quality of life to before their illness, which may influence owner decision‐making
when MV is indicated.
SEIZURE OCCURRENCE AND ATRACURIUM CONTINUOUS RATE INFUSION IN MECHANICALLY VENTILATED
PATIENTS
Donaldson, RE, Cortellini, S, Humm, K
The Royal Veterinary College, London, United Kingdom
Introduction: Atracurium is a nondepolarizing benzylisoquinolinium agent commonly
used to improve patient synchrony during mechanical ventilation (MV). Degradation
of atracurium produces laudanosine, which is cumulative and has been associated with
central nervous system excitement and seizures in people. The objectives of this study
were to investigate seizure occurrence in canine and feline patients after MV, and
to evaluate if atracurium administration increased its prevalence.
Methods: Medical records of a veterinary university teaching hospital were reviewed
for cats and dogs which underwent MV in the intensive care unit (ICU) between January
2004 and February 2018. Signalment, any recorded seizure activity, whether the patient
was weaned from MV, and outcome (discharge from hospital, cardiopulmonary arrest,
or euthanasia) were documented. Patients were grouped into those that had been administered
an atracurium continuous rate infusion (CRI) during MV and those that had not and
those that had displayed abnormal neurological activity (including seizures) after
weaning from MV and those that did not. Statistical analysis was performed. Significance
was set at P = 0.05.
Results: Five hundred seven records were retrieved from the initial search, of which
196 were cats or dogs mechanically ventilated in the ICU. Sixty patients (30.6%) were
weaned from MV. Sixteen of these patients had seizure activity documented of which
11 had had seizure activity prior to MV. The remaining 5 patients had seizure activity
for the first time following weaning from MV. Three of the 5 patients were administered
an atracurium CRI. Six patients (5 dogs and 1 cat) in total received atracurium. The
3 patients that received an atracurium CRI and did not have documented seizure activity
were not weaned from MV. Patients weaned from MV that were administered an atracurium
CRI were more likely to have seizures (P = 0.0006). Besides age (P = 0.001), there
were no other significant differences between the atracurium and no atracurium groups.
Age was not associated with an increased risk of seizures overall (P = 0.092).
Conclusion: There appears to be an association between post‐MV seizures in the ICU
and the use of atracurium CRI in dogs, which should be considered when using the drug.
Younger patients were more likely to receive atracurium in this institute.
REPEATED INFUSION OF LYOPHILIZED CANINE ALBUMIN SAFELY AND EFFECTIVELY INCREASES SERUM
ALBUMIN AND COLLOID OSMOTIC PRESSURE IN HEALTHY DOGS
Enders, BD
1, Musulin, SE1, Holowaychuk, MK2, Hale, AS3
1North Carolina State University, Raleigh, NC, USA
2Critical Care Vet Consulting, Calgary, AB, Canada
3BodeVet, Inc., Rockville, MD, USA
Introduction: Hypoalbuminemia is associated with increased morbidity and mortality
in critically ill people and animals. Albumin solutions may be administered to increase
intravascular volume and colloid osmotic pressure in hypoalbuminemic animals. The
aims of this study were to evaluate the safety of repeated administration of a novel
lyophilized canine‐specific albumin (CSA) product and to quantify its effect on serum
albumin concentration and colloid osmotic pressure (COP) in healthy dogs.
Methods: Six healthy purpose‐bred Beagles were administered 3 separate 1 g/kg doses
of 16% reconstituted CSA (HemoSolutions, LLC), over 2 hours on days 1, 2, and 14.
Dogs were monitored for evidence of transfusion‐associated complications during the
infusions and at 1, 2, 12, and 24 hours postinfusion. Serum albumin and COP were measured
at baseline and at 2, 12, and 24 hours after each infusion. Complete blood count and
serum biochemical analysis were evaluated at baseline and on days 3, 15, and 28. Repeated
measures ANOVA were used to evaluate collective albumin and COP changes from all infusions.
Results: All dogs tolerated the CSA infusion with no evidence of acute hypersensitivity
reaction. One dog vomited 1 hour after completion of the infusion on day 2. This occurred
immediately after eating and was thought to be unrelated to the study drug since the
dog displayed no other clinical abnormalities. No dogs displayed signs of delayed
hypersensitivity reaction during the 28‐day study period. Serum biochemistry and hematology
profiles remained within normal limits at all time points. Colloid osmotic pressure
increased by a mean of 2.1 mm Hg at 2 hours (range, 0.7–3.7 mm Hg; P = 0.0002) and
remained significantly higher than baseline at 12 (P < 0.0001) and 24 hours (P = 0.0034)
postinfusion. Serum albumin increased by a mean of 0.48 g/dL at 2 hours (range, 0.2–0.8
g/dL; P < 0.0001) and remained significantly higher than baseline at 12 (P < 0.0001)
and 24 hours (P = 0.0002) postinfusion.
Conclusion: This dose of CSA was effective at increasing serum albumin and COP. Repeated
infusions appear safe with no adverse changes to physical examination, hematologic,
or biochemical parameters.
EVALUATION OF SYMMETRIC DIMETHYLARGININE AND NEUTROPHIL GELATINASE‐ASSOCIATED LIPOCALIN
AS MARKERS OF KIDNEY INJURY IN A CANINE MODEL OF GRAM‐POSITIVE SEPSIS
Fick, ME
1, Hansen, BD1, Solomon, SB2, Vigani, A1
1North Carolina State University, Raleigh, NC, USA
2National Institutes of Health, Bethesda, MD, USA
Introduction: Although experimental endotoxemia may not affect serum (sNGAL) or urine
(uNGAL) concentration of neutrophil gelatinase‐associated lipocalin, its utility to
detect acute kidney injury in dogs with sepsis is unknown. The aims of this study
were to compare established renal functional markers (sCr and symmetric dimethylarginine
[SDMA]) with sNGAL and uNGAL in canine septic shock and determine the relationship
between these biomarkers and renal histopathology.
Methods: Sixty Beagles received pulmonary inoculation with S. aureus (0.5–1.5 × 10^9
CFU/kg). The dogs were sedated, mechanically ventilated, and treated for septic shock
via a standardized protocol until death or euthanasia at 96 hours. Blood and urine
samples for analysis were collected at T0 (inoculation), T24, and T48 (24 and 48 hours
postinoculation) and complete necropsy was performed on all. A nephropathologist blinded
to dog identity evaluated renal histopathology.
Results: Thirty‐three of 60 dogs (55%) survived past T48, with 18/33 having complete
sample sets with timely necropsy limiting postmortem autolysis. Fourteen of 18 dogs
had moderate or severe lesions identified via renal histopathology. Four dogs had
developed AKI (KDIGO sCr criteria) by T48, and 3 of these died before 96 hours. All
4 had moderate or severe lesions and 12 to 177‐fold increases in uNGAL at T24. Fifteen
(83%) dogs had at least 4‐fold increases in uNGAL by T24 and all had > 9‐fold increases
by T48. uNGAL was < 35 pg/mL in 3 of the 4 dogs with mild lesions at T24, and was
> 90 pg/mL in all dogs at T48. sNGAL changed only slightly (< 3‐fold increase or decrease
from T0) in 17/18. SDMA increased or decreased at T24 and T48 in proportion to changes
in sCr in all dogs, regardless of renal histopathology score.
Conclusion: AKI was not identified by change in serum creatinine during the first
48 hours of sepsis in most dogs that ultimately developed moderate or severe histopathological
lesions. uNGAL rose over time independent of change in sNGAL, and was markedly elevated
in all dogs by 48 hours. Increased uNGAL may predict development of AKI earlier than
changes in sCr, and does not appear to be secondary to the inflammatory state of sepsis
alone.
THE AMERICAN COLLEGE OF VETERINARY EMERGENCY AND CRITICAL CARE VETERINARY COMMITTEE
ON TRAUMA (ACVECC‐VetCOT) REGISTRY DATA SUMMARY – ALL DOG CASES TO APRIL 2018
Hall, KE
1, Sharp, CR2
1ACVECC‐VetCOT, Stillwater, MN, USA
2Murdoch University, Perth, Australia
Introduction: Traumatic injury is common and a leading cause of death in dogs. Large
databases provide opportunity to assess and improve patient care and develop and test
research hypotheses. Canine trauma cases presenting to 31 ACVECC VetCOT Veterinary
Trauma Centers (VTC) from September 2013 to April 2018 are reported.
Methods: Using a Web‐based data capture system (REDCap), personnel at each VTC prospectively
recorded admission and outcome data from dogs presenting following trauma. Summary
data are described.
Results: A total of 23,931 dog trauma cases from 2 sequential VetCOT trauma registries
were included. A majority (19,350, 80.9%) presented directly to a VTC. Penetrating
trauma was most common (12,525, 52.4%), followed by blunt (10,566, 44.2%), while 827
(3.5%) had both blunt and penetrating injury. Penetrating trauma was predominantly
caused by bite (9,469, 76.9%). The most common type of blunt trauma was struck by
vehicle (4761, 41.8%), followed by falls (2,529, 22.2%); however, a large number of
causes of both blunt and penetrating trauma were classified as “Other.” Presentation
data included animal trauma triage (ATT) score (median 1, IQR 1, 2) and modified Glasgow
coma scale score (median 18, IQR 18, 18). There was evidence of head injury in 12.9%
(2932) dogs, while 5.8% (1,326) had spinal trauma. Surgery was performed on 10,250
(43.3%) dogs, with procedures performed in both the emergency room (64.4%) and operating
rooms (35.6%). Only 1.4% received blood product transfusions. Most dogs (21,899, 92.5%)
survived to discharge; 1,473 (6.2%) were euthanized and 314 (1.3%) died.
Conclusion: These data constitute the largest epidemiologic study of trauma in dogs
to date. The majority of dogs sustained relatively minor trauma, characterized by
a low ATT score and high rate of survival to discharge.
DETERMINATION OF SERUM ASCORBIC ACID CONCENTRATIONS OF DOGS WITH PARVOVIRAL ENTERITIS
Henao, LN, Acciacca, RA, Sullivan, L
Colorado State University, Fort Collins, CO, USA
Introduction: Vitamin C (ascorbic acid) is an endogenous antioxidant that becomes
deplete during critical illness. Exogenous supplementation of ascorbic acid improves
outcome in septic people. Canine parvovirus (CPV) causes septicemia in dogs and may
present similar correlations between blood ascorbic acid levels and other markers
of disease.
Methods: Serum collected from CPV dogs (n = 42) during critical illness and recovery
were compared to serum collected from healthy control dogs (< 6 months of age, n = 13)
for measurement of ascorbic acid concentrations using mass spectrometry. Correlation
between ascorbic acid concentrations and clinical disease severity, length of hospitalization,
and survival were also evaluated.
Results: Dogs with CPV and concurrent neutropenia (n = 33) did not have significantly
different serum ascorbic acid concentrations at baseline [mean 4.37 μg/mL (95% CI,
1.88–6.85 μg/mL)] when compared to dogs with CPV without neutropenia [n = 7, mean
4.7 μg/mL (95% CI, 2.78–6.62 μg/mL)] or healthy control dogs [n = 13, mean 4.18 μg/mL
(95% CI, 2.7–5.68 μg/mL), P = 0.38]. Baseline serum ascorbic acid concentrations were
not associated with clinical severity score (P = 0.6), duration of hospitalization
(P = 0.54), or mortality (P = 0.3).
Conclusion: Serum ascorbic acid concentrations are not significantly different in
dogs infected with CPV when compared to healthy control dogs, and ascorbic acid levels
were not associated with the presence of neutropenia or other markers of disease severity.
The clinical utility of measuring and supplementing vitamin C in this population of
critically ill dogs is uncertain and would require further investigation.
ASSESSMENT OF CARDIOPULMONARY RESUSCITATION FOLLOWING IMPLEMENTATION OF RECOVER GUIDELINES
IN 166 DOGS AND 45 CATS AT A UNIVERSITY TEACHING HOSPITAL (2013–2018)
Hoehne, SN, Hopper, K, Epstein, SE
University of California, Davis, Davis, CA, USA
Introduction: A recent retrospective study reported increased return of spontaneous
circulation (ROSC) following implementation of RECOVER cardiopulmonary resuscitation
(CPR) guidelines. This study aimed to prospectively describe CPR outcomes at a veterinary
teaching hospital since implementation of RECOVER guidelines compared to their prior
publication, to evaluate factors associated with outcome, and to report the patient
population according to veterinary Utstein‐style guidelines.
Methods: Clinicians completed a form for CPR events immediately following their conclusion.
Forms were created in 2013 based on human Utstein‐style guidelines for reporting of
CPR events. Medical records were retrospectively reviewed, and reported categories
adjusted to comply with 2016 veterinary Utstein‐style guidelines where necessary.
Groups with ROSC and not achieving ROSC were compared using Fisher's exact and Mann–Whitney
U testing.
Results: One hundred sixty‐six dogs and 45 cats in cardiopulmonary arrest (CPA) that
underwent CPR were prospectively enrolled. One hundred animals (47%) attained ROSC,
22 (10%) were alive at 24 hours, and 21 (10%) were discharged alive [13 dogs (8%)
and 8 cats (18%)]. Rates of ROSC were comparable at our facility prior to introduction
of RECOVER guidelines, but significantly more cats survived to discharge (18% vs 3%;
P = 0.0008). Respiratory failure was the most common suspected cause of CPA in both
dogs (37/166, 22%) and cats (10/45, 22%). Higher ROSC rates were seen with witnessed
CPA (59% vs 24%; P < 0.0001), palpable pulses during CPR (62% vs 25%; P < 0.0001),
presence of a peripheral intravenous catheter before CPA (55% vs 35%; P = 0.0047),
and in CPAs occurring in ICU (62% vs 42%; P = 0.02). Median (IQR) time to administration
of epinephrine 1.25 (0.5–3) versus 3 (1–4) minutes (P < 0.0001) and atropine 1.5 (0.5–3)
versus 2.5 (1–5) minutes (P = 0.0002) were shorter, as well as higher maximal end
tidal CO2 reading 23 (18–34) versus 15 (5–25) mm Hg (P = 0.0001) in patients achieving
ROSC.
Conclusion: Witnessed CPA events and early CPR interventions were associated with
increased ROSC, emphasizing timely CPA recognition and initiation of CPR. Although
incorporating RECOVER guidelines did not further improve ROSC rates, more cats than
previously reported survived to discharge. This may suggest that the systematic approach
to CPR translates positively into improved post‐CPA care.
EVALUATION OF FAECAL PCR PANEL RESULTS IN DOGS IN WESTERN AUSTRALIA
Kim, MW
1, Sharp, CR1, Boyd, CJ1, Twomey, L2
1Murdoch University, Murdoch, Australia
2Vetpath Laboratory Services, Ascot, Australia
Introduction: Real‐time PCR assays for common canine enteropathogens have become widely
available as a diagnostic tool to investigate acute diarrhea in dogs. The prevalence
of enteropathogens in dogs in Western Australia is currently unknown. The primary
objective of this study was to describe and compare the fecal real‐time PCR (qPCR)
results of dogs presenting to veterinary facilities in Western Australia.
Methods: Electronic medical records at The Animal Hospital at Murdoch University (TAHMU)
were searched for dogs who had fecal qPCR submitted. Results were compared with those
from a major regional reference laboratory (VetPath Laboratory Services). Prevalence
of each pathogen was compared between groups using Fisher's exact test; a P‐value
of < 0.05 was considered significant.
Results: In the TAHMU cohort (n = 92), Clostridium perfringens α toxin gene (CP) was
the most frequently detected enteropathogen (in 90% cases), followed by Campylobacter
spp. (27%), canine parvovirus (CPV; 26%), Salmonella spp. (11%), and Giardia (3%).
In the VetPath cohort (n = 951), 86% were CP positive, 32% Campylobacter spp. positive,
13% CPV positive, 8% Giardia positive, and 8% Salmonella spp. positive. The TAHMU
cohort included significantly more cases of CPV (P < 0.001) and CP (P = 0.044). In
the TAHMU cohort, diarrhea was a presenting complaint in 90/92 dogs. The majority
(68/92) of dogs were recorded as current on vaccinations; 60/92 dogs were treated
as inpatients, and 59/60 survived to discharge. Of the dogs seen, 57/92 dogs received
antimicrobials, 47 of which started antimicrobials prior to receipt of qPCR results.
Following qPCR results, 32/92 continued antimicrobial therapy, with drug selection
unchanged in 11 of these dogs. Of the 24 CPV‐positive dogs, 21 were current on vaccinations,
with a 2‐week (range, 3 days–22 months) median duration from time of last vaccination
to presentation; 29/92 dogs had CPV fecal antigen testing performed, with 11 testing
negative in contrast to positive CPV detection on qPCR; 9/11 of these dogs were current
on vaccinations.
Conclusion: The prevalence of CPV was significantly higher in the TAHMU cohort, and
CP was frequently detected in both populations of dogs. The potential role of the
identified pathogens in disease requires further elucidation.
EVALUATION OF THE ENDOTHELIAL GLYCOCALYX IN HEALTHY ANESTHETIZED DOGS USING RAPID,
PATIENT‐SIDE GLYCOCHECK ANALYSIS SOFTWARE
Londoño, LA, Bowen, CM, Buckley, GJ
University of Florida, Gainesville, FL, USA
Introduction: The endothelial glycocalyx (EG) is a biopolymer interface located on
the luminal side of endothelial cells. Disruption or shedding of this layer is a primary
event in microvascular dysfunction. Damage to the EG increases capillary permeability
to proteins and alters the gradient between subglycocalyx colloid osmotic pressure
and plasma colloid osmotic pressure, resulting in a number of derangements, including
hypoalbuminemia, edema, microvascular dysregulation, and ultimately heterogeneity
of perfusion. GlycoCheck, a novel glycocalyx measurement software that provides automated
analysis of microvascular video recordings using side stream dark‐field video microscopy,
has been used in people. The objective of this study is to evaluate the endothelial
glycocalyx layer in a population of healthy anesthetized dogs using this technology.
Methods: Fifty client‐owned, healthy dogs presenting for elective procedures were
enrolled. A handheld video microscope connected to the GlycoCheck software was used
to acquire images of the sublingual microvasculature immediately following anesthetic
induction. For each dog, 2 or 3 microvascular readings were acquired. The perfused
boundary region (PBR), a marker for endothelial glycocalyx barrier properties for
red blood cell accessibility, was determined in vessels between 5 and 25 mm based
on column width. Anesthetic protocols, monitoring macrovascular parameters, and patient
characteristics were compiled for analysis alongside the microvascular parameters.
Results: The median time from induction to image acquisition was 5 minutes (range,
1–24 minutes). Data acquisition was accomplished in a median time of 1.41 minutes
per reading (0.43–10.99 minutes). Application of the microvascular camera was easily
performed and minimal training was required for data acquisition. The mean perfused
boundary region of all measured segments (PBR, 5–25 mm) was 2.04 ± 0.31 mm (range,
1.36–2.86 mm), values similar to those described in people. None of the patient characteristics,
macrovascular variables, nor the anesthetic protocol used had a significant correlation
with microvascular parameters.
Conclusion: This study demonstrates that the indirect evaluation of the endothelial
glycocalyx layer is possible in dogs, with results that closely resemble those from
investigations in people and reveal the potential for application of this technology
in a clinical, bed‐side setting.
RIVAROXABAN PHARMACODYNAMICS ARE UNAFFECTED BY CONCURRENT FEEDING OR GASTROPROTECTANT
ADMINISTRATION IN HEALTHY DOGS
Lynch, AM
1, Ruterbories, L1, Griffith, EH1, Hanel, RM2, Stablein, AP3, Brooks, MB3
1North Carolina State University, Raleigh, NC, USA
2BluePearl Veterinary Partners, Tampa, FL, USA
3Cornell University, Ithaca, NY, USA
Introduction: Rivaroxaban, a direct oral factor Xa inhibitor, is an attractive anticoagulant
option for dogs but its reported oral bioavailability in healthy dogs may be as low
as 60%. The impact of concurrent feeding and gastroprotectant administration on the
pharmacodynamics of rivaroxaban in dogs is currently unknown. The aim of this pilot
study was to determine the impact of feeding, coadminstration of omeprazole and coadministration
of sucralfate on the anticoagulant effect of rivaroxaban in healthy dogs.
Methods: Five healthy male neutered Beagles were used in this pilot study. Four distinct
stages were investigated involving administration of 2 mg/kg rivaroxaban once daily
for 2 consecutive days with either (1) no food, (2) food, (3) 0.5 g oral sucralfate,
or (4) 1 mg/kg oral omeprazole. A 14‐day minimum washout period was employed between
each stage. One day prior to commencement of each study stage, the dogs were sedated
to facilitate insertion of jugular sampling catheters. Starting the next day, blood
samples were obtained, using a 3‐syringe technique, at time 0, 2, 4, 8, 24 36, and
48 hours relative to rivaroxaban administration. Measurement of rivaroxaban‐specific
anti‐Xa activity (RIVA) was used to assess the anticoagulant intensity. A repeated
measures mixed statistical model was used, with post hoc Tukey's adjustment, to evaluate
the impact of these 4 stages on the RIVA level
Results: All dogs tolerated the study interventions without serious adverse effects.
Rivaroxaban administration resulted in significant changes in individual dog RIVA
(P = 0.02). The peak RIVA occurred 2–4 hours following administration but varied among
dogs. Feeding was associated with significantly higher RIVA at the 36‐hour (P < 0.0001)
and 48‐hour (P = 0.003) time points compared with values for dogs administered sucralfate.
Overall, however, administration of rivaroxaban with food, sucralfate, or omeprazole
did not significantly changed RIVA compared to dogs administered rivaroxaban on an
empty stomach (P = 0.20).
Conclusion: The anticoagulant effect of oral rivaroxaban, based on measurement of
rivaroxaban's specific anti‐Xa activity, was unaffected by concurrent feeding, sucralfate,
or omeprazole administration in healthy dogs. This study has relevance for critically
ill dogs where several therapeutic interventions may be provided concurrently.
PROTHROMBIN TIME CORRELATES BETTER WITH ANTI‐XA ACTIVITY THAN THROMBOELASTOGRAPHIC
VARIABLES IN HEALTHY DOGS RECEIVING RIVAROXABAN
Lynch, AM
1, Ruterbories, L1, Griffith, EH1, Hanel, RM2, Stablein, AP3, Brooks, MB3
1North Carolina State University, Raleigh, NC, USA
2BluePearl Veterinary Partners, Tampa, FL, USA
3Cornell University, Ithaca, NY, USA
Introduction: Rivaroxaban is an increasingly popular anticoagulant option in dogs.
Therapeutic monitoring is advisable in dogs to gauge anticoagulant intensity. Rivaroxaban‐specific
anti‐Xa activity (RIVA) is the gold standard test, which is typically available as
a send‐out test. Time‐sensitive assessment of the anticoagulant effect of rivaroxaban
is therefore problematic with little information regarding the role of other coagulation
tests for rivaroxaban monitoring. The aim of this study was to assess the correlation
between RIVA with prothrombin time (PT), activated partial thromboplastin time (aPTT),
thromboelastography (TEG) variables, and thrombin generation variables.
Methods: Blood samples were collected from 5 healthy male neutered Beagles enrolled
in a rivaroxaban pharmacodynamics study. Briefly, 4 specific stages were investigated
with dogs administered 2 mg/kg rivaroxaban once daily for 2 consecutive days with
either (1) no food, (2) food, (3) 0.5 g oral sucralfate, or (4) 1 mg/kg oral omeprazole,
with a 14‐day minimum washout period between each stage. Blood samples were obtained
using a 3‐syringe technique from pre‐placed jugular sampling catheters at time points
corresponding to 0, 2, 4, 8, 24, 36, and 48 hours after rivaroxaban administration.
At each time point, a RapidTEG (recalcified TEG with kaolin/tissue factor activation)
was performed, before harvesting citrated plasma for later batch analysis of RIVA,
PT, aPTT, and thrombin generation. Pearson's correlations between the RIVA level and
PT, aPTT, RapidTEG R, RapidTEG MA, RapidTEG G, and thrombin generation variables [lag
time, peak thrombin, and endogenous thrombin potential (ETP)] were determined.
Results: In total, 140 separate blood samples were available for analysis. Prothrombin
time had a strong positive correlation to RIVA (r = 0.915, P < 0.0001), followed by
the thrombin generation lag time (r = 0.827, P < 0.0001), and aPTT (0.772, P < 0.0001).
RapidTEG variables had poor correlation with RIVA [R (r = 0.553, P < 0.0001), MA (r = 0.106,
P < 0.0001), and G (r = 0.108, P < 0.0001)]. The remaining thrombin generation variables
had a fair negative correlation with RIVA [peak thrombin (r = –0.752, P < 0.0001),
ETP (r = –0.762, P < 0.0001)].
Conclusion: Prothrombin time correlated best with the rivaroxaban specific anti‐Xa
activity, which may prove a convenient second line monitoring option for dogs receiving
rivaroxaban. Thromboelastography performed with strong activators correlated poorly
with the anti‐Xa activity.
BLOOD AND EFFUSION BIOMARKER CONCENTRATIONS AID DIFFERENTIATION OF TYPES OF PERITONEAL
EFFUSION IN DOGS
Martiny, PM, Goggs, R
Cornell University, Ithaca, NY, USA
Introduction: Accumulation of peritoneal effusion is common in dogs, and rapid differentiation
of the type of effusion present is important for the early institution of appropriate
diagnostic and therapeutic interventions. Various biomarkers have been evaluated but
no previous study has simultaneously measured multiple biomarkers in both blood and
effusion to determine which is the most discriminating for the underlying cause. This
study aimed to compare blood and effusion concentrations of novel biomarkers in dogs
with septic peritonitis (SP), nonseptic peritonitis (NSP), and other causes of peritoneal
effusion (OPE).
Methods: Eighteen dogs with SP, 19 age‐matched controls with systemic inflammation
but NSP, and 18 age‐matched controls without systemic inflammation and OPE were prospectively
enrolled. Blood and effusion were obtained at presentation, and concentrations of
cell‐free DNA (cfDNA), glucose, high mobility group box‐1 (HMGB‐1), inflammatory cytokines,
lactate, N‐terminal pro‐C‐type natriuretic peptide (NT‐proCNP), neutrophil gelatinase
associated lipocalin (NGAL), nucleosomes, and procalcitonin (PCT) were measured. Within
groups, biomarker concentrations were compared with Wilcoxon matched‐pairs signed‐rank
tests. Between groups, biomarker concentrations in blood and in effusion were compared
by Kruskal–Wallis with Dunn's post hoc test for multiple comparisons. Effusion‐blood
gradients were also compared between groups by Kruskal–Wallis. P‐values were adjusted
for multiple comparisons by Bonferroni correction.
Results: In dogs with SP, multiple biomarkers including cfDNA, glucose, HMGB‐1, NGAL,
nucleosomes, and some inflammatory cytokines were significantly different between
blood and effusion. In dogs with NSP, and OPE concentrations of CCL2 and KC‐Like were
significantly different between blood and effusion. Effusion concentrations of lactate,
IL‐6, and IL‐10 were significantly different in dogs with SP compared to dogs with
NSP. All biomarkers except for cfDNA, KC‐Like, lactate, PCT, and TNF‐α were significantly
different between dogs with SP and those with OPE. Many biomarker effusion‐blood gradients
were also significantly different between dogs with SP compared to those with OPE,
including glucose, lactate, nucleosomes, and some cytokines.
Conclusion: This study suggests that in dogs with SP particularly, concentrations
of multiple biomarkers are different in blood versus effusion. In addition, measurement
of novel biomarkers in blood and effusion can be used to aid in the differentiation
of effusions with distinct pathophysiologic origins.
DIAGNOSIS OF SEPTIC PERITONITIS USING EFFUSION‐BLOOD GRADIENTS OF NOVEL BIOMARKERS
IN DOGS
Martiny, PM, Goggs, R
Cornell University, Ithaca, NY, USA
Introduction: Septic peritonitis (SP), defined as the presence of bacteria within
the abdominal cavity, is common in dogs and is associated with high mortality. Early
recognition and aggressive management is essential to maximizing survival. Few biomarkers
for diagnosis of SP have been evaluated in dogs to date. This study aimed to evaluate
the utility of novel biomarkers for the diagnosis of SP in dogs.
Methods: Eighteen dogs with SP and 19 age‐matched controls with evidence of systemic
inflammation but nonseptic abdominal effusion (NSP) were prospectively enrolled. Blood
and effusion were obtained at presentation, and concentrations of cell‐free DNA (cfDNA),
glucose, high mobility group box‐1 (HMGB‐1), inflammatory cytokines, lactate, N‐terminal
pro‐C‐type natriuretic peptide (NT‐proCNP), neutrophil gelatinase associated lipocalin
(NGAL), nucleosomes, and procalcitonin (PCT) measured using commercial reagents and
assays. Effusion‐blood gradients were compared between dogs with SP and with NSP by
Mann–Whitney U test. P‐values were adjusted for multiple comparisons by Bonferroni
correction. Receiver operating characteristic (ROC) curve analysis and calculation
of area under the curve (AUROC) was used to determine the most discriminating gradients
for identification of SP.
Results: Compared with dogs with NSP, dogs with SP had significantly greater effusion‐blood
gradients of C‐C Motif Chemokine Ligand 2 (CCL2), interleukin‐6 (IL‐6), IL‐10, and
lactate (all P ≤ 0.0255), and significantly smaller effusion‐blood gradients of glucose
(P = 0.0135). ROC curve analysis indicated that these 5 biomarkers were discriminant
for the differentiation of SP from NSP. Calculation of AUROC indicated that from most
to least discriminating were IL‐10 (AUROC 0.8216, P = 0.012), CCL2 (AUROC 0.8173,
P = 0.015), glucose (AUROC 0.8085, P = 0.0195), lactate (AUROC 0.7968, P = 0.03),
and IL‐6 (AUROC 0.7924, P = 0.036).
Conclusion: This study suggests that effusion‐blood gradients of IL‐10, CCL2, glucose,
lactate, and IL‐6 are discriminating for the differentiation of SP from NSP in dogs.
Three of these biomarkers are inflammatory cytokines that require complex laboratory
analyses, while the others can be measured at the point of care. Therefore, this study
supports the use of effusion‐blood gradients of glucose and lactate for differentiation
of SP from NSP in dogs.
DOSE ESCALATION TRIAL OF DESULFATED HEPARIN IN SEPTIC PERITONITIS
Mauro, KD, Nesser, VE, Thawley, VJ, Otto, CM
University of Pennsylvania, Philadelphia, PA, USA
Introduction: Septic peritonitis is associated with significant morbidity and mortality.
As a potential therapeutic agent in the treatment of sepsis, 2‐0, 3‐0 desulfated heparin
(ODSH) reduces histones and platelet factor 4 (PF4) in murine sepsis models. This
clinical trial evaluated the safety and effect of ODSH in client‐owned dogs with septic
peritonitis. The potential use of ODSH as a novel therapeutic in septic peritonitis
was investigated.
Methods: In an IACUC‐approved, open‐label, prospective, dose‐escalation clinical trial
in dogs with spontaneous septic peritonitis, ODSH treatment was initiated following
surgical intervention. Dose escalation was based on aPTT prior to each ODSH dosage.
Platelet count, white blood cell count, cell‐free DNA, and PF4 were collected at the
time of each ODSH dosage. In addition, APPLEfast and APPLEfull scores on admission,
the source of septic peritonitis, requirement for vasopressors, administration of
blood products, and survival to discharge were recorded.
Results: Six dogs (1 female netered, 1 female intact, 4 male neutered) were enrolled.
The mean APPLEfast and APPLEfull scores on admission were 22 and 32, respectively.
Gastrointestinal (3 dogs), hepatobiliary and splenic (2 dogs), and urogenital (1 dog)
sources of sepsis were identified. Two dogs received vasopressors in the pre‐ or postoperative
period. Four dogs received 4 dosages of ODSH and 2 dogs received 3 dosages of ODSH
intravenously. No dog required dose de‐escalation and no dog had any evidence of bleeding.
The mean 24‐hour dosage of ODSH was 50 mg/kg. Four dogs survived to discharge.
Conclusion: No adverse effects of ODSH were seen in dogs with septic peritonitis.
A randomized controlled trial is necessary to evaluate ODSH as a novel therapeutic
in the treatment of septic peritonitis.
ETIOLOGY OF PERICARDIAL EFFUSION IN 397 DOGS UNDERGOING EMERGENT PERICARDIOCENTESIS:
2003–2016
McManamey, AK, Lynch, AM, Keene, BW
North Carolina State University, Raleigh, NC, USA
Introduction: Hemangiosarcoma and idiopathic effusions are considered the most common
causes of PCE in dogs, with recognized demographic predispositions (eg, older, large
breed dogs). The etiology of PCE in less typical breeds is less well defined. This
study was performed to characterize the etiology of PCE in a large cohort of dogs
that underwent emergent pericardiocentesis.
Methods: Electronic records from dogs that underwent emergency pericardiocentesis
between 2003 and 2016 were abstracted for age, body weight, breed, and echo‐ or histopathology‐derived
etiology of PCE.
Results: Records of 397 dogs were analyzed. The median age was 10 years (range 1–20)
and the median weight was 29 kg (range 3–69). Hemangiosarcoma or a right atrial mass
compatible with hemangiosarcoma was the most common diagnosis, present in 215 of 397
dogs (54.2%). Hemangiosarcoma was a less likely diagnosis in dogs < 20 kg [32/108
vs 183/289, P < 0.0001]; but left atrial rupture [28/108 vs 0/289, P < 0.0001] or
suppurative pericarditis [5/109 vs 4/289, P = 0.0445] were more likely than in dogs
weighing ≥ 20 kg. Dogs weighing < 10 kg were more likely to have an open diagnosis
[13/57 vs 31/340, P = 0.0009] or carcinoma [3/57 vs 4/340, P = 0.0224] compared to
dogs weighing ≥ 10 kg. In dogs without hemangiosarcoma, those < 10 years of age were
significantly more likely to have mesothelioma [14/143 vs 10/254, P = 0.01], suppurative
[7/143 vs 2/254, P = 0.0098], or idiopathic pericardial effusion [15/143 vs 12/254,
P = 0.0345] than dogs ≥ 10 years. Brachycephalic breeds were less likely to have hemangiosarcoma
[20/47 vs 195/350, P = 0.05] or left atrial rupture [0/47 vs 28/250, P = 0.04] as
a cause of PCE, and more likely to have chemodectoma [11/47 vs 12/47, P < 0.0001]
compared to nonbrachycephalic breeds.
Conclusion: Hemangiosarcoma or right atrial masses thought to be hemangiosarcoma were
the most common cause of PCE in dogs requiring emergent pericardiocentesis during
this epoch. However, alternative diagnoses were often found in younger, smaller, or
brachycephalic breeds.
A PROSPECTIVE EVALUATION OF RIVAROXABAN ON HEMOSTATIC PARAMETERS IN APPARENTLY HEALTHY
DOGS
Murphy, LA
3, Evans, LA1, Tansey, C1, Wiebe, M1, Sloan, CQ2, Patlogar, JE1, Northcutt, S1, Nakamura,
RK4
1Veterinary Specialists Emergency Services, Upland, CA, USA
2Advanced Veterinary Care Center, Lawndale, CA, USA
3Veterinary Specialty Center, New Castle, DE, USA
4Veterinary Specialty Emergency Center, Thousand Oaks, CA, USA
Introduction: Rivaroxaban is an orally administered factor Xa inhibitor that has been
shown to be effective and safe for preventing venous thromboembolism in people with
a reduced risk of bleeding complications compared to warfarin. Due to its predictable
pharmacokinetics and pharmacodynamics routine laboratory monitoring is not required
in people. The aim of this study was to determine if rivaroxaban administered at 1
mg/kg orally once daily in a group of healthy dogs produced a significant change in
hemostatic parameters.
Methods: Eleven dogs had a baseline complete blood count, fibrinogen, platelet count,
serum chemistry profile, prothrombin time, activated partial thromboplastin time,
and thromboelastography performed. Dogs were then administered approximately 1.0 mg/kg
of rivaroxaban orally once daily for 1 week and the blood work and hemostatic parameters
were re‐evaluated.
Results: One dog had to be excluded due to identification of a macrocytic thrombocytopenia
on pretreatment blood work. The remaining 10 enrolled dogs received a median dose
of 1.02 mg/kg (range 0.94–1.17 mg/kg) of rivaroxaban once daily. There was a significant
increase in platelet count and fibrinogen. There was no significant change in the
hemostatic parameters
Conclusion: The primary finding of this study is that rivaroxaban administered at
1 mg/kg orally once daily for 1 week failed to produce any significant change in hemostatic
parameters in 10 apparently healthy dogs. There were significant increases in fibrinogen
levels and platelet counts in dogs receiving rivaroxaban. Both of these increases
can be associated with inflammation which may indicate rivaroxaban could potentially
be proinflammatory. This is a potentially important finding as rivaroxaban is typically
used in conditions where inflammation is concurrently present such as immune‐mediated
hemolytic anemia. The effects of rivaroxaban on inflammatory biomarkers in dogs may
require further investigation.
SEMIQUANTITATIVE ACID–BASE ANALYSIS IN DOGS WITH ADDISON'S DISEASE
Osborne, LG, Burkitt‐Creedon, JM, Epstein, SE, Hopper, K
University of California, Davis, Davis, CA, USA
Introduction: Acidemia is common in dogs with Addison's disease and is generally attributed
to impaired renal hydrogen ion excretion and lactic acidosis. Semiquantitative acid–base
assessment has not been characterized in the veterinary literature, and characterization
of acid–base influences can affect fluid choice. The primary objectives of this retrospective
study are to describe the semiquantitative acid–base status of dogs with naturally
occurring Addison's disease and to compare this to the status determined by traditional
acid‐base analysis.
Methods: The electronic medical record database of a university teaching hospital
was searched for dogs with Addison's disease between 2000 and 2017. Dogs were included
if they had newly‐diagnosed Addison's disease, post‐ACTH stimulation serum cortisol
concentration < 2 μg/dL, and an acid–base/electrolyte panel and serum biochemistry
panel drawn within 6 hours of presentation. Patients were excluded if the Na:K ratio
was ≥ 28 or the patient had received a mineralocorticoid‐containing corticosteroid
medication within the preceding month. Traditional and semiquantitative acid–base
analyses were performed and described.
Results: Thirty‐three cases met the study criteria. Traditional acid‐base analysis
identified normal acid‐base status in 1 dog, simple respiratory acid‐base abnormalities
in 2/33 dogs, and simple metabolic acidosis in 14/33 dogs. A mixed disorder was most
common, occurring in 16/33 patients. The semiquantitative approach identified metabolic
abnormalities in all cases. All dogs had ≥ 1 acidifying process, while 29/33 had both
acidifying and alkalinizing processes. Acidosis attributable to excess free water
was present in all dogs, and an acidifying phosphate effect was present in 27/33.
Hyperlactatemia contributed to the acidosis in only 8/33 patients, with a median lactate
of 1.5 mmol/L (range 0.3–4.2 mmol/L). The most common alkalinizing effect was hypoalbuminemia
(21/33).
Conclusion: This study demonstrates that dogs with untreated Addison's disease have
complex acid‐base derangements. The semiquantitative approach to acid‐base analysis
provides greater insight into the underlying mechanisms of metabolic acid‐base abnormalities
in these patients, particularly since lactic acidosis appears to be a minor influence
in most cases. These results suggest that dogs with Addison's disease may benefit
from fluid resuscitation using balanced electrolyte solutions that contain a buffer
and have lower sodium and chloride concentrations than 0.9% NaCl.
PROSPECTIVE EVALUATION OF THE FELINE ACUTE PATIENT PHYSIOLOGIC AND LABORATORY EVALUATION
(FELINE APPLE) SCORE IN ADMITTED CATS TO A SMALL ANIMAL TEACHING HOSPITAL
Scotti, KM, Levy, NA, Koenigshof, AM
Michigan State University, East Lansing, MI, USA
Introduction: The feline APPLE (acute patient physiologic and laboratory evaluation)
score was developed as a tool to stratify illness severity in cats admitted to the
intensive care unit. The APPLEfull score utilizes 8 parameters (maximum score of 80)
and the APPLEfast score utilizes 5 parameters (maximum score of 50), with higher scores
associated with a worse prognosis. This system was developed and validated at the
same institution; however, it has not been prospectively evaluated since the initial
publication. The goal of this study was to prospectively evaluate the utility of the
feline APPLE scoring system in predicting the outcome of cats admitted to a novel
ICU.
Methods: All cats admitted to the ICU during a 3‐month time period (January 1, 2018–April
1 2018) were prospectively enrolled following owner consent. Feline APPLEfull and
APPLEfast scores were calculated within 24 hours of admission.
Results: One hundred fifty‐five cats were included in the study with 133 survivors
and 22 nonsurvivors (euthanasia and natural death). The median age was 7 years (IQR
3–12 years), median weight was 4.8 kg (3.8–5.8 kg), and median length of hospitalization
(LOH) was 2 days (IQR 1–3). APPLEfull scores were calculated in 154 cats and were
significantly lower in survivors than nonsurvivors with a mean of 39.9/80 (SD ±8.2)
and 47.3/80 (SD ±9.5), respectively (P = 0.0002). The AUROC (area under the receiver
operator characteristic curve) for the APPLEfull score was 0.72, and improved after
excluding nonsurvivors who were euthanized (0.81). APPLEfast scores were calculated
in 155 cats and were significantly lower in survivors than nonsurvivors with a mean
of 21.3/50 (SD ±7.3) and 27.6/50 (SD ±9.9), respectively (P = 0.0005). The AUROC for
the APPLEfast score was 0.68, and improved after excluding euthanized nonsurvivors
(0.71). APPLEfull scores were positively correlated with LOH in cats that survived
to discharge (P = 0.007, r = 0.24), though APPLEfast scores were not (P = .19).
Conclusion: The APPLEfull score was a good prognostic indicator in this population
of hospitalized cats when euthanized cats were excluded. The reliability of scoring
systems to predict outcomes in veterinary medicine is complicated by the option of
euthanasia.
THE AMERICAN COLLEGE OF VETERINARY EMERGENCY AND CRITICAL CARE VETERINARY COMMITTEE
ON TRAUMA (ACVECC‐VetCOT) REGISTRY DATA SUMMARY – ALL CAT CASES TO APRIL 2018
Sharp, CR
1, Hall, KE2
1Murdoch University, Perth, Australia
2ACVECC‐VetCOT, Stillwater, MN, USA
Introduction: Traumatic injury is common and a leading cause of death in cats. Large
databases provide opportunity to assess and improve patient care and develop and test
research hypotheses. Feline trauma cases presenting to 31 ACVECC VetCOT Veterinary
Trauma Centers (VTC) from September 2013 to April 2018 are reported.
Methods: Using a Web‐based data capture system (REDCap), personnel at each VTC prospectively
recorded admission and outcome data from cats presenting following trauma. Summary
data are described.
Results: A total of 4,823 cat trauma cases from the 2 VetCOT trauma registries were
included. A majority (3,825, 79.3%) presented directly to a VTC. Blunt trauma was
most common (2,744, 57%), followed by penetrating (1,837, 38.1%), while 234 (4.9%)
had both blunt and penetrating injury. The most common type of blunt trauma was motor
vehicle accident (869; 29.2%), followed by falls (665; 22.3%). Penetrating trauma
was predominantly caused by bite (1,065, 53.8%); however, a large number of causes
of trauma were classified as “Other.” Presentation data included animal trauma triage
(ATT) score (median 2, range 0–18) and modified Glasgow coma scale score (median 18,
range 3–18).16.2% (739) cats had evidence of head injury, while 8.6% (393) had spinal
trauma. Surgery was performed on 1,679 (35.15%) of cats, with procedures performed
in both the emergency room (47.4%) and operating rooms (52%). Only 2.3% received blood
product transfusions. Most cats (3,943, 82.54%) survived to discharge; 768 (16.08%)
were euthanized and 66 (1.38%) died.
Conclusion: These data constitute the largest epidemiologic study of trauma in cats
to date. The majority of cats sustained relatively minor trauma, characterized by
a low ATT score and high rate of survival to discharge.
OUTCOME PREDICTORS IN DOGS WITH SEPTIC PERITONITIS: INVESTIGATION OF THE UTILITY OF
NLR AND QSOFA SCORES
Stastny, T, Koenigshof, A, Levy, NA
Michigan State University, East Lansing, MI, USA
Introduction: Recent focus in both human and veterinary medicine has been on early
detection and risk stratification in septic patients. The 2016 Sepsis 3.0 definition
recommends using the quick Sequential (Sepsis‐related) Organ Failure Assessment (qSOFA)
score to rapidly identify septic patients with greater risk for poor outcomes via
assessing three clinical criteria: systolic blood pressure, respiratory rate, and
mental status. Similarly, a high neutrophil‐to‐lymphocyte ratio (NLR) has been identified
as being independently associated with unfavorable prognosis in human septic patients.
The NLR and the qSOFA score have not been evaluated in dogs. The purpose of this study
was to assess the prognostic utility of Systemic Inflammatory Response Syndrome (SIRS)
criteria, NLR, and qSOFA score for in‐hospital mortality among dogs with septic peritonitis.
Methods: Medical records of dogs diagnosed with septic peritonitis between 2011 and
2018 were reviewed. Signalment, length of hospitalization (LOH), admission vital signs,
Doppler blood pressure, glucose, lactate, vasopressor use, and differential WBC counts
were recorded, and SIRS criteria, qSOFA scores, and NLR were obtained.
Results: One hundred fifty‐five patients met inclusion criteria. Overall in‐hospital
mortality was 32.9% (51/155). Patients that died or were euthanized were more likely
to have a qSOFA ≥ 2 (P < 0.0001, relative risk (RR) 4.9, odds ratio (OR) 9.3). qSOFA
≥ 2 was negatively associated with blood pressure (P < 0.0001, r = –0.72). Patients
with qSOFA ≥ 2 were more likely to receive vasopressors than those with qSOFA < 2
(P < 0.001, RR 33.8, OR 61.4). qSOFA scores and lactate were positively correlated
(P < 0.0001, r = 0.43). There was no difference in NLR between survivors and nonsurvivors,
and qSOFA scores and NLR were not correlated. While 94.1% of patients met SIRS criteria,
there was no difference in frequency of SIRS diagnosis between survivors and nonsurvivors.
Conclusion: qSOFA ≥ 2 was associated with a higher risk of in‐hospital morbidity and
mortality within this study population, suggesting that the qSOFA may have utility
in identifying patients at greater risk of vasopressor requirement and poor outcome;
however, further prospective studies would be necessary to validate this assessment
tool. No prognostic utility was identified with NLR and outcome in this population,
however, further evaluation in a larger population is needed.
THE INFLUENCE OF AZOTEMIA AND HYPOTENSION ON LACTATE CONCENTRATIONS IN DOGS AND CATS
Wolf, JM, Stefanovski, D, Silverstein, DC
University of Pennsylvania, Philadelphia, PA, USA
Introduction: It has long been postulated that uremic patients have altered lactate
concentrations, yet no studies in human or veterinary medicine have demonstrated this
clinically. Previous studies have suggested two main etiologies for altered lactate
concentrations in uremia: decreased production via uremic toxin‐induced mitochondrial
dysfunction or increased excretion via the proximal convoluted tubule of the kidney.
This study sought to demonstrate altered lactate concentrations in dogs and cats presenting
to the emergency department at a university hospital. It was hypothesized that azotemic,
hypotensive patients would have a significantly lower lactate than nonazotemic, hypotensive
dogs and cats presenting to the emergency department.
Methods: The electronic medical record database was searched for dogs and cats presented
to the emergency department that had severe azotemia (creatinine ≥ 443.1 μmol/L [5
mg/dL]), hypotension (Doppler blood pressure ≤ 90 mm Hg), and a lactate measurement
within 2 hours of one another. Nonazotemic, normotensive patients, nonazotemic, hypotensive
patients, and azotemic, normotensive patients that presented to the emergency service
were used as control populations. Patients were excluded from analysis if they had
a known cause of Type B lactic acidosis, hypertension (Doppler blood pressure > 150
mm Hg), or incomplete medical records.
Results: Dogs and cats with hypotension and severe azotemia had a lower lactate than
dogs and cats with hypotension without azotemia (P = 0.031 and < 0.001, respectively).
Median lactate concentration in hypotensive dogs (1.75 mmol/L) and cats (1.90 mmol/L)
with severe azotemia were within normal limits.
Conclusion: Hypotensive animals with severe azotemia have significantly decreased
lactate concentrations as compared to hypotensive, nonazotemic animals and their lactate
concentration are often within normal limits. This may be due to either decreased
mitochondrial production of lactate or increased excretion of lactate. Lactate concentrations
should be used cautiously when making therapeutic decisions in this patient population.
Further research is needed to determine which of these mechanisms is responsible and
the significance of abnormal blood pressure and lactate measurements in azotemic,
hypotensive animals and whether differences in lactate concentrations exist between
acute and chronic azotemic patients and those with less severe azotemia.
EFFICACY OF THREE DISINFECTANT AGENTS IN REDUCING BACTERIAL CONTAMINATION OF KEYBOARDS
IN A VETERINARY TEACHING HOSPITAL
Wong, EK, Koenig, A, Burgess, BA, Brainard, BM, Greene, CE, Hurley, DJ
University of Georgia, Athens, GA, USA
Introduction: Computer keyboard contamination contributes to healthcare‐associated
infections (HAIs). Studies have shown that once daily cleaning can result in sustained
reduction of keyboard contamination. The study goal was to determine the efficacy
of three commonly used disinfectant wipes for reducing bacterial contamination on
keyboards in a veterinary teaching hospital. We hypothesized there would be no difference
between agents.
Methods: Thirty keyboards were randomized to “dirty” or “clean” halves. Cultures were
obtained from the “dirty” halves. The “clean” halves were disinfected with a randomly
assigned wipe (peroxygen‐based (AHP), quaternary ammonium‐based (QAC), or alcohol‐based),
allowed to dry, and then cultured. All cultures were acquired with sterile premoistened
sponges, which were agitated in sterile broth and wrung out, and the broth was plated
onto tryptic soy blood agar. Plates were incubated at 35°C; colony‐forming units (CFU)/cm2
were enumerated after 24 and 48 hours of incubation. Percent CFU reduction between
dirty and clean sides was calculated.
Results: Colony‐forming units reduction after 24 hours of incubation was 86.4% for
alcohol (95% confidence interval (CI) 0.66–1.21), 76.7% for QAC (95% CI 0.45–1.02),
and 77.5% for AHP (95% CI 0.29–0.87). After 48 hours of incubation, % CFU reduction
was 75.2% for alcohol (95% CI 0.60–1.28), 76.7% for QAC (95% CI 0.55–1.25]), and 87.5%
for AHP (95% CI 0.55–1.26). There were no significant differences in percent reduction
of CFUs following cleaning between treatment groups.
Conclusion: All three cleaning products were equally efficacious at reducing bacterial
keyboard contamination. Further studies are required to assess if routine keyboard
decontamination decreases the incidence of HAIs.
EVALUATION OF CANINE PLATELET FUNCTION USING MULTIPLE PLATELET FUNCTION ANALYZER AFTER
ADMINISTRATION OF DDAVP IN HEALTHY DOGS ON ASPIRIN OR CLOPIDOGREL
Yankin, I
1, Carver, AM1, Koenigshof, A2
1University of Florida, Gainesville, FL, USA
2Michigan State University, East Lansing, MI, USA
Introduction: Acetylsalicylic acid (aspirin) and clopidogrel (Plavix) are commonly
used in dogs for prevention of blood clots; however, there is no clinically used reversal
agent for these medications. In people, a single injection of desmopressin acetate
(DDAVP), a vasopressin analog that mediates release of von Willebrand factor from
endothelium stores, has been shown to improve platelet function and reverse the antiplatelet
effects of aspirin and clopidogrel leading to reduced perioperative bleeding in human
patients on these drugs. The aim of this study was to evaluate the effect of DDAVP
on platelet aggregation in healthy dogs receiving aspirin or clopidogrel.
Methods: This was a randomized double‐blinded crossover study. Multiplate function
analysis (MPA) was performed on whole heparinized blood in 7 healthy staff‐owned dogs.
Then, the dogs were randomized to receive 1 mg/kg/d of aspirin or clopidogrel for
4 days. The MPA was performed again prior to and 30–60 minutes after a 0.3 μg/kg IV
DDAVP injection in these dogs on antiplatelet therapy. There was a 14‐day washout
period before the groups received the other drug (aspirin or clopidogrel) for 4 days.
The MPA was repeated at baseline, and at day 4 before and after DDAVP administration.
A total of 4 analyses were performed on every blood sample using adenosine diphosphate
(ADP), collagen (COL), thrombin (TRAP), and arachidonic acid (ASPI) as agonists.
Results: Platelet aggregation was significantly decreased after administration of
clopidogrel compared to baseline values using ADP (P = 0.0012), ASPI (P = 0.0012),
and TRAP (P = 0.0007) as the agonists. There was no significant difference in platelet
aggregation after administration of aspirin using mentioned‐above agonists. The administration
of DDAVP did not result in the significant increase of platelet aggregation after
clopidogrel administration.
Conclusion: Clopidogrel resulted in a significant decrease of platelet function in
healthy dogs when it was given at the dose of 1 mg/kg/d for 4 days. The administration
of DDAVP had no effect on platelet aggregation in healthy dogs on clopidogrel therapy.
No inhibition of platelet aggregation was noted in the dogs receiving aspirin at 1
mg/kg/dose for the same period of time, and no conclusion can be made in regards to
DDAVP effects after aspirin administration.
Posters
SYSTEMIC HYPERTENSION IN CANINE ACUTE KIDNEY INJURY: A PROSPECTIVE STUDY
Cole, LP, Dawson, C, Jepson, R, Humm, K
The Royal Veterinary College, London, United Kingdom
Introduction: Systemic hypertension (SH) is a recognized consequence of acute kidney
injury (AKI) in people, and has been described in feline and canine AKI retrospective
studies. The relationship between SH and AKI severity has been assessed in cats but
not dogs and there is no literature on the prevalence of target organ damage in either
species. The aims of this prospective study were to describe the prevalence of SH
and any associated hypertensive retinopathy in canine AKI patients and to investigate
the relationship between SH and severity of AKI.
Methods: Dogs presenting to a veterinary university referral hospital with community‐acquired
AKI were prospectively recruited between July 2016 and March 2018. Patients were excluded
if they had other diseases associated with SH (including chronic kidney disease) or
prior treatment with anti‐hypertensive drugs. Systolic blood pressure (SBP), urine
output (UOP), and evidence of fluid overload were assessed daily. The IRIS (International
Renal Interest Society) grade of AKI on arrival, fundic examination findings, urine
protein/creatinine ratio, length of hospitalization, and survival to discharge were
recorded. Systemic hypertension was defined as SBP ≥ 150 mm Hg. The prevalence of
SH was calculated and the relationship between SH and the recorded factors was examined
using nonparametric statistical tests.
Results: Thirty‐nine dogs were eligible for inclusion. The prevalence of SH on admission
was 71.8% (28/39) and this was severe (> 180 mm Hg) in 25.6% (10/39) of cases. The
prevalence of SH increased to 78.9% (30/38) during hospitalization and was severe
in 50% (19/38) cases. Note that 21.2% (7/33) dogs had evidence of hypertensive retinopathy
and 60% (12/20) had significant proteinuria. Of the cases included, 25.6% (10/39)
were considered fluid overloaded on admission and 23.1% (9/39) developed fluid overload
during hospitalization. There was no association between SH and IRIS AKI grade, creatinine
on presentation, oligo/anuria, survival to discharge, length of hospitalization, and
proteinuria. Dogs with fluid overload on presentation were more likely to be hypertensive
at admission (P < 0.05).
Conclusion: Although SH is common in dogs with AKI target organ damage is less common.
Systemic hypertension does not appear to be associated with severity of injury but
may be associated with fluid overload.
ACCURACY OF PULSE OXIMETRY AT THE TAIL DURING HYPEROXEMIA AND HYPOXEMIA IN ANESTHETIZED
DOGS
Endo, E
1, Kawase, K1, Miyasho, T2, Sano, T2, Yamashita, K2
1Sapporo Nighttime Animal Hospital, Sapporo, Japan
2Rakuno Gakuen University, Ebetsu, Japan
Introduction: The tail is an attractive site for measuring pulse oximetry because
of its stable perfusion. We evaluated the accuracy of pulse oximetry measuring at
the tail with a neonatal pulse oximetry adhesive sensor in anesthetized dogs under
hypoxemia and hyperoxemia.
Methods: This study was approved by the Animal Care and Use Committee of Rakuno Gakuen
University (VH16B24). Six Beagle dogs (age 3 years, body weight 12.4 ± 1.2 kg) were
included in this study. We used two types of pulse oximetry sensor, a tip‐clip ear
sensor was attached to the tongue and a neonatal adhesive sensor was attached to the
tail in each dogs. Each sensor was connected to the Masimo Radical‐7 pulse oximeter
for measuring SpO2. Anesthesia was induced and maintained with sevoflurane. After
intubation, the arterial oxygen saturation (SaO2) was recorded simultaneously, and
compared with each pulse oximeter readings. The oxygen fraction of inspired gas (FiO2)
was stepwise reduced from 1.0 to 0.8, 0.6, 0.4, 0.2, and 0.1 by blending with nitrous
oxide. After each step‐down FiO2, FiO2 was increased 0.4 and 1.0. Data analysis included
Bland–Altman plots, linear regression analysis.
Results: Forty‐eight arterial blood samples paired with SpO2 were obtained. SpO2 at
the tail ranged from 37.5% to 100 %, SpO2 at the tongue ranged from 39.0% to 100 %,
SaO2 ranged from 33% to 100 %. The mean bias for the tail and tongue was –0.86% and
–1.09% (P < 0.001), with corresponding precision values of 2.95 and 3.04. The coefficients
of determination were 0.98 and 0.96 for the tail and tongue (P < 0.001), respectively.
The limits of agreement were 4.93/–6.66% and 4.86/–7.05% for the tail and tongue.
Conclusion: The tail pulse oximetry measurement is feasible and demonstrates accurate
values of oxygen saturation during hyperoxemia and hypoxemia in anesthetized dogs.
The neonatal pulse oximetry adhesive sensor is a useful tool for pulse oximetry in
the dog's tail.
BIOMARKERS OF ENDOTHELIAL ACTIVATION ARE INCREASED IN DOGS WITH SEVERE SEPSIS
Gaudette, SM
1, Smart, L2, Hughes, D1, Sharp, CR2, Bailey, SR1, Dandrieux, JRS1, Santos, LL1, Woodward,
AP1, Boller, M1
1University of Melbourne, Werribee, Australia
2Murdoch University, Murdoch, Australia
Introduction: Endothelial dysfunction plays an important role in the pathophysiology
of sepsis and may emerge as a novel therapeutic target. Studies in dogs investigating
biomarkers of endothelial activation in naturally occurring sepsis are lacking. Herein,
we investigated changes in markers of endothelial activation in dogs with severe sepsis
compared to healthy controls. We further aimed to determine if there is an association
between endothelial marker concentrations, inflammatory mediators, illness severity,
and survival to discharge.
Methods: Eighteen dogs with severe sepsis (S) were prospectively enrolled at two academic
referral hospitals, with 20 healthy dogs serving as control group (C). Venous blood
samples from study dogs were collected at the time of diagnosis of severe sepsis and
plasma stored at –80°C until analysis. Markers of different aspects of endothelial
function were quantified in duplicates by canine ELISAs, including vascular endothelial
growth factor (VEGF), hyaluronan (HA), plasminogen activator inhibitor‐1 (PAI‐1),
and von Willebrand factor (vWf). Plasma concentrations of the inflammatory markers
IL‐1, IL‐8, IL‐10, MCP‐1, and C‐reactive protein (CRP) were determined by canine ELISA.
Wilcoxon rank‐sum test was used to test for differences between groups and Spearman's
rho was determined for associations between variables. P‐value was set at 0.05.
Results: Most animals (83% [15/18]) in group S died, 39% (7/18) due to euthanasia
and 44% (8/18) due to cardiopulmonary arrest. Median concentrations were significantly
higher for VEGF (S: 98.5 [range: 39.3–1319.0] pg/mL; C: 39.3 [39.3–39.3] pg/mL), HA
(S: 244.7 [21.3–251.8] ng/mL; C: 75.9 [26.2–147.3] pg/mL), PAI‐1 (S: 87.4 [30.3–1028.6]
ng/mL; C: 25.0 [4.8–62.3] ng/mL), IL‐6 (S: 3102.6 [206.4–39852] pg/mL; C: 51.4 [51.2–3134]
pg/mL), IL‐8 (S: 3641.0 [306.4–118918] pg/mL; C: 483.0 [94.2–1776] pg/mL), IL‐10 (S:
198.3 [73.0–992.3]; C: 73.0 [73.0–172.8] pg/mL), MCP‐1 (S: 6974.4 [1939–203884] pg/mL;
C: 788.4 [132.4–1285] pg/mL), and CRP (S: 200.3[80.2–343.3] pg/mL; C: 19.1[19.1–87.3]
pg/mL) but not vWF (S: 109.9 [24–491]; C: 117.9 [57–198] ng/mL). Multiple strong correlations
were found between endothelial and inflammatory markers, but not between any of the
markers and severity of illness or survival to discharge.
Conclusion: Endothelial activation occurs in dogs with severe sepsis, which is similar
to results found in people with sepsis. Accordingly, VEGF, PAI‐1 and HA may all be
potential biomarkers of endothelial activation in septic dogs.
CANINE PERIPHERAL INTRAVENOUS CATHETER LONGEVITY IN A SMALL ANIMAL INTENSIVE CARE
UNIT
Hedges, KM, Odunayo, A, Smith, R, Okafor, CC
University of Tennessee, Knoxville, TN, USA
Introduction: Intravenous catheters (IVC) are used commonly in the management of critically
ill animals. While some institutions use IVCs until they are removed, some institutions
routinely replace IVC after 72 hours of use. The goal of this study is to evaluate
the average duration of peripheral catheterization in a small animal intensive care
unit, as well as the most common reasons for peripheral catheter (PC) removal in that
population.
Methods: Dogs and cats admitted to the small animal intensive care unit (ICU) at the
University of Tennessee between June 1 and August 31, 2017, with a peripheral catheter
placed in the ICU, were enrolled in the study. The site of PC placement, duration
of the PC in the patient, and reason for PC removal were recorded.
Results: There were 316 patients enrolled in the study with 277 dogs (87%) and 39
cats (12%). Two hundred forty‐one PCs (76%) were placed in a cephalic vein. One hundred
seventy‐two (54%) PCs were removed due to patient discharge from the hospital, 38
(12%) PCs were removed due to euthanasia, 33 (10%) PCs were removed due to PC occlusion,
and 12 (4%) PCs were removed due to phlebitis. The mean duration of catheterization
for all patients was 32 h:56 min (range 0:23 min to 277 h: 05 min). Twenty‐three patients
(7%) had catheters that were patent for greater than 72 hours.
Conclusion: Most PCs were placed in a cephalic vein and were removed because the patient
was ready to be discharged. Occlusion of the catheter was the most common reason for
PC replacement in hospitalized patients while phlebitis was an uncommon cause in this
population of ICU patients. Additional information from this study showed that PCs
may not need to be routinely replaced after 72 hours of use.
COMPARISON OF THREE INTRAOSSEOUS CATHETER PLACEMENT SITES IN RABBITS
Kennedy, CR, Gladden, J, Rozanski, EA
Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
Introduction: Intraosseous (IO) catheters can be used in place of intravenous catheters
in critically ill rabbits, but there is no data on the ideal catheter placement site.
The primary goal of this study was to determine if IO catheters can be placed with
greater success in the tibia, femur, or humerus of rabbits. The secondary goal was
to compare commonly used clinical criteria for successful IO catheterization with
fluoroscopically confirmed success.
Methods: Participants underwent a 15‐minute training session on IO catheter placement
technique. Eight rabbit cadavers were used. All participants attempted timed catheter
placement at all 3 sites (tibia, femur, humerus). Clinical success (CS) was defined
by: placement of a hypodermic needle, in under 3 minutes; concurrent ability to manipulate
the leg via the catheter, and to infuse 1 mL saline with the apparent absence of a
postinfusion subcutaneous fluid accumulation. Fluoroscopic success (FS) was confirmed
by infusing iohexol and identifying intramedullary flow via fluoroscopy. A Fisher's
exact test was used to compare FS rates between sites of catheter placement (P < 0.05).
Results: Twelve participants with varying clinical experience were recruited. Fourteen
catheters were attempted at each of the 3 sites for a total of 42 attempts. Overall
CS was documented in 28/42 (66.7%) cases, while FS was confirmed in only 18/42 (42.9%)
(P = 0.01). Out of the total 14 attempts for each site, 10/14 (71.4%) of the tibial
catheters, 5/15 (35.7%) of the humeral, and 3/14 (21.4%) of femoral were fluoroscopically
successful (P = 0.03). Median time until FS placement was shortest for the tibia (45.5
seconds, range 19–150 seconds), followed by the humerus (76 seconds, range 15–125
seconds); placement time was longest for the femur (135 seconds, range 91–140 seconds).
Conclusion: The rate of successful IO catheter placement in rabbit cadavers was highest
for the tibia, followed by the humerus and then the femur. The median placement time
was also shortest in the tibia. Clinical success criteria overestimated the true intramedullary
placement of catheters confirmed via fluoroscopy.
THE USE OF LUNG ULTRASOUND TO EVALUATE FOR PULMONARY HYPERTENSION‐ASSOCIATED PULMONARY
EDEMA IN DOGS WITHOUT LEFT ATRIAL ENLARGEMENT
Kulhavy, DA
1, Lisciandro, GR2
1Hong Kong Veterinary Ultrasound, Hong Kong, Hong Kong
2Hill Country Veterinary Specialists, Spicewood, TX, USA
Introduction: Pulmonary edema has been sparsely reported in dogs with moderate to
severe pulmonary hypertension (PH). Many clinicians are unaware of this PH complication.
Accurate diagnosis is important because the PH‐associated pulmonary edema can be severe
and is refractory to loop diuretics. This study aimed to evaluate the use of a lung
ultrasound protocol (VetBLUE) in documenting PH‐associated pulmonary edema and other
lung pathology in dogs with moderate to severe PH in the absence of left atrial enlargement.
Methods: Prospective case series of privately owned dogs referred for echocardiography
to a mobile ultrasound practice in Hong Kong over a 12‐month period. Patients with
a systolic pulmonary artery pressure (PAP) > 60 mm Hg and Stage B1 or less mitral
valve disease were included in the study. The presence of more than one B‐line at
more than one view was considered positive for PH‐associated pulmonary edema. Additional
findings were described using the published visual system of lung ultrasound signs
(shred, tissue, wedge, and nodule sign).
Results: Approximately 1,000 complete echocardiograms were performed during the 12‐month
enrollment period, of which 44 dogs were diagnosed with PH having a PAP > 60 mm Hg
and 28 were no more advanced than Stage B1 mitral valve disease meeting the inclusion
criteria. Of the 28, 12 had complete studies for review; and 9/12 dogs had multiple
views positive for B‐lines with an average of 5.3/8 (range 3–7); and 6/12 patients
were treated with loop diuretics for cardiogenic edema on initial presentation. Average
age was 11 years (range 8–16); and average LA:Ao ratio was 1.14 (range 0.89–1.38);
and average systolic pulmonary arterial pressure (PAP) was 86 mm Hg (range 60–121
mm Hg). Concurrent respiratory disease was identified in 9 patients, 8 with brachycephalic
syndrome, and a single dog with a lung mass.
Conclusion: The imaging protocol used proved useful combined with echocardiography
as a point‐of‐care rapid tool to screen for evidence of PH‐associated pulmonary edema
as well as screen for other underlying lung pathology. Dogs with PH‐associated pulmonary
edema may be misdiagnosed with left‐sided congestive heart failure and treated inappropriately
with loop diuretics rather than sildenafil or other effective phosphodiesterase inhibitors.
PROSPECTIVE COMPARATIVE QUALITY CONTROL STUDY OF A NOVEL GRAVITY‐DRIVEN HOLLOW‐FIBER
WHOLE BLOOD SEPARATION SYSTEM FOR THE PRODUCTION OF CANINE BLOOD PRODUCTS
Lehmann, H
1, Hindricks, E2, Hassdenteufel, E1, Moritz, A2, Bauer, N2
1Small Animal Clinic, Gießen, Germany
2Clinical Pathology, Gießen, Germany
Introduction: The aim of this study was to evaluate the quality of blood products
produced by a centrifuge (C) compared to a novel gravity driven hollow fiber separation
system (HF).
Methods: Between February 2017 and June 2017, client‐owned healthy dogs (n = 31) from
a pre‐established blood donation program were included and allocated to the groups
(C) centrifugation (n = 15) or (HF) hollow‐fiber system (n = 16). Dogs were included
if they donated a blood volume of more than 400 mL without sedation in lateral recumbency
from the jugular vein and no moderate or severe lipemia was present. After donation,
samples were aseptically drawn from different locations of separation system: donor
(D), whole blood bag (WB), whole blood bag samples stored at room temperature for
the duration of separation process (WBlate), plasma bag (P), and red blood cell bag
(pRBC). Comparative measurements of cell content, biochemical parameters (eg, total
solids, albumin, electrolytes) were run in D, WB, P, and pRBC. Coagulation times (PT/aPTT),
fibrinogen concentration, and factor activity (factor V, factor VIII, antithrombin,
and von Willebrand factor) were run in samples D, WB, P, and WBlate.
Results: The separation by HF resulted in a significant (P < 0.0001) prolongation
of PT (HF: median 9.4 s [range 7.7–12.4 s]; C: 7.9 s [range 7.2–9 s]) and aPTT (HF:
median 14.9 s [range 11.7–19.6 s] C: 13.1 s [range 10.9–14.2 s] [P = 0.006]). In P
after separation, fibrinogen was significantly lower (P < 0.0001) in HF (1 g/L [range
0.4–1.6]) compared to C (1.5 g/L [range 1.2–3.4]). Additionally, a significant lower
concentration of total solids and albumin in HF was detected in comparison to C. Leukodepletion
resulted in both groups in a significant decrease in FVIII activity (HF: median –12.97%
[range –27.72–(–4%)]; C: median –13.51% [range –34.69–(12.33)]). Plasma storage (WBlate)
at room temperature had no effect on coagulation time or factor activity. Compared
to the HF system a significant higher hematocrit, hemoglobin, and RBC count of the
red blood cell concentrate was detected in C.
Conclusion: Blood product quality was negatively affected using the hollow‐fiber system,
especially for plasma quality. In case of the absence of a centrifuge, the hollow‐fiber
system provides an alternative for whole blood separation.
THE USE OF A POINT‐OF‐CARE LUNG ULTRASOUND PROTOCOL AND SONOGRAPHIC GALLBLADDER WALL
EVALUATION PRE‐ AND POSTANESTHESIA FOR THE DETECTION OF LUNG ATELECTASIS AND GALLBLADDER
WALL EDEMA IN 63 DOGS UNDER GOING GENERAL ANESTHESIA
Lisciandro, GR
1, Fosgate, GT2
1Hill Country Veterinary Specialists, Spicewood, TX, USA
2University of Pretoria, Onderstepoort, South Africa
Introduction: Lung ultrasound (LUS) is used for the rapid detection of atelectasis
and pulmonary complications perioperatively. Recently, Vet BLUE (VB‐LUS) profiles
in dogs undergoing elective surgical sterilization showed minimal changes; however,
LUS has not been applied to dogs undergoing longer and more involved general anesthetic
procedures. Gallbladder wall edema, a marker for canine anaphylaxis and right‐sided
volume overload, was a secondary objective since dogs often receive opioids and intravenous
contrast agents that can incite histamine release; and splanchnic venous pooling occurs
during general anesthesia.
Methods: Lung ultrasound and sonographic gallbladder wall characterization pre‐ and
postgeneral anesthesia was performed at induction and extubation. Findings of dry
lung (A‐lines with glide sign), wet lung (B‐lines), and consolidation (shred and tissue
sign) were recorded. Gallbladder wall edema was defined by the presence of a sonolucent
intraluminal line with gallbladder thickening referred to as the gallbladder halo
sign. Comparison of LUS findings were made pre‐ and postprocedure, between spontaneous
breathing (SB) and anesthetic mechanical ventilation (AMV), and induction agents.
Positive LUS findings postprocedure had repeated evaluations performed.
Results: Lung ultrasound findings differed pre‐ and postprocedure (P < 0.001; Wilcoxon
signed rank test) but not between SB (n = 52) and AMV (n = 11) (P = 0.452; Mann–Whitney
U‐test) or induction agents (P = 0.136; Mann–Whitney U‐test). Gallbladder wall edema
was absent in dogs pre‐medicated with morphine, including several dogs that had associated
vomiting, or those administered intravenous contrast agents. Dogs with positive LUS
findings postprocedure had resolution of LUS findings within 1–3 hours.
Conclusion: Lung ultrasound findings of lung atelectasis were apparent postprocedure
with resolution occurring within 1–3 hours postextubation. The induction agent tiletamine‐zolazepam,
although not statistically significant, had a higher frequency of abnormal LUS findings
compared to the other agents. Gallbladder wall edema did not occur with morphine with
or without associated vomiting, contrast agents, or with venous splanchnic pooling.
These findings are important for interpreting LUS and sonographic gallbladder findings
perioperatively to distinguish between expected LUS and gallbladder wall findings
versus anesthetic‐related complications.
THE FREQUENCY OF B‐LINES AND OTHER LUNG ULTRASOUND ARTIFACTS DURING LUNG ULTRASOUND
IN 91 HEALTHY PUPPIES AND KITTENS
Lisciandro, GR
1, Romero, LA1, Fosgate, GT2
1Hill Country Veterinary Specialists, Spicewood, TX, USA
2University of Pretoria, Onderstepoort, South Africa
Introduction: Lung ultrasound (LUS) is effective in diagnosing common respiratory
conditions in people. Established frequency of LUS artifacts in puppies and kittens
is unknown and having greater total body water, could be higher and confuse LUS interpretation.
Thus, the objective of this study was to determine the expected frequency of LUS artifacts
in puppies and kittens.
Methods: Lung ultrasound was performed on healthy 6‐ to 14‐week‐old puppies and kittens.
Numbers and locations of B‐lines and other LUS signs (shred, tissue, nodule, wedge)
were recorded. Data included breed, body condition score (BCS), age, sex, and weight.
The number of B‐lines per hemithorax, at each LUS view, and other signs were recorded.
Lung ultrasound findings were evaluated relative to BCS weight, sex, left and right
hemithoraces, and LUS views.
Results: Ninety‐one animals were enrolled (41 puppies, 50 kittens). Puppies included
2 Chihuahuas, 1 Labrador Retriever, and 38 mix breeds; and 20 males and 21 females.
Kittens included 43 domestic short‐hair and 7 domestic medium‐hair; and 27 males and
23 females. The mean (range) BCS (0–9 scale), age (weeks), and weight (kg) of puppies
were 3.4 (2–4), 10.1 (6–14), and 4.4 (0.9–8.8), respectively. Total number of B‐lines
per hemithorax were 1 on the left and right side with positive views being left cranial
(n = 1) and right cranial lung regions (n = 1). The mean (range) BCS, age, and weight
of kittens were 3.6 (2–4), 9.3 (7–14), and 1.1 (0.2–2.0), respectively. Total number
of B‐lines per hemithorax were 2 on the left and 3 on the right side; positive views
were left caudodorsal (n = 2), right caudodorsal (n = 1), perihilar (n = 1), and middle
lung regions (n = 1). All positive views had only a single B‐line present. Age, BCS,
weight, and sex were not significantly different when compared between puppies or
kittens with B‐lines versus those without B‐lines; however, animals with B‐lines were
significantly younger (P = 0.036) when all were combined in a single analysis.
Conclusion: Healthy puppies and kittens ages of 6–14 weeks have similar LUS profiles
as adults; however, because animals with B‐lines were younger, B‐line frequency may
be higher in those < 6 weeks of age.
DEVELOPMENT OF A NOVEL SCORING SYSTEM TO PREDICT MORTALITY IN CANINE PATIENTS WITH
INFECTIONS
Lyons, BM, Stefanovski, D, Silverstein, DC
University of Pennsylvania, Philadelphia, PA, USA
Introduction: Over the past 2 decades, the syndrome of sepsis has been defined as
the systemic inflammatory response (SIRS) to infection. With this definition, dogs
were clinically recognized as having sepsis if they met 2 out of 4 SIRS criteria.
Although the SIRS criteria were previously considered sensitive but not specific for
sepsis, recent evidence has called into question the sensitivity of this scoring system
as well. The advent of Sepsis‐3 in human critical care has redefined sepsis as life‐threatening
organ dysfunction caused by a dysregulated host response to infection, prompting the
recommendation that the sequential organ failure assessment (SOFA) score be used in
lieu of SIRS to recognize patients with infection that develop sepsis. The advent
of new definitions of sepsis in the human literature begs the question as to how to
define sepsis in the critically ill canine patient. The goal of this study was to
evaluate physical parameters and clinicopathologic abnormalities that may help to
better identify patients with infection that are at higher risk for mortality.
Methods: This was a prospective, observational study. All dogs admitted to the ICU
were eligible for admission, with the exception for patients that recovered from anesthesia
in the ICU postoperatively but were discharged to the general wards within 12 hours.
Blood work was obtained at the discretion of the primary clinician.
Results: One hundred dogs were enrolled, 45 of which had documented evidence of infection.
A mortality prediction score was generated using survival as an outcome with mentation,
heart rate, and PvCO2 (AUROC 0.88). This compared favorably to SIRS (AUROC 0.52),
as well as the APPLEfull (AUROC 0.60) and APPLEfast (AUROC 0.54) in this population.
Conclusion: A new scoring system was determined to predict mortality in hospitalized
dogs with infection. Further prospective evaluation in a larger patient cohort would
help to further validate this score and may also reveal other parameters that may
predict mortality or organ dysfunction in canines with infection.
EVALUATION OF THE TIMING OF SURGERY ON TRANSFUSION REQUIREMENTS AND OUTCOME IN DOGS
WITH SPONTANEOUS HEMOPERITONEUM
Mastrocco, A
1, Drobatz, KJ2, Reineke, EL2
1The Animal Medical Center, New York, NY, USA
2University of Pennsylvania, Philadelphia, PA, USA
Introduction: The goals of this study were to evaluate whether the time to surgery
affects transfusion requirements, length of hospitalization, cost, or outcome in dogs
with spontaneous hemoperitoneum. We hypothesized that dogs with delayed time to surgery
would receive more blood products and have increased morbidity and mortality compared
with dogs that had early surgical intervention.
Methods: Medical records of dogs surgically treated for spontaneous hemoperitoneum
between 2010 and 2016 were reviewed. Time from admission to surgical intervention,
volume of blood transfusion products administered (mL/kg), length of hospitalization
(hours), outcome (survival to hospital discharge, death, or euthanasia), and total
costs were recorded. All data are presented as median and range.
Results: One hundred thirty‐seven dogs were included in the study. Thirty‐six dogs
had surgery within 6 hours of admission (36/137; 26%), 20 (20/137; 15%) within 6–12
hours, 65 (65/137; 47%) within 12–24 hours, and 16 (16/137; 12%) had surgery greater
than 24 hours after admission. Packed cell volume (30%, 15–50), total solids (6 g/dL,
3.8–8.8), and base excess (–7.9, –0.3 to –17.4) values measured at admission were
associated with need for transfusion in this study (P = 0.0001, 0.0076, 0.0001). There
was no difference between groups in the overall dose (mL/kg) of packed red blood cell
or fresh frozen plasma administered during hospitalization. Dogs that had surgery
within 6 hours of admission received a significantly greater number of blood product
transfusions intraoperatively (1; 0–4) compared with dogs in the 6–12 hours group
(0; 0–1; P = 0.004) and 12–24 hours group (0; 0–2; P = 0.007). Delayed surgery was
significantly associated with increased length of hospitalization (P = 0.0001), but
there was no effect of the timing of surgery on cost of hospitalization or patient
outcome.
Conclusion: In this retrospective study evaluating dogs with spontaneous hemoperitoneum,
delay in surgical management led to a significantly increased length of hospitalization
but did not affect overall transfusion requirements or short‐term outcome. These findings
provide justification for further, prospective evaluation of the effect of surgical
timing on outcome in dogs with spontaneous hemoperitoneum.
EVALUATION OF AN EMERGENCY MEDICINE‐FOCUSED CLINICAL PATHOLOGY TRAINING COURSE FOR
NONCLINICAL PATHOLOGY HOUSE OFFICERS
Pavlides, S
1, Lynch, AM2, Snowden, KS1, Leissinger, M1
1University of Florida, Gainesville, FL, USA
2North Carolina State University, Raleigh, NC, USA
Introduction: The clinical pathology proficiency of emergency veterinarians is considered
low but accurate diagnostics are essential for case management. The aim of this study
was to determine whether an emergency medicine‐focused training course in clinical
pathology improved the proficiency and confidence of nonclinical pathology house officers.
Methods: A 4‐hour prospective, blinded study was performed using teaching materials
derived from historical clinical specimens. A pre‐ and postcourse multiple‐choice
question examination was taken by the study participants, along with assessment of
their confidence level using a novel scoring system [ranging from 1 (very low) through
to 7 (very high)].
Results: The study was completed by 21 people [didactic training only (9/21), online
lectures only (10/21), combination of didactic and online learning (2/21)]. Test results
were significantly improved after the course (precourse: mean 49% ± 12; postcourse:
mean 72.5% ± 15.7; P < 0.0001), with improvement in 3 specific study areas [hematology
(precourse: mean 47% ± 16; postcourse: mean 71% ± 15.8; P ≤ 0.0001); urinalysis (precourse:
mean 65.7% ± 12.5; postcourse: mean 87.6% ± 22.1; P = 0.0004); fluid analysis (precourse:
mean 37.1% ± 14.1; postcourse: mean 60.5% ± 15; P ≤ 0.0001)]. There was also a significant
increase in the study participants’ clinical pathology confidence score after training
(precourse: mean 2.2 ± 1.5; postcourse: 3.6 ± 1.4; P = 0.0005).
Conclusion: This study identified that this 4‐hour training course, delivered either
via didactic or in a prerecorded online lectures, improved the knowledge and confidence
of nonclinical pathology house officers. A similar training course may prove helpful
in the future to improve clinical pathology skills for small animal emergency veterinarians.
THE PROGNOSTIC VALUE OF ABNORMAL COAGULATION TIMES IN DOGS THAT ARE AT RISK OF DEVELOPING
SEPSIS
Rodrigues, LR
1, Branco, SB1, Viegas, IV2, Ferreira, AF3, Martins, AM2
1Universidade de Évora, Évora, Portugal
2Universidade Lusófona, Lisbon, Portugal
3Universidade de Lisboa, Lisbon, Portugal
Introduction: Sepsis is a hard to define syndrome associated with a deleterious systemic
inflammatory response that ultimately leads to coagulopathy, organ dysfunction, and
death. The primary aim of this prospective study was to evaluate if coagulation times
can be predictive of disease severity and outcome in patients at risk of developing
sepsis. A secondary objective was to correlate activated partial thromboplastin time
(aPTT) and prothrombin time (PT) with the quick sequential organ failure assessment
(qSOFA) scoring system at the moment of admission to the intensive care unit (ICU)
and evaluate their combined prognostic value.
Methods: A total of 43 dogs were prospectively enrolled in the study between September
2016 and March 2017. Patients that were hemodynamically altered with clinical signs
of coagulopathy, infection, shock, or SIRS were included, as well as those affected
by polytrauma, organ dysfunction, or neoplasia, upon presentation. All these patients
were susceptible to subclinical infections and bacterial translocation, therefore
being at risk of developing sepsis. Coagulation testing and qSOFA scoring were performed
at the time of admission to the ICU and were statistically analyzed using descriptive
and inferential analyses. Other variables such as signalment, diagnosis, duration
of hospitalization and postdischarge treatment, and outcome were also recorded and
analyzed.
Results: Mortality rate was 34.9%. Mortality increased with the number of qSOFA points
(0 points: 10%; 1 point: 30.8%; 2 points: 47.1%; 3 points: 66.7%). The aPTT was significantly
higher (P = 0.029) in patients with a qSOFA score of 2 points in comparison to those
with 1 point. A positive correlation was found between aPTT and PT (r = 0.406, n = 43,
P = 0.005). Mean values for aPTT and PT were similar between surviving and nonsurviving
patients. Ten out of 15 patients (66.7%) that died did so between the first and fifth
day of treatment, and 3 of the remaining 5 deaths (60%) were caused by neoplastic
disease.
Conclusion: The results of this study suggest the existence of hemostatic dysfunction
amongst patients with a qSOFA score of 2 points. In isolation, however, prolonged
coagulation times at ICU admission were not predictive of outcome.
INDUCED VOMITING IN CONJUNCTION WITH THE “HEIMLICH MANEUVER” FOR GASTRIC FOREIGN BODY
EXTRACTION IN DOGS: 100 CASES
Roux, FA, Duperrier‐Simond, C, Deschamps, JY
College of Veterinary Medicine, Nantes, France
Introduction: Gastric foreign bodies are conventionally managed by endoscopic extraction
or gastrotomy.
Methods: This study examines the results of a first‐line noninvasive technique for
the management of gastric foreign bodies in a population of dogs presented to an emergency
department between January 1, 2013 and March 1, 2017. The population included dogs
presented after ingestion of a foreign body, and dogs in which a gastric foreign body
had been identified by imaging. Our practice favors oral evacuation. The technique
consists of giving a large meal, inducing vomiting with an emetic substance (apomorphine
or hydrogen peroxide solution) and then exerting pressure on the abdomen during vomiting.
We have named this procedure the “Heimlich maneuver” in reference to the procedure
described by H.J. Heimlich in 1970 for airway obstruction in people. In case of failure
other options are considered: “wait‐and‐see,” endoscopic extraction or gastrotomy.
Results: One hundred seventeen dogs were identified. Initially, induced vomiting in
conjunction with a “Heimlich maneuver” was attempted in 100 dogs (85%); 77 (77%) of
these dogs vomited, allowing extraction of 63 (63%) foreign bodies, 82% of vomiting
dogs. Surveillance without intervention was elected in 9 dogs (8%); 5 dogs (4%) underwent
endoscopic extraction; and 3 dogs (3%) underwent extraction by gastrostomy. Subsequently,
among the 37 dogs for which the foreign body was not recovered (23 dogs who did not
vomit and 14 dogs who vomited but in whom the Heimlich maneuver did not produce the
foreign body), 27 dogs (23% of total gastric foreign bodies) received no treatment,
6 dogs (5%) underwent endoscopic extraction, and 4 dogs (3%) underwent gastrotomy.
In total, induction of vomiting associated with the Heimlich maneuver resulted in
extraction of 54% of gastric foreign bodies, and “wait‐and‐see” approach sufficed
in 30%. Noninvasive management was therefore effective in 84% of cases. Only 16% of
cases required intervention: endoscopic extraction (10%) or gastrotomy (6%).
Conclusion: We propose a novel, simple, minimally invasive, and often effective extraction
technique for gastric foreign bodies in dogs. This technique and “wait‐and‐see” approach
should be considered before endoscopy or gastrotomy is attempted.
PLASMA SYMMETRIC DIMETHYL ARGININE CONCENTRATION IN CATS WITH AKI RELATED TO URETHRAL
OBSTRUCTION
Roux, FA, Troussier, GC, Deschamps, J‐Y
Oniris Veterinary Medicine School, Nantes, France
Introduction: Symmetric dimethylarginine (SDMA) is considered a biomarker for early
detection of renal dysfunction in case of acute kidney injury (AKI). At present, no
studies exist analyzing the relevance of SDMA in cats with AKI. We hypothesize that
SDMA would correctly identify cats with acute renal disease and that values would
correlate with IRIS grading in cats with urethral obstruction (UO).
Methods: Twenty‐two cats with UO presented to the Emergency Service were compared
with 22 healthy comparable cats. Urea, creatinine, potassium, and SDMA were measured
on admission. Cats with UO were classified according to the IRIS AKI Grading scale.
Nonparametric statistical analysis was performed.
Results: Median urea, creatinine, and SDMA concentration were higher in the UO group
as compared to the control group. The SDMA/creatinine ratio was not different. In
regards to cats with UO and the control groups, SDMA was highly correlated with creatinine
(R = 0.58; P = 0.000042). The median SDMA concentration was below reference range
of 14.0 μg/dL for both IRIS stage 1 and stage 2. Comparing the 5 IRIS groups (IRIS
1: n = 5; IRIS 2: n = 5; IRIS 3: n = 5; IRIS 4: n = 4; IRIS 5: n = 3) urea, creatinine,
and SDMA were highly different in the 5 groups whereas potassium and SDMA/creatinine
were not. When IRIS ≤ 2 with IRIS ≥ 3 UO cats were compared, the median urea, creatinine,
potassium, and SDMA concentrations were higher in the IRIS ≥ 3 UO group as compared
to the IRIS ≤ 2 group and SDMA/creatinine ratio was not different. Twenty‐two cats
were alive 30 days postdischarge and 15 cats were alive 1 year after. The urea, creatinine,
potassium, SDMA, and SDMA/creatinine ratio were not different between the 15 alive
and 7 deceased cats. Of 15 alive cats, 5 cats had a recurrence of UO. Three of those
5 cats were initially IRIS ≤ 2. None of the studied parameters including SDMA and
SDMA/creatinine ratio were different as regard to recurrence of UO episode.
Conclusion: Plasma SDMA concentration is a suitable marker for identifying AKI in
UO cats. SDMA correlates with IRIS stages but not SDMA/creatinine ratio.
PHOSPHATIDYLSERINE POSITIVE MICROPARTICLES IN CANINE HEMORRHAGIC ABDOMINAL FLUIDS
Sowy, S, Jeffery, UL, Rutter, C
Texas A&M University, College Station, TX, USA
Introduction: Hemoperitoneum is a common finding in dogs in the emergency setting
and may necessitate use of blood products. Autotransfusion could reduce cost and mitigate
adverse transfusion reactions; however, shed hemothorax blood from human trauma patients
contains high concentrations of potentially detrimental procoagulant phosphatidylserine
positive microparticles. The objectives of this study were to compare phosphatidylserine
positive microparticle concentration and phosphatidylserine‐mediated procoagulant
activity of canine hemoperitoneum fluids and packed red blood cell units (pRBCs).
Methods: Ten dogs with hemoperitoneum (neoplasia = 7; trauma = 1; Other = 2) were
recruited, and 5 pRBC units purchased. Supernatants were collected from hemoperitoneum
and pRBC samples. Phosphatidylserine positive microparticle concentrations were measured
via flow cytometry and phosphatidylserine‐mediated procoagulant activity by a commercial
thrombin generation assay.
Results: The concentration of phosphatidylserine positive microparticles was not significantly
different between pRBCs (median: 415/mL, range 173–1331/mL) and hemoperitoneum samples
(median: 314/mL, range 132–3880/mL; P = 0.77). Phosphatidylserine‐mediated procoagulant
activity was significantly higher for supernatants collected from pRBC (median 54
nM, range 53–60 nM) than hemoperitoneum samples (median 43 nM; range 7–51 nM; P = 0.0007).
Conclusion: The findings suggest shed hemoperitoneum blood does not contain more phosphatidylserine
positive microparticles, nor does it have higher phosphatidylserine‐mediated procoagulant
activity than pRBC units. Measurement of other procoagulant and proinflammatory microparticle
components and investigation of the effect of autotransfusion versus pRBC transfusion
on circulating microparticle concentrations is warranted.
EVALUATION OF FELINE RED BLOOD CELLS COLLECTED WITH AN OPEN SYSTEM AND STORED FOR
35 DAYS AS WHOLE BLOOD UNITS
Spada, E, Perego, R, Baggiani, L, Martino, Pa, Proverbio, D
University of Milan, Milan, Italy
Introduction: The increasing access to veterinary hospital blood banks and commercial
sources of feline blood products means that transfusion therapy is more widely available
to veterinarians and feline stored blood products are used more often. Despite the
increasing availability of feline blood collected and stored for transfusion purposes,
few studies have investigated storage lesions in feline whole blood (FWB) units and
no study has evaluated hematological changes in FWB units. The objective of this study
was to assess changes in feline RBCs collected and stored for transfusion purposes
as FWB units.
Methods: A prospective, laboratory in vitro study was conducted. Twelve nonleukoreduced
FWB units were collected with an open system using three 20‐mL syringes prefilled
with citrate, phosphate, dextrose, and adenine (CPDA‐1) preservative‐anticoagulant
solution with ratio with blood of 1:7 from anesthetized feline blood donors. Units
were stored in a blood bank dedicated refrigerator and sampled every 7 days (D7, D14,
D21, D28) from collection (D0) to the end of storage (35 days, D35). At each time
point, the following were evaluated: (1) hematological parameters (RBC, HGB, HCT,
MCV, MCH, MCHC, RDW); (2) percentage of hemolysis; (3) morphological index, scored
of 0 to 4 based on echinocyte transformation of the normal discocyte; and (4) aerobic
and anaerobic blood culture. Results were statistically compared to D0, with t‐test
or Wilcoxon test, as appropriate with statistical significance set at P < 0.01.
Results: There was no significant difference in hematological parameters at any time
point with respect to D0. Significant increases were found in percentage of hemolysis
and morphological index starting from 21 days of storage (P = 0.0002 and P = 0.0039,
respectively). Mean hemolysis percentage value was less than 1% up to 21 days of storage.
All blood cultures were negative for bacterial growth.
Conclusion: RBCs in FWB units collected with an open system can undergo some significant
hematological changes, but these results suggest that storage for up to 21 days is
safe. In vivo studies are required to establish if these changes affect the ability
of stored RBCs to circulate and provide adequate oxygen delivery after transfusion.
ASSESSMENT OF A NASOGASTRIC TUBE PLACEMENT PROTOCOL TO MINIMIZE IATROGENIC TUBE MISPLACEMENT
COMPLICATIONS
Taylor, AQ, Gladden, JN, Wayne, AS
Tufts University, North Grafton, MA, USA
Introduction: There is no standard method of nasogastric tube (NGT) placement in veterinary
medicine, and many are placed blindly. Blind techniques can result in tracheal, pulmonary,
or pleural malposition wherein life‐threatening complications may develop. Cases of
tracheopulmonary misplacement have been reported in both dogs and humans resulting
in death. Although radiographic assessment of NGT placement is the most reliable indicator
of position, recognition of NGT malpositioning once a tube has been fully advanced
does not prevent pulmonary complications. To limit complications, a lateral cervical
radiograph has been recommended in the recent veterinary literature to verify correct
tube placement above the larynx and within the esophagus prior to further NGT advancement
and final positioning. The goal of this study was to assess whether a standardized
protocol incorporating a lateral cervical radiograph could correctly identify NGT
tracheal misplacement prior to tube advancement.
Methods: Prospective study performed at a veterinary teaching hospital between December
1, 2017 and April 15, 2018. Following NGT placement, a questionnaire that included
the following information: patient factors (reason for placement, mentation, recumbency,
head conformation, placement nostril, evidence of coughing and/or swallowing at time
of placement, and use of sedation or general anesthesia); tube factors (size, presence
of a stylet), and placement factors (clinician experience, number of attempts, time
to placement, number of radiographs obtained, and presence of misplacement) was completed
by the attending clinician.
Results: Of 19 total NGT placements (14 dogs and 5 cats), 2 tracheal misplacements
(10.5%, 1 dog and 1 cat) were identified before the tube was fully advanced. Both
animals were in sternal recumbency and neither received a sedative. The dog was noted
to have a brachycephalic confirmation and alert mentation, and the cat was reported
as mesocephalic with quiet mentation. Both tubes were placed by residents with no
coughing reported and evidence of swallowing described in both cases.
Conclusion: The use of a standardized protocol that incorporates a lateral cervical
radiograph identified NGT tracheal misplacements in 10.5% of cases where blind technique
safety assessments including lack of swallowing and presence of a cough failed to
alert the clinician to tube malpositioning.
EFFECTS OF POTENTIAL CONFOUNDING VARIABLES ON ACCURACY AND PRECISION OF A COMMERCIAL
VETERINARY HEMATOCRIT METER
Thevelein, BAL, Koenig, A, Brainard, BM
University of Georgia, Athens, GA, USA
Introduction: Rapid and accurate measurement of hematocrit using small sample volumes
is useful in critically ill patients. Interference from substances in the blood (eg,
lipemia) may influence the function of machines that rely on optical measurement.
We aimed to evaluate precision and accuracy of a veterinary point‐of‐care (POC) hematocrit
meter and to study the effects of potential confounding variables on meter function.
We hypothesized that the meter is accurate and precise over a wide range of hematocrits
and that the confounders would not affect meter function.
Methods: Canine and feline venous whole blood EDTA samples (n = 56) were run in duplicate
on the POC, which reported hemoglobin (POCHb), measured via optical reflectance, and
a calculated hematocrit (POCHct). Meter results were compared to results from a laboratory‐based
analyzer (CBC). Samples with grossly visible lipemia, icterus, hemolysis, and auto‐agglutination
were noted.
Results: CBC hematocrit ranged from 3.5% to 79.8% (mean 38.9 ± 14.5%) and hemoglobin
concentration ranged from 1 to 24.6 g/dL (mean 12.9 ± 4.9 g/dL). The average differences
between duplicate POCHct and duplicate POCHb values were –0.58 ± 2.96 and –0.31 ±
1.06 g/dL, respectively. There was good correlation between the meter and CBC for
both hematocrit (R
2 = 0.91) and hemoglobin (R
2 = 0.89). There was no apparent influence of visible lipemia (n = 12), icterus (n = 9),
or hemolysis (n = 8) on meter accuracy. The POC failed to read 5 samples; 4 had marked
auto‐agglutination and 4 had hematocrit ≤11%.
Conclusion: Overall, the POC had excellent precision and correlation with CBC. The
meter was not influenced by icterus, lipemia, or hemolysis but did not provide data
for samples with auto‐agglutination or hematocrit ≤11%.
ADIPONECTIN AS SEPSIS‐BIOMARKER IN DOGS: DIAGNOSTIC AND PROGNOSTIC VALUE
Torrente Artero, C
1, García Manzanilla, EG2, Bosch, L1, Pastor, J1, Ruiz de Gopegui, RR1, Cerón, JJ3
1Universitat Autònoma de Barcelona, Barcelona, Spain
2Animal‐Grassland Research Centre, Cork, Ireland
3Universidad de Murcia, Murcia, Spain
Introduction: To investigate the diagnostic and prognostic value of plasma adiponectin
(ADPN) concentrations versus other traditional inflammatory biomarkers, on admission
and over the ICU stay, of dogs affected by natural sepsis.
Methods: This observational prospective observational study included 20 critically
ill dogs with clinical evidence of systemic inflammatory response syndrome (SIRS)
of infectious origin on admission. Plasma ADPN, albumin (ALB), C‐reactive protein
(CRP), ferritin (FRT), haptoglobin (HAP), and fibrinogen (FBG) were measured upon
sepsis diagnosis and every 24–48 hours until death or discharge. Twenty‐seven dogs
with local inflammation and 18 healthy dogs were included in the study as positive
and negative control groups, respectively. All studied variables were compared among
groups using general linear models. Values were also compared between outcome groups
for animals in the septic group. Alpha level for significance was 0.05.
Results: As expected, animals on localized inflammation (n = 27) and sepsis (n = 20)
groups had lower ADPN and ALB and higher CRP, FBG, and FRT levels than control animals
(n = 18) on admission. Dogs with sepsis had lower ADPN (2.4 ± 0.46 vs 4.5 ± 0.41 μg/mL,
P < 0.001), ALB (1.7 ± 0.1 vs 2.2 ± 0.08 g/dL, P < 0.001), and higher CRP (87 ± 4.8
vs 73 ± 4.1 μg/mL, P < 0.001) concentrations than dogs with localized inflammation.
Regarding initial and final ADPN concentration in septic dogs, no significant differences
in outcome were detected on that group (P = 0.306).
Conclusion: Adiponectin may be a reliable marker of sepsis and changes related to
the severity of disease and progression of the inflammatory response in dogs. However,
further studies are warranted to confirm the prognostic value of this inflammatory
marker.
EVALUATION OF PARAOXANASE AND BUTYRYLCHOLINESTERASE ACTIVITY IN DOGS WITH SEPSIS
Torrente Artero, C
1, García Manzanilla, EG2, Bosch, L1, Pastor, J1, Ruiz de Gopegui, RR1, Cerón, JJ3
1Universitat Autònoma de Barcelona, Barcelona, Spain
2Animal‐Grassland Research Centre, Cork, Spain
3Universidad de Murcia, Murcia, Spain
Introduction: To evaluate the diagnostic and prognostic value of plasma paraoxonase
(PON1) concentration and butyrylcholinesterase (BChE) activity versus other traditional
inflammatory biomarkers, on admission and over the ICU stay of dogs affected by natural
sepsis.
Methods: This observational prospective study included 20 critically ill dogs with
clinical evidence of infectious SIRS on admission. Plasma PON1, BChE, albumin (Alb),
and C‐reactive protein (CRP) were measured upon sepsis diagnosis and every 24–48 hours
until patient's death or discharge. Twenty‐seven dogs with local inflammation and
18 healthy dogs were included in the study as positive and negative control groups,
respectively. All studied variables were compared among groups using general linear
models. Values were also compared between outcome groups for animals in the septic
group. Alpha level for significance was 0.05
Results: Animals on localized inflammation (n = 27) and sepsis (n = 20) groups had
lower PON1 and higher BchE activity than control animals (n = 18) on admission. Dogs
with sepsis had lower PON1 (1.1 ± 0.10 vs 1.6 ± 0.08 UI/mL, P < 0.001), than dogs
with local inflammation, but no differences in BchE activity (3.8 ± 0.41 vs 3.5 ±
0.35 μmol/mL·min; P = 0.448). In septic dogs, PON1 was correlated with APPLEfast score
and BChE activity (r = –0.47; P < 0.046 and r = 0.38; P < 0.121., respectively). In
septic dogs, no differences in outcome for both parameters were detected in the population
submitted to study.
Conclusion: In conclusion, the present study has identified lower serum PON1 and higher
BChE activities in septic dogs. Further studies are warranted to describe PON1 and
BChE activities as potential useful markers of sepsis progress and recovery.
COMPARISON OF HEPARINIZED SALINE AND 0.9% SODIUM CHLORIDE FOR MAINTAINING CENTRAL
VENOUS CATHETER PATENCY IN HEALTHY DOGS
Vose, J, Odunayo, A, Price, J, Schildt, J, Daves, ME, Tolbert, MK
University of Tennessee, Knoxville, TN, USA
Introduction: To determine whether heparinized saline would be more effective in maintaining
the patency of central venous catheters (CVC) in dogs compared to 0.9% sodium chloride.
Methods: Twenty‐four healthy purpose‐bred dogs were randomized into 2 groups, a treatment
and a control group. A central venous catheter was placed in the jugular vein of each
dog. Each dog in the treatment group had their CVC flushed with 10 IU/mL heparinized
saline while dogs in the control group had their CVCs flushed with 0.9% sodium chloride,
every 6 hours for 72 hours. Immediately prior to flushing, each catheter was evaluated
for patency by aspiration of blood. The catheter site was also evaluated for phlebitis
and a rectal temperature was obtained in each dog every 6 hours. Blood samples were
obtained from all dogs at hour 0 and 72 to evaluate PT and aPTT values of each group.
Results: All CVCs in both groups were patent after 72 hours, demonstrated by aspiration
of blood and ease of flushing the catheter. Two CVCs in the 0.9% sodium chloride group
had a negative aspiration at hour 12 and 36, respectively. One CVC in the heparinized
saline group had a negative aspiration at hour 18. Signs of phlebitis occurred in
3 dogs, 2 in the 0.9% sodium chloride group and 1 in the heparinized saline group.
No dog was hyperthermic (> 103°F). Two catheters were inadvertently removed during
the study, both in the heparinized saline group [OA1]. There was no significant difference
between PT values or aPTT values of the dogs in either group.
Conclusion: 0.9% sodium chloride was as effective as 10 IU/mL heparinized saline in
maintaining central venous catheters for up to 72 hours in healthy dogs. Further evaluation
in clinical patients is warranted.
Listing of Large Animal IVECCS Abstracts (in alphabetical order of presenter)
Oral Presentations
THE IMPACT OF ADVANCED PATIENT AGE ON OUTCOME AND BLOOD‐DERIVED INFLAMMATORY BIOMARKERS
IN HOSPITALIZED HORSES WITH COLITIS OR DIARRHEA
Sage, S
1, Bedenice D1, Long, A1, Mazan, M1, McKinney, C1, Paradis, MR1, Wagner, B2
1Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
2Cornell University, Ithaca, NY, USA
Introduction: This study assessed whether aged horses with colitis or diarrhea showed
greater disease morbidity, systemic inflammatory responses, and mortality than similarly
affected young‐adult horses.
Methods: A retrospective cohort analysis included 159 hospitalized horses diagnosed
with colitis or diarrhea (2014–2018), to determine the potential effects of patient
age on disease progression and mortality. A subset of horses (n = 27) with hospital‐acquired
diarrhea were evaluated prospectively to identify age‐associated changes in coagulation
and blood‐derived inflammatory biomarkers during early disease. Prospective analyses
at times 0 (diarrhea onset) and 6 hours later, included a CBC, partial‐thromboplastin‐time,
plasma lactate, Horse Cytokine 5‐plex (IL‐4, IL‐10, IL‐17, IFN‐α, IFN‐γ), and 3‐plex
(IL‐2, CCL2, sCD14) assays. Univariate and multivariate statistical tests were used
to detect age‐effects, and identify parameters affecting survival to discharge in
the retrospective analysis (P < 0.05).
Results: Surviving colitis horses were significantly younger (median age: 12.7 years)
than nonsurviving horses (17.4 years) in the retrospective assessment, with a 6% increase
in mortality for each year the horse aged. Similarly, geriatric horses (> 20 years)
were significantly more likely to die than young‐adults (2–12 years), despite a higher
financial investment in their hospital care, and longer hospitalization (multivariate
outcome analysis). Plasma transfusion and fecal transplant were not associated with
outcome. None of the blood‐derived inflammatory biomarkers were significantly different
between young‐adult and aged horses in the prospective assessment.
Conclusion: This data support that outcome of colitis is less favorable in geriatric
versus young‐adult horses but cannot be explained by age‐related differences in measured
inflammatory responses during early disease.
OUTCOME AND COMPLICATIONS IN HORSES ADMINISTERED STERILE OR NONSTERILE INTRAVENOUS
FLUIDS
Kopper, JJ
1, Bolger, ME2, Schott, HC2
1Washington State University, Pullman, WA, USA
2Michigan State University, Lansing, MI, USA
Introduction: Intravenous fluids are an important component of fluid therapy in critically
ill equine patients. Unfortunately, a commercially available maintenance formula is
not available for horses. Additional recent challenges included manufacturer shortages
and increases in cost which made treating horses with intravenous fluids challenging
at best. One solution in our hospital was the use of nonsterile reverse osmosis water
and custom electrolyte formulas. We hypothesized that horses receiving nonsterile
IV fluids (JUG) would not have increased rates of morbidity or mortality compared
to horses receiving traditional intravenous fluids (IVF).
Methods: Medical records for horses at Michigan State University Veterinary Medical
Center receiving JUG or IVF between December 2013 and August 2017 were reviewed. Data
retrieved included signalment, type of fluid administered, hematological evaluations,
development of complications, and survival to discharge. Survival was compared by
chi‐square analysis. Normality of numerical data was assessed using the Shapiro–Wilk
test and compared with a one‐way ANOVA or ANOVA on ranks using a post hoc Holm Sidak
test or Dunn's test.
Results: A total of 278 horses were included: 213 received IVF and 65 received JUG.
There was no difference in survival to discharge between horses receiving JUG versus
IVF (82% vs 79%, P = 0.86). There was an increased incidence of jugular vein complications
(9% vs 0.9%, P = 0.003) and laminitis (6% vs 0.9%, P = 0.028) in horses that received
JUG vs horses that received IVF.
Conclusion: Administration of JUG did not affect survival to discharge; however, the
association with jugular vein complications and laminitis warrants informed discussion
with owners prior to utilization.
NEONATAL INTENSIVE CARE OF HOSPITALIZED GIRAFFE CALVES (GIRAFFA CAMELOPARDALIS) REQUIRING
HAND‐REARING
Dixon, CE
1, Bedenice, D2, Brewer, P4, Knafo, E5, Mazan, M2, Restifo, M3
1University of Glasgow, Glasgow, UK
2Tufts University, North Grafton, MA, USA
3Brandon Equine Medical Center, Brandon, FL, USA
4Southwick Zoo, Mendon, MA, USA
5Red Bank Veterinary Hospital, Tinton Falls, NJ, USA
Introduction: The study purpose was to describe the clinicopathologic findings, diagnoses,
treatment, and outcome of hand‐reared newborn giraffe calves experiencing neonatal
illness.
Methods: Retrospective cohort analysis of 10 neonatal giraffe calves admitted to a
university teaching hospital. All data are presented descriptively.
Results: Ten calves (5 male, 5 female), of which 9 were reticulated giraffes (Giraffa
cameloparadalis reticulata) and 1 was a Masai giraffe (G. c. tippelskirchi), were
admitted at less than 2 days of age. Failure of passive transfer (FPT) was evident
in 5/10 calves based on the assessment of serum protein, globulin, and gamma‐glutamyl
transferase; and successfully treated with oral bovine colostrum or hyperimmune bovine
plasma intravenously. Diarrhea occurred in 6/10 calves, and was managed with supportive
care, fecal transfaunation, and limiting milk intake. The incidence of diarrhea was
reduced by offering 10% body weight in milk per day at 2‐ to 4‐hour intervals and
< 2 L per feeding. Less common diagnoses included pneumonia (n = 3) and mycoplasma‐associated
septic arthritis (n = 1). Eight calves received systemic antimicrobial therapy. Hyperlactatemia
(lactate > 5 mmol/L; n = 8) and hypercreatininemia (creatinine > 2.0 mg/dL, n = 7)
were the most common presenting laboratory abnormalities, which resolved with intravenous
fluid therapy. All neonatal giraffes survived to discharge following a median hospitalization
of 9.5 days (range: 5–37), and were successfully hand‐reared.
Conclusion: Early bovine colostrum administration or intravenous hyperimmune bovine
plasma infusion to manage FPT was well tolerated. Diarrhea is a common clinical problem,
and can be related to feeding regimens. Hospitalized neonatal giraffe calves may carry
an excellent prognosis following early intervention.
PLASMA PHARMACOKINETICS, PULMONARY DISPOSITION, AND SAFETY OF SUBCUTANEOUS GAMITHROMYCIN
IN ALPACAS
Gordon, E
1, Alshahrani, SM2, Cebra, CK2, Christensen, JM2, Duong, T3, Huang, RA3, Stang, BV2
1Massey University, Palmerston North, New Zealand
2Oregon State University, Corvallis, OR, USA
3Merial Limited, New Brunswick, MA, USA
Introduction: Gamithromycin is a long‐acting antimicrobial that concentrates in neutrophils
and the respiratory tract of ruminants. Gamithromycin was therefore considered as
a potential antimicrobial candidate in camelids that might also improve owner and
animal compliance due to infrequent dosing.
The study objective was to determine the disposition of gamithromycin in plasma, peripheral
blood neutrophils (PMNs), pulmonary epithelial lining fluid (PELF), and bronchoalveolar
lavage (BAL) cells in alpacas.
Methods: A single subcutaneous injection of gamithromycin (6.6 mg/kg body weight)
was administered to 6 healthy adult alpacas. Gamithromycin concentration was analyzed
via LC‐MS in plasma, polymorphonuclear cells, pulmonary epithelial lining fluid and
bronchoalveolar lavage cells until day 14 post‐injection. Plasma gamithromycin was
measured in all 6 alpacas; the remaining 3 body compartments were analyzed in 4 alpacas.
Results: Gamithromycin rapidly concentrated in blood PMNs, BAL cells, and PELF. The
Tmax, Cmax, and AUC were lower in plasma than the other three compartments. Mean peak
gamithromycin concentrations were highest in BAL cells (26001.75 ± 12400 ng/mL) and
PMNs (2573.00 ± 963.25 ng/mL) compared to PELF (660.75 ± 413.70 ng/mL) and plasma
(542.00 ± 196.00 ng/mL). Mean terminal half‐lives were 69.80 ±14.05 hours in plasma,
56.56 ± 10.60 hours in PELF, 62.80 ± 85.30 hours in PMNs, and 93.60 ± 124.80 hours
in BAL cells. No injection site reactions occurred. One alpaca developed colic.
Conclusion: Gamithromycin concentrates significantly in white blood cells and pulmonary
tissues of alpacas as expected. Further studies are necessary to determine clinical
safety and to identify MIC data for bacterial isolates originating from camelids.
GASTROINTESTINAL COLIC IN HORSES IN MEDELLIN, COLOMBIA: 410 CASES (2005–2015)
Moyano Parra, LA
1, Gomez Neito, DE2, Leon, S4, Montoya, S5, Paredes Higuera, MD3, Salazar, V4
1Universidad CES, Medellin, Colombia
2University of Florida, Gainesville, FL, USA
3Universidad de Antioquia, Medellin, Colombia
4Universidad de Tolima, Ibague, Colombia
5Corporacion universitaria La Sallista, Medellin, Colombia
Introduction: This study aimed to explore different causes of gastrointestinal colic
of horses from Colombia.
Methods: Medical records of horses referred to a teaching hospital for colic from
2005 to 2015 were reviewed. Final diagnosis was achieved by physical examination,
rectal palpation, nasogastric intubation, blood work, abdominocentesis, and exploratory
laparotomy or at necropsy exam.
Results: A total of 410 records of horses with colic were included. Three hundred
thirty‐one (81%) horses were Paso Fino, and 79 (19%) other breeds. There were 253
(62%) surgical and 157 (38%) medical cases identified. Large colon impaction was the
most common cause of colic (n = 123; 30%) followed by small colon impactions (n = 70;
17%). The most common causes for surgical colic were large colon impaction (n = 9;
23%), small colon impaction (n = 49; 19%), and small intestine strangulating obstruction
(n = 32; 13%). The most common causes of medical colic were large colon impactions
(n = 64; 41%) and small colon impactions (n = 21; 13%). The overall survival rate
was 85% (n = 348); 43 (10%) horses were euthanized and 19 (4.6%) died because of clinical
complications. In surgical cases, 82% (n = 207) survived, 13% (n = 34) were euthanized,
and 5% (n = 12) died. Medically treated colic cases, 90% (n = 141) cases survived,
4.5% (n = 7) were euthanized, and 5.5% (n = 9) died.
Conclusion: The high proportion of Paso Fino horses with colic is consistent with
the population presented to our hospital. The survival rates were similar between
groups and comparable with previous studies worldwide. The rate of horses with large
colon impaction requiring surgery was higher than previously reported, something that
warrants investigation.
A COMPARISON OF THE I15 VERSUS EPOC FOR BLOOD GAS AND BIOCHEMISTRY ANALYSIS IN HORSES
Scicluna, C
Equi'Institut Chamant, France
Introduction: For the last 10 years, miniaturization has allowed portability and easier
use of numerous tools in veterinary practice. Following the introduction of the Epoc
device to the market, the i15 (Edan) is a brand new POCT device designed for human
and veterinary blood gases and biochemical analysis that can be used in critical or
routine situations on the field.
Methods: The Epoc and i15 were compared in equine clinical routine examinations and
general anesthesia for reliability, easiness of use, price, and rapidity. Thirty of
the same venous or arterial blood samples were analyzed with the Epoc and i15 machines
simultaneously. The blood pH, pCO2, pO2, HCO3
−, ABE, SO2, Na+, K+, Ca2+, tCO2, Ht, Hb, BE, glucose, and lactate values were compared
by Student's t‐test (P < 0.05 significant). Analysis time, easiness to use, and failures
were also evaluated.
Results: The Epoc results were higher than those obtained from i15 but this did not
reach statistical significance, except for K+ and Ca2+ (4 vs 3.9 and 1.43 vs 1.54
‐ i15 vs Epoc, respectively). The I15 parameters panel was wider, including Anion
Gap, H+, osmolarity, pO2/FiO2, RI, pO2(A‐a), and pO2(a/A) ratios.
Both were easy to use, but i15 did not need any preparation waiting time before injecting
the sample into the cartridge. Total analysis time was shorter with i15. Printer and
a large display screen on i15 make the machine easier to read and interpret results.
Sample cartridges are cheaper and do not need to be stored in the fridge, making it
more convenient.
Conclusion: Both the Epoc and i15 devices are portable and easy to use in equine practice.
The I15 offers reliable results and more parameters for routine and anesthesia blood
gases and chemistry analysis.
PLASMA TRANSFUSION REACTIONS IN FOALS WITH FAILURE OF TRANSFER OF PASSIVE IMMUNITY
IN COLOMBIA: 48 CASES
Paredes Higuera, MD
1, Ariza, GE3, Moyano Parra, LA2, Zambrano Cardona, F1
1Universidad de Antioquia, Medellin, Colombia
2Universidad CES, Medellin, Colombia
3Universidad La Salle, Bogata, Colombia
Introduction: Plasma transfusion (PT) is a common therapeutic procedure in septic
foals or foals with failure of transfer of passive immunity (FTPI). The incidence
of PT reactions when fresh plasma is used varies between 8.7% and 10%. This study
aimed to explore the incidence of PT reactions in foals with FTPI receiving fresh
plasma in a teaching hospital from Colombia.
Methods: Medical records of foals receiving a fresh plasma transfusion due to FTPI
were reviewed. The FTPI was defined as: total failure when IgG levels were < 400 mg/dL
and partial when the IgG levels were between 400 and 800 mg/dL.
Results: Forty‐eight foals were included. Thirty‐seven (77 %) of the foals were Paso
Fino, 5 (10.4%) were pony breeds, 3 (6.2 %) were Quarter Horse, and 3 (6.2 %) other
breeds. Median age at presentation was 24 hours (range: 0–144 hours). The median weight
was 25 kg (range: 7–54 kg). The median volume of plasma transfused was 2 L (range:
0.3–2.5 L). The compatibility major and minor test was performed in 18% (n = 9) of
cases. Overall, immediate reactions were observed in 24 (48%) of the cases and included
fever (n = 8; 16%), tachycardia (n = 7; 14%), tachypnea (n = 13; 26%), tremors (n = 2;
4%), and diarrhea (n = 2; 4%). In total 6 foals died for reasons not associated to
the plasma transfusion.
Conclusion: In this study, PT reaction rates were higher than the previously reported.
This could be explained, at least in part, by the low rate of compatibility testing.
EFFICACY OF A FIRST‐IN‐CLASS (LY315920), SMALL‐MOLECULE SNAKEBITE ANTIDOTE IN A PORCINE
MODEL OF LETHAL ENVENOMATION
Gilliam, LL
1, Bulfone, TC3, Gilliam, JN1, Lewin, MR3, Samuel, SP3
1Oklahoma State University, Stillwater, OK, USA
2Queen Elizabeth Hospital, Kings Lynn, United Kingdom
3Ophirex, San Francisco, CA, USA
Introduction: Worldwide, approximately 125,000 people die annually due to snake envenomation.
Livestock and companion animal mortality numbers are likely higher. Venom sPLA2 is
ubiquitous among viper and elapid venoms and the most lethal component in the majority
of snake venoms. Neurotoxicity and coagulopathy are primary mechanisms by which a
majority of snake venoms cause death. Antivenom is available only in the hospital
setting and requires refrigeration, but >75% of snakebite deaths occur outside the
hospital. An ideal antidote for snake envenomation would be broad‐spectrum (venom
agnostic), heat stable, readily available, cost‐effective, and easy to administer
even outside the hospital. This study utilized a porcine model to investigate the
ability of a first‐in‐class, small molecule (LY315920) to prevent mortality due to
experimental lethal Micrurus fulvius envenomation.
Methods: Pigs were anesthetized, instrumented, and subcutaneously envenomed with 100%
lethal doses of Micrurus fulvius venom. Control pigs received excipient only while
treatment pigs received drug through one of three routes following envenomation: Intravenous
(IV), constant rate infusion (CRI) plus oral (PO), or oral‐only at various doses/frequencies.
Laboratory samples were collected at baseline and 8 time points following envenomation.
A clinical and lameness scoring system was utilized, all subjects received analgesia
and were euthanized according to predetermined criteria.
Results: All control pigs reached a clinical score warranting euthanasia within 6
hours. One hundred percent of pigs in all treatment categories survived and were clinically
normal by the end of the study. No adverse effects of the drug were noted.
Conclusion: This antidote shows great promise in treating snakebite envenomation.
ETHYL PYRUVATE IN HORSES WITH LARGE COLON VOLVULUS – PRELIMINARY RESULTS
Shearer, TR
1, Holcombe, SJ1, Fogle, C2, Lynch, T5, Morresey, P6, Shroeder, E3, Southwood, L4
1Michigan State University, Lansing, MI, USA
2North Carolina State University, Raleigh, NC, USA
3Ohio State University, Columbus, OH, USA
4University of Pennsylvania, Kennett Square, PA, USA
5Peterson Smith Equine Hospital, Ocala, FL, USA
6Rood and Riddle Equine Hospital, Lexington, KY, USA
Introduction: Ethyl pyruvate was used in preclinical models of gastrointestinal ischemia
and sepsis to improve tissue healing and survival by mitigating oxidative damage and
inflammation. Ethyl pyruvate was shown to be safe and effective in an equine endotoxemia
model. The objective of this study was to evaluate the efficacy of ethyl pyruvate
in clinical cases following surgical correction of large colon volvulus.
Methods: In a randomized, placebo‐controlled, multicenter prospective study horses
received either 150 mg/kg ethyl pyruvate in LRS or LRS every 6 hours for 24 hours
following recovery from surgical correction of a 360° LCV. HR, PCV, L‐lactate were
monitored for 24 and 48 hours and blood was sampled for proinflammatory cytokine gene
expression before and after the treatment. Preliminary descriptive statistics were
performed.
Results: Twelve horses were enrolled. Six horses receiving ethyl pyruvate had admission
median (range) HR = 80 (36–120)/min, PCV = 46 (35–70)%, and L‐lactate = 5.8 (2.9–7.5)
mmol/L. At 24 hours postop, HR = 44 (40–68)/min, PCV = 33 (21–46)%, and L‐lactate = 1.0
(0.8–1.5)mmol/L. Four of 6 horses survived to discharge. Six horses receiving LRS
had admission median HR = 73 (32–120)/min, PCV = 0 (35–53)%, and L‐lactate = 5.3 (1.3–12.2)
mmol/L. At 24 hours postop, HR = 48 (42–68)/min, PCV = 36 (35–40)%, and L‐lactate = 0.8
(0.5–1.4) mmol/L. Three of 6 horses survived to discharge. No adverse events associated
with ethyl pyruvate occurred.
Conclusion: Enrollment of additional cases will allow us to determine the effectiveness
of ethyl pyruvate on postoperative outcome of horses with 360° LCV.
EFFECTS OF ETHYL PYRUVATE ON CARDIOPULMONARY PARAMETERS AND RECOVERY IN ANESTHETIZED
HORSES
Munoz, K
1, Holcombe, SJ1, Hubbell, JE3, Robertson, S2, Szarek, MR1
1Michigan State University, Lansing, MI, USA
2Lap of Love, Gainesville, FL, USA
3Rood and Riddle Equine Hospital, Lexington, KY, USA
Introduction: Cardiovascularly compromised horses are anesthetized for surgical correction
of ischemic intestinal lesions. Frequently, these horses suffer from diminished oxygen
delivery, which is compounded by anesthetic drugs. Ethyl pyruvate, prometabolic antioxidant
with diverse pharmacological effects, limits ischemic tissue injury and hastens tissue
recovery. In a previous terminal study, we showed that ethyl pyruvate significantly
increased cardiac output, oxygen delivery, and central venous pressure, compared to
values in control horses receiving LRS. We hypothesized that ethyl pyruvate would
improve cardiopulmonary parameters of anesthetized horses and have no negative effects
on anesthetic recovery.
Methods: Six Standardbred geldings were enrolled in a randomized crossover design.
Horses were anesthetized for 90 minutes and received 1 L of LRS or 150 mg/kg ethyl
pyruvate in 1 L LRS over 60 minutes. Direct arterial pressures, HR, RR, and ETCO2
were recorded every 5 minutes. Arterial blood gases were assessed every 20 minutes.
Anesthetic recovery was recorded and scored by two blinded observers. Total recovery
time, time to extubation, time to sternal recumbency, number of attempts to stand,
and time to stand were recorded. Data were assessed by univariate tests, P < 0.05.
Treatment and time were fixed effects.
Results: All horses completed the study with no complications. No significant differences
between the ethyl pyruvate treatment and LRS controls were detected for any of the
anesthesia recovery or cardiopulmonary variables measured.
Conclusion: Study limitations included low horse numbers and using healthy Standardbred
geldings. These results suggest that ethyl pyruvate may be used in anesthetized clinical
cases without impacting anesthetic recovery.
COMPARISON OF TWO TECHNIQUES FOR TRANSPHARYNGEAL ENDOSCOPIC AUDITORY TUBE DIVERTICULOTOMY
IN THE HORSE
Koch, DW, Easley, JT, Delcambre, JJ, McCready, EG, Hackett, ES
Colorado State University, Fort Collins, CO, USA
Introduction: Chronic infection within the auditory tube diverticula, and subsequent
empyema and chondroid formation, is well described in the horse. Medical therapy has
been reported with mixed success, with treatment failures attributed to chronic inflammation
and inadequate drainage from the nasopharyngeal ostium. Auditory tube diverticulotomy
allows continuous egress from this cavity. The aim of the present study was to compare
two transpharyngeal endoscopic auditory tube diverticulotomy locations and describe
the relative anatomy, duration, and incision properties for each surgical approach.
Methods: Transpharyngeal endoscopic auditory tube diverticulotomy was performed using
a diode laser either at a single dorsopharyngeal recess location, or bilaterally caudal
to the nasopharyngeal ostium in 10 horse head specimens. Laser energy, activation
time, and procedure duration were recorded. A two‐sample t‐test was used to compare
total laser energy, laser activation time, and surgical duration between surgical
procedures.
Results: Both methods resulted in clear communication between the nasopharynx and
auditory tube diverticula. Diverticulotomy performed in the dorsal pharyngeal recess
required less laser energy and activation time and had a shorter surgical duration
than diverticulotomy performed caudal to the nasopharyngeal ostium.
Conclusion: Both surgical methods resulted in clear communication between the pharynx
and the auditory tube diverticula, though the techniques differed in location of diverticulotomy,
laser energy and activation time, and surgical duration. Further study is warranted
relative to the clinical application of these techniques.
EFFECT OF SEASON AND GEOGRAPHIC LOCATION ON THE INCIDENCE OF ENTERIC PATHOGENS
Willette, JA
1, Kogan, CJ2, Kopper, JJ3, Leutenegger, CM4, Schott, HC5
1University of Pennsylvania, Kennett Square, PA, USA
2Mathematics and Statistics, Washington State University, Pullman, WA, USA
3Washington State University, Pullman, WA, USA
4Idexx Laboratories, Sacramento, CA, USA
5Michigan State University, Lansing, MI, USA
Introduction: Acute diarrheal disease (enterocolitis) can be a life‐threatening equine
emergency. Determining an etiologic cause of enterocolitis is desirable to tailor
specific therapy. We hypothesized that the incidence of enteric pathogens causing
enterocolitis would be influenced by season and geographical region.
Methods: Results of equine enteric disease fecal PCR panels submitted to IDEXX Laboratories,
from adult horses between January 2011 and December 2014, were reviewed. The panel
tests for Salmonella spp., Neorickettsia risticii, Clostridium difficile type A toxin,
Clostridium difficile type B toxin, Clostridium perfringens type B toxin, coronavirus,
Cryptosporidium spp., Rhodoccus equi, Lawsonia intracellularis, and rotavirus were
performed. States were separated into geographic regions and months were grouped into
seasons. To relate the probability of disease to geographic region and season, logistic
regression was performed using a Tukey correction for multiple comparisons. Significance
was set at P < 0.05.
Results: 3,417 fecal samples were tested during the study period. 39% yielded a positive
result. Significant differences in the incidence of Cryptosporidium spp., C. perfringens
and Salmonella spp. were identified between geographic regions. The incidence of rotavirus,
R. equi, Lawsonia spp., and coronavirus was different between seasons. There was a
significant interaction between region and season for N. risticii. The incidence of
C. difficile type A and C. difficile type B toxins were not affected by geographic
region or season.
Conclusion: The incidence of Cryptosporidium spp., C. perfringens, Salmonella, rotavirus,
R. equi, Lawsonia spp., coronavirus, and N. risticii is affected by geographic location
and/or season.
POSITIVE PIROPLASMOSIS STATUS AND HYPERTHERMIA IN HORSES HOSPITALIZED FOR COLIC
Benamou, AEM
1, Guidi, EEA2, Lefebvre, SE2, Milard, CM1
1Lyon Veterinary School, Lyon/Marcy L'Etoile, France
2VETAGROSUP, Marcy L'Etoile, France
Introduction: A 4‐year retrospective study was conducted among a population of 322
horses referred for primary colic (2013–2016) in order to investigate development
of fever and other complications in that population.
Methods: One hundred fifty‐two horses were managed medically, and 170 were managed
surgically. Intensive care was provided. Usual complications noted included recurrent
colic and diarrhea at similar rates other studies. Pyrexia (> 38.9°C) lasting > 48
hours was also observed during hospitalization in 44 horses (11% of medical colics
and 14% of surgical colics). Thorough standard clinical investigation of the fever
was carried out to exclude primarily: endotoxemia, peritonitis, enterocolitis, secondary
pleuropneumonia, and thrombitis. Other examinations included: CBC, biochemistry and
inflammatory proteins panel, ultrasonographic exams (abdomen, thorax, vessels), airway
endoscopic examination, and peritoneal fluid cytology, when necessary. When no significant
cause for the hyperthermia was found, blood was tested for hemopathogens. Horses were
considered piroplasmosis positive (for Babesia caballi or Theileria equi) based on
PCR positivity or seropositivity at > 1/320. Risk factors were assessed by studying
correlations between piroplasmosis status and incidence of fever.
Results: Among the 44 horses tested, 31 (70%) tested piroplasmosis positive (90% involved
T. equi). Some developed other complications such as thrombophlebitis (at least 25%),
significant limb vasculitis (50%) or respiratory distress (18%), also possibly related
to piroplasmosis infection.
Conclusion: Positive piroplasmosis status in horses hospitalized for colic appears
to be an increased risk factor for development of hyperthermia and other complications.
This status is important to consider during intensive care especially in endemic areas.
COMPARISON OF CEPHALIC TO JUGULAR VENOUS BLOOD GAS ANALYSIS IN CLINICALLY ILL HORSES
Baker, RE
1, Cebra, C2, Kitada, H3, Schlipf, JW2
1Louisiana State University, Baton Rouge, LA, USA
2Oregon State University, Corvallis, OR, USA
3Reed College, Portland, OR, USA
Introduction: Lactate is an end‐product of glycolysis and is a valuable marker for
critical illness or sepsis. In equine medicine, lactate production varies between
different body regions; however, little information regarding production in the limbs
exists. The objective of this study was to compare jugular to cephalic plasma lactate
concentrations in both healthy and clinically ill horses.
Methods: Prospective case–controlled study of horses presented between August 2015
and February 2017. Twenty‐four clinically ill horses and 10 healthy control horses
were investigated. Blood samples were drawn from both the jugular and cephalic vein
for analysis at presentation and during the first 24 hours of hospitalization.
Results: Cephalic vein lactate was significantly higher than the jugular vein lactate
in healthy control horses (P < 0.05). Cephalic vein lactate was significantly higher
than jugular vein lactate at presentation in clinically ill horses and during all
time points after (P < 0.05). When clinically ill horses were investigated for specific
outcomes (survivors vs nonsurvivors and laminitis vs nonlaminitis) cephalic vein lactate
was significantly higher in survivors and horses that did not develop laminitis (P
< 0.05). No difference was found in nonsurvivors or horses that developed laminitis.
No difference was seen in the rate of change in lactate over time when survivors were
compared to nonsurvivors and when laminitis horses were compared to nonlaminitis horses.
Conclusion: Significant differences between the jugular and cephalic vein lactate
production were seen in healthy and clinically ill horses. Further investigation is
warranted to see how these values change over time and during the course of clinical
disease.
PRELIMINARY STUDY INTO HEART RATE VARIABILITY PARAMETER (ROOT MEAN SQUARE OF SUCCESSIVE
DIFFERENCE) IN CORRELATION WITH PAIN SCORES IN HORSES WITH COLIC
Benamou‐Smith, AEM, Camdeborde, PC, Lesca, HC, Tourrel, ME
Lyon Veterinary School Lyon/Marcy L'Etoile, France
Introduction: Heart rate variability (HRV) analysis is a relevant indicator of cardiac
autonomic control. The aim of this study is to assess if one main parameters of HRV,
the root mean square of successive difference (RMSSD), can be used as indicator of
pain in horses suffering from colic.
Materials: Twenty‐one horses hospitalized for colic were enrolled. Horses were studied
daily (and for at least 5 days) at 2 set quiet times to make measurements via a heart
rate monitor (Polar H7 – RS800cx) and determine 2 pain scores (the Dalla Costa Grimace
Pain Score (GPS) and the Bussière Composite Pain Scale (CPS)) during 10 minutes of
observation. Data were analyzed with specialized software (Kubios) to obtain RMSSD.
Nonparametric statistical analysis was conducted (analysis of variance/correlations).
Results: All cases showed a positive evolution according to GSC and CPS. Eight of
them among medical and surgical colics demonstrated that the RMSSD was clearly increasing
while the pain score was decreasing. A marked increase in the RMSSD (by more than
170 ms) was noted in 4 horses in which the pain reached a zero score at the end of
the hospitalization. Similarly, marked trends were also were observed in 3 surgical
cases, with GSC and CPS scores decreasing from 7 to 0, while RMSSD values were ×4.
Conclusion: Preliminary data in changes in RMSSD during colic management show that
trends can be marked and tend to correlate with pain scores. More data are necessary
to establish possible significance and improve experimental design.
THE PROGNOSTIC VALUE OF CLINICAL CRITERIA TO DEFINE SYSTEMIC INFLAMMATORY RESPONSE
SYNDROME (SIRS) IN NEONATAL FOALS
Long, A
1, Barr, B3, Bedenice, D1, Burns, T4, Dembeck, K2, Magdesian, G7, Olson, E8, Sanchez,
C5, Slovis, NM6, Ruby, R2, Wong DM2, Paradis, MR1, Wilkens, P9
1Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
2Iowa State University, Ames, IA, USA
3Rood and Riddle Equine Hospital, Lexington, KY, USA
4Ohio State University, Columbus, OH, USA
5University of Florida, Gainesville, FL, USA
6Hagyard Equine Medical Institute, Lexington, KY, USA
7University of California, Davis, CA, USA
8Cornell University, Ithaca, NY, USA
9University of Illinois, Urbana, IL, USA
Introduction: The study assessed the prognostic value of select neonatal SIRS definitions
in hospitalized foals.
Methods: A retrospective multicenter study (n = 8) included 210 ill neonatal foals
for which standardized physical and clinicopathologic admission findings were obtained.
Three age‐adjusted SIRS definitions were directly compared: (1) equine SIRSNEO based
on vital, leukocyte, lactate, and glucose parameters (Wong, 2015), (2) SIRSPED adapted
from diagnostic criteria in pediatric patients (Goldstein, 2005), and (3) SIRSDH proposed
as a standardized SIRS diagnosis in foals, at the 2018 Dorothy–Havemeyer consensus
meeting. Binary statistical tests (logistic regression and chi‐square analyses, P
< 0.05) were performed to estimate the prognostic value of SIRS; and to determine
the utility of neutrophil, band neutrophil, and total leukocyte assessments as proposed
diagnostic criteria of SIRS.
Results: A total of 210 foals (40% fillies; 79% survivors) were included (median age:
1 day, 0–22). The diagnoses of SIRSNEO (86/210, 41%), SIRSPED (120/210, 57%), and
SIRSDH (111/210, 53%) were all significantly associated with nonsurvival, with SIRSDH
showing the highest mortality risk (odds ratio, 5.7, P < 0.001). Assessment of neutrophil
count in lieu of total leukocyte numbers, or exclusion of band neutrophils as diagnostic
criteria of SIRS, minimally reduced the likelihood to predict mortality through the
diagnosis of SIRS. The absence of SIRSDH was most likely associated with survival
(predictive value: 0.92).
Conclusion: These data support that the absence of SIRS based on age‐specific assessment
of leukocytes, band‐neutrophils, body temperature, heart, and respiratory rate may
identify foals at lower fatality risk following critical illness. The application
of SIRSDH criteria slightly outperformed other diagnostic methods tested.
EVECC Congress Abstracts presented June 21–23, 2018 in Venice, Italy
Listing of Small Animal EVECC Abstracts (in alphabetical order of presenter)
Oral Presentations
ESTABLISHMENT OF NORMAL REFERENCE INTERVALS IN DOGS USING VISCOELASTIC COAGULATION
MONITOR (VCM) AND VALIDATION OF THE VCM DEVICE USING THROMBOELASTOGRAPHY (TEG)
Buriko, Y, Silverstein, D
University of Pennsylvania, Philadelphia, PA, USA
Introduction: Viscoelastic testing has recently gained popularity in veterinary medicine
for the diagnosis of coagulation disorders. Due to its technical difficulty and sensitivity
of the equipment, its use has been limited. A novel portable handheld viscoelastic
analyzer Viscoelastic Coagulation Monitor (VCM vet) has been designed to fulfill a
clinical need for a user‐friendly near‐patient viscoelastic test. Following venipuncture,
whole fresh blood is directly placed into a disposable cassette for VCM testing. Within
the cassette are 2 glass capillary plates that move in relation to each other. As
the blood sample is placed into the cassette, it covers the lenses between the plates,
initiating contact activation. Numerical values generated include clotting time (CT),
clot formation time (CFT), alpha angle, A10, A20 (clot firmness after X minutes),
and maximal clot function (MCF).
Objectives: The objective of this study is to establish a reference interval for the
VCM in a healthy canine population, assess variability between individual VCM devices,
and to evaluate VCM performance using thromboelastography (TEG) performed with and
without tissue factor (TF) activation.
Methods: Blood from 48 healthy adult dogs was collected by performing jugular venipuncture.
Immediately upon collection, blood was directly added from the syringe and dosed into
the cassette of each of 2 VCM devices to perform the test in duplicate. Remaining
blood was placed in citrated tubes, and after a 30‐minute rest time, 2 TEG tests were
performed concurrently, one with recalcified whole blood only, and the other with
a 1:3400 TF dilution.
Results: Canine reference intervals for the VCM were: CT 221–460 seconds, CFT 100–265
seconds, alpha angle 45–69 degrees, A10 15–32 VCM units, A20 21–40 units, and MCF
28–46 units. Coefficients of variation between the VCM devices ranged from 6.7% for
CT to 12.7% for CFT. TEG reference intervals derived from this population were similar
to previously reported references for both native and 1:3400 TF activated samples.
Positive correlations were documented between VCM and corresponding TEG parameters.
Conclusion: VCM is a feasible option as a semiquantitative point of care viscoelastic
test. Further investigation of the device performance in dogs with altered coagulation
is necessary.
PERCUTANEOUS TRACHEOSTOMY USING THE PORTEX MINITRACH II SELDINGER KIT IN A CANINE
CADAVERIC STUDY
Ceccherini, G, Cadringher, V, Breghi, G, Briganti, A
Department of Veterinary Science, University of Pisa, S. Piero a Grado, Italy
Objective: To describe the technique for percutaneous tracheostomy using the Portex
Minitrach II Seldinger kit in a canine cadaveric model.
Study design: Ex vivo study.
Animals: Canine cadavers (n = 8).
Methods: Percutaneous tracheostomy was performed using the Portex Minitrach II Seldinger
Kit. The Mini‐Trach II is designed for rapid mini‐tracheotomy in people. The kit enables
the placement of a Mini‐Trach cannula (4 mm ID) in the trachea utilizing the Seldinger
technique. Animals of different breeds and weights were used for the study. Time needed
from percutaneous puncture to the introduction of the Minitrach tube was recorded.
Complications were recorded and classified as: (1) difficulty to locate the anatomic
tracheal marker (large neck, obesity), (2) guide wire kinking, (3) difficult sliding
of cannula over the guide, and (4) second deeper skin incisions needed. A time ≤ 3
minutes and a number of complication < 2 to complete the procedure, were considered
as successful. Data were tested for normality with D'Agostino and Pearson's test.
Time for placement was compared with complications encountered and site of placement
using a chi‐square and a paired t‐test, respectively. P < 0.05 was considered significant.
Results: Placement of Minitrach was successful in 7 out of 8 dogs. The median weight
of dogs enrolled was 20 kg (7–50 kg), with an average age of 9.3 ± 3 years. The time
required to place the cannula was 2.4 ± 0.6 minutes. The site of placement was: between
the 2nd and 3rd tracheal ring in 5/8 (62.5%) dogs and between the 1st and 2nd tracheal
ring in 3/8 (37.5%). No complications were found in two dogs. The main complication
registered was number 4 (3/8; 37.5%), followed by complication number 3 (2/8; 25%).
In one dog complication number 1 (overweight dog) and 3 were registered. No significant
difference was found between time needed, site of placement, and complications (P
> 0.05).
Conclusion: Percutaneous tracheostomy using the Portex Minitrach II Seldinger Kit
is a feasible, relatively easy, and rapid technique. Further investigations as an
alternative to tracheostomy for initial stabilization for dogs in severe respiratory
distress, in emergency setting are warranted.
COMPARISON OF TWO PATIENT WARMING SYSTEMS IN ICU PATIENTS
Doerfelt, R, Imbacher, E, Grotheer, MS
Clinic for Small Animal Medicine, Ludwig‐Maximilian University, Munich, Germany
Introduction: Critically ill dogs and cats are often hypothermic. Effective warming
improves cardiovascular response and metabolism. The aim of the study was to compare
the efficacy of 2 patient warming systems in dogs and cats.
Methods: Forty‐seven hypothermic dogs and cats in a veterinary university ICU were
prospectively included in the study. Patient warming was randomly performed either
by the Bair Hugger or the HotBody system. The temperature of the Bair Hugger was set
at 43°C and at the HotBody at the interval 42.5–43.4°C. Rectal temperature was monitored
every 5 minutes until 38.0°C was achieved or patient did not tolerate warming any
more. Sixteen animals were excluded as duration of warming was shorter than 30 minutes.
Results were analyzed for normality by D´Agostino and Pearson's omnibus normality
test. Non‐normal data were analyzed by Mann–Whitney U test.
Results: Twenty‐two dogs and 18 cats were enrolled. Seven patients were hypothermic
due to the underlying disease and 33 due to an anesthesia performed in advance.
Staring temperature was 36.2°C (32.0–37.3°C). Median duration of warming was 60 minutes
(30–110 minutes) for Bair Hugger and 40 minutes (30–110 minutes) for HotBody (P = 0.3085).
End temperature was 37.8°C (34.4–38.2°C) for Bair Hugger and 38.0°C (36.2–38.4°C)
for HotBody (P = 0.31).
Temperature increase after 30 minutes was 0.9°C (0.0–3.2°C) using the Bair Hugger
and 0.9°C (0.0–2.9°C) using the HotBody system (P = 0.77). Patient temperature increase
was not different at any time point between the warming devices.
Temperature drop was stopped after median of 5 minutes (5–20 minutes) and temperature
increased at time point of 5 minutes (5–50 minutes) in Bair Hugger and stopped decrease
after 5 minutes (5–15 minutes) and increased after 5 minutes (5–25 minutes) using
the HotBody system (P = 0.812; P = 0.7075). Warming was stopped due to reaching target
temperature in 10 patients in each group. Three dogs were euthanized and 17 did not
tolerate further warming before reaching the target temperature.
Conclusion: Both warming devices were effective and not different between each other
in patient warming. The median temperature increase after 30 minutes was 0.9°C.
RED BLOOD CELL DISTRIBUTION WIDTH (RDW) AS A PROGNOSTIC FACTOR IN CRITICALLY ILL DOGS
Garcia Arce, M
1, Gow, A2, Handel, I2, Ngoi, W2, Thomas, E2
1Vets Now, London, United Kingdom
2Royal (Dick) School of Veterinary Studies, Edinburgh, United Kingdom
Introduction: Red blood cell distribution width (RDW) is a measure of size variability
in circulating red blood cells. Increased RDW has been associated with outcome in
people with specific disease processes and also in critically ill patients. There
are limited veterinary studies on the use of RDW as a prognostic biomarker, and its
use has not previously been evaluated in critically ill dogs.
Objective: To assess the correlation between high RDW values and outcome/length of
hospitalization in critically ill dogs.
Methods: Data were collected retrospectively from dogs admitted consecutively to an
intensive care unit (ICU) in a veterinary teaching hospital between December 2016
and April 2017. Patients were included if they had a complete blood cell count performed
within the first 24 hours of hospitalization. When available, biochemistry parameters
were used to calculate an APPLEfast score. Patients were grouped according to diagnosis
and subgroup analysis was performed. Survival to discharge and length of stay were
recorded.
Results: There were 247 dogs admitted to the ICU during the study period, of which
127 met the inclusion criteria. Median age was 8 years (IQR 6.9), 76/127 (60%) were
males, of which 53 (70%) were neutered, and 51/127 (40%) were females, of which 38
(75%) were neutered. Patients were grouped into diagnostic categories (abdominal 36%,
hematological 13%, respiratory 13%, neurological 12%, cardiovascular 11%, integument
3%, traumatic event 3%, musculoskeletal 2%, and others 7%). The overall mortality
rate was 29% (37/127) and median length of hospital stay was 3 days (IQR 5). The median
RDW value was 13.8% (IQR 1.6%; reference range 11.9–14.5%). The APPLEfast score was
calculated in 92/127 (72%) patients, the median score was 24/50 (IQR 9). There was
no significant correlation between RDW and APPLEfast score (= 0.163). Increased RDW
was not associated with outcome overall (P = 0.381) nor with outcome in any individual
subgroup analysis. No association was found between length of stay and high RDW values
in either survivors (P = 0.548) or nonsurvivors (P = 0.083).
Conclusions: In this study, RDW was not found to be an accurate prognostic indicator
in critically ill dogs.
EVALUATION OF SERUM APOLIPOPROTEIN‐A1 IN CANINE SEPSIS
Grossi, G, Troìa, R, Bergamini, I, Pietra, M, Fracassi, F, Dondi, F, Giunti, M
Department of Veterinary Medical Science, University of Bologna, Ozzano dell'Emila
(Bo), Italy
Introduction: Alterations in lipid profile are well‐described in human sepsis. Specifically,
decreased serum apolipoprotein‐A1 (Apo‐A1) concentration is associated with greater
disease severity and mortality. Apo‐A1 has been recently measured as a biomarker of
treatment monitoring in dogs with leishmaniosis; however, its usefulness in canine
sepsis is unknown. The study aimed to evaluate the diagnostic and prognostic role
of serum ApoA1 concentrations in dog with sepsis.
Methods: Serum samples collected between February 2015 and October 2017 from dog with
sepsis (n = 91), acute hemorrhagic diarrhea syndrome (AHDS, n = 12), and healthy controls
(n = 15) were retrospectively analyzed. Septic dogs were subgrouped according to sepsis
origin (septic peritonitis, n = 19; parvoviral enteritis, n = 26; pyometra, n = 20;
miscellaneous, n = 26). ApoA1 was measured using an immunoturbidimetric method previously
validated in dogs. Nonparametric statistics was used for comparison. Data were reported
as median and range. P was set at < 0.05.
Results: No significant differences were found in ApoA1 concentration between the
overall population of septic dogs (118 mg/dL, 51–173), AHDS (131 mg/dL, 64–147), and
healthy dogs (133 mg/dL, 121–139) (P = 0.06). However, significant lower Apo‐A1 concentrations
were documented in dogs with septic peritonitis (92 mg/dL, 58–147) compared to AHDS
and healthy dogs, and between dogs with parvoviral enteritis (114 mg/dL, 51–159) and
healthy controls (P = 0.001). In septic dogs, significant lower ApoA1 concentrations
were detected in nonsurvivors (95 mg/dL, 51–159, n = 27) compared to survivors (124
mg/dL, 56–173, n = 64) (P = 0.0007). According to the AUROC curve analysis, ApoA1
< 96 mg/dL had a fair accuracy (AUC = 0.72) to correctly predict mortality (P = 0.0004).
Conclusions: The diagnostic potential of Apo‐A1 in selected diseases causing intra‐abdominal
canine sepsis (eg, septic peritonitis, parvoviral enteritis) is warranted. Moreover,
Apo‐A1 seems to be prognostic in this population of septic dogs. This finding is promising
in canine sepsis, and parallels human data. Whether decreased Apo‐A1 concentrations
reflect greater sepsis severity or directly contribute to immune dysfunction is yet
to be determined. Further prospective studies are needed to confirm the prognostic
significance of Apo‐A1 in dogs with sepsis, and to evaluate its diagnostic performance
in homogeneous models of canine sepsis.
EFFICACY OF MANUAL VENTILATION TECHNIQUES DURING CARDIOPULMONARY RESUSCITATION
Hopper, K
1, Rezende, ML2, Borchers, A1
1University of California, Davis, CA, USA
2Colorado State University, Fort Collins, CO, USA
Introduction: The current cardiopulmonary resuscitation (CPR) guidelines for dogs
recommend ventilation during CPR with a cuffed orotracheal tube. When this is not
possible, bag‐mask ventilation with a tight fitting face mask or mouth‐to‐nose rescue
breathing are considered reasonable options. The guidelines note that the efficacy
of these alternative methods of ventilation have not been evaluated. The objective
of this study was to compare the effectiveness of manual ventilation using a tight
fitting face mask or mouth‐to‐nose rescue breathing with a cuffed orotracheal tube
during CPR in dogs.
Methods: Twenty‐five purpose‐bred research dogs in a terminal teaching laboratory
were randomized to be ventilated by orotracheal tube (n = 6), tight fitting face mask
(n = 6), mouth‐to‐nose breathing (n = 7), or no ventilation (n = 6) during CPR. Orotracheal
tube and face mask ventilation was performed using a bag‐valve mask on room air. Chest
compressions were performed during the experimental procedure and no other CPR interventions
were provided. Arterial blood gases were performed prior to euthanasia (baseline),
at 3 minutes and at 6 minutes of CPR. PaO2 and PaCO2 were compared for each time point,
between groups.
Results: There was no difference in PaO2 or PaCO2 between groups at baseline. At 6
minutes, all groups had a significantly higher PaCO2 (P < 0.02) and the facemask and
no ventilation groups had a significantly lower PaO2 (P < 0.04) when compared to the
orotracheal tube group. There was no difference between the PaO2 of the mouth‐to‐nose
group compared to the orotracheal tube group at 3 or 6 minutes. Gastric distension,
regurgitation, and face mask leak were all noted in the face mask group. Gastric distention
and regurgitation was noted in the mouth‐to‐nose group. In one dog, mouth‐to‐nose
breathing failed to generate any effective breaths for the entire period of CPR.
Conclusions: In this study, mouth‐to‐nose ventilation provided better oxygenation
than face mask ventilation, although with supplemental oxygen, it is likely that facemask
ventilation would show greater efficacy. Mouth‐to‐nose ventilation maybe an effective
rescue breathing technique in dogs. Complications were noted with both face mask and
mouth‐to‐nose ventilation.
SERUM CHOLESTEROL CONCENTRATION AS A MARKER OF SEVERITY IN DOGS ENVENOMATED WITH VIPERA
PALAESTINAE
Kelmer, E, Aroch, I, Segev, G, Beeri, I, Klainbart, S
Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
Introduction: Vipera palaestinae, presently termed Daboia palaestinae, is the most
common venomous snake in Israel. Reported mortality rates range from 0.5% to 2% and
3.7% to 15%, in people and dogs envenomated by D. palaestinae, respectively.
Objective: People envenomed by D. palaestinae and rabbits injected with its venom,
have serum cholesterol concentration (sChol) inversely correlated with the severity
of envenomation. We therefore hypothesized that in dogs envenomed by D. palaestinae,
sChol may serve as a marker of severity and outcome.
Method: Data were retrospectively collected from the medical records of dogs diagnosed
with D. palaestinae envenomation between 1989 and 2017, in which sChol was measured
at presentation.
Results: The study included 193 dogs. The overall mortality rate was 8.8%. Median
sChol was significantly (P = 0.046) lower in nonsurvivors (17 dogs; 87 mg/dL) compared
to survivors (176 dogs; 175 mg/dL). Mean serum albumin concentration was significantly
(P = 0.004) lower in the nonsurvivors (16 dogs; 2.7 ± 0.8 g/dL) compared to the survivors
(159 dogs; 3.2 ± 0.7 g/dL). Receiver operating characteristic (ROC) analyses for sChol
and sAlb at presentation as predictors of the outcome had an area under curve (AUC)
of 0.625 and 0.687, respectively. The optimal sChol cutoff of 103 mg/dL corresponded
to sensitivity of 59% and specificity of 79%. An optimal sAlb cutoff of 2.58 g/dL
corresponded to sensitivity of 56% and specificity of 83%.
There was a difference in mean sChol between dogs presenting different mental statuses.
Dogs with normal mentation had significantly higher sChol (165 ± 69.1 mg/dL) compared
with those with depression, obtundation, and semicoma or coma (144 ± 73.2 mg/dL; 126
± 89.5 mg/dL; 91 ± 62.0 mg/dL, respectively, P = 0.011). sChol was significantly lower
in dogs presenting with leukocytosis, hypoproteinaemia and thrombocytopenia (P < 0.002).
Conclusion: The present results show that sChol on presentation is a good marker for
the severity of envenomation, and a moderate outcome predictor in dogs envenomed by
D. palaestinae. In addition, the presence of hypocholesterolemia may aid in the diagnosis
of snake envenomation in dogs presenting with vague clinical signs. Future studies
are needed to evaluate whether changes in sChol throughout hospitalization correlate
with clinical improvement or outcome.
INTRAOSSEOUS CATHETERIZATION FLOW RATES AND EASE OF PLACEMENT AT VARIOUS SITES IN
CANINE CADAVERS
Lange, JM
1*, Boysen, SR2, Stillion, JR3, Bentley, AD3, Atilla, A2
1Western Veterinary Specialist and Emergency Centre, Calgary, Canada
2University of Calgary, Calgary, Canada
3Western Veterinary Specialist Centre, Calgary, Canada
*Winner of best oral presentation.
Background: There are numerous anatomical sites that may facilitate placement of an
intraosseous catheter. Traditionally, the tibia has been the site of choice for intraosseous
catheter placement in veterinary medicine. However, in human studies other sites such
as the humerus have shown equivalent flow rates and ease of placement, which may be
an important consideration in the resuscitation of hypovolemic patients.
Objective: To compare intraosseous catheter placement difficulty, success rates, and
flow rates at four different anatomical locations in canine cadavers.
Method: Animal Care Committee approval and owner consent was obtained for this prospective
study. Dogs presenting for euthanasia were recruited. Heparin (1,000 IU/kg intravenously)
was administered at least 5 minutes prior to euthanasia. After euthanasia, EZIO intraosseous
catheters were placed into the ilial wing, proximal medial tibia, proximal lateral
humerus, and distal lateral femur on one side of the animal. Sterile saline was infused
into each location simultaneously over 5 minutes, first via gravity followed by 300
mm Hg of pressure. The procedure was repeated on the contralateral side of the animal.
A Kruskal–Wallis one‐way analysis of variance was performed to evaluate any differences
between anatomical sites (P < 0.05 considered statistically significant).
Results: Placement was successful in 6/12 ilial wings, 10/12 tibial, and 12/12 femoral
and humeral attempts. Gravity infusion rates in the tibia (0.267 mL/kg/min ± 0.293)
were statistically lower than the humerus (1.316 mL/kg/h ± 1.049) and femur (1.018
mL/kg/min ± 0.520). Pressurized infusion rates in the tibia (0.6068 mL/kg/min ± 0.4836)
were statistically lower than the humerus (3.219 mL/kg/min ± 2.588) and the femur
(2.360 mL/kg/min ± 0.837). No other statistically significant differences were noted
for flow rates between sites.
Conclusion: Pressurized intraosseous flow rates were higher in the humerus and femur
compared to the tibia. Additionally, both humerus and femur had the highest successful
placement compared to the tibia and ileum. This suggests that the humerus and femur
may be preferred sites for intraosseous catheter placement in dogs if rapid infusion
rates are desired.
XENOTRANSFUSION OF CANINE BLOOD TO CATS: A REVIEW OF 37 CASES AND THEIR OUTCOME
Le Gal, A
1, Thomas, E2, Humm, K1
1Clinical Science and Services, The Royal Veterinary College, Hatfield, United Kingdom
2The Royal (Dick) School of Veterinary Studies, Edinburgh, United Kingdom
Introduction: Xenotransfusion of canine blood to cats is a recognized veterinary technique,
but literature describing long‐term outcome is lacking.
The objectives of this study were threefold. First, to review and describe the clinical
situations where xenotransfusion was performed. Second, to describe the outcome of
the recipient cats. Third, to assess recipient owners’ retention of information regarding
xenotransfusion.
Methods: Cats administered xenotransfusions in 2 referral hospitals between January
2016 and December 2017, were recruited. Reason for transfusion, blood type, PCV, cross‐match
results, transfusion volume, transfusion reactions, PCV 12‐hours posttransfusion,
and survival to discharge were all recorded. Owners of the cats who survived to discharge
were questioned about the implications of the xenotransfusion. Mean and standard deviation
were calculated for normally distributed data and median and interquartile range were
calculated for nonparametric data.
Results: Thirty‐seven cats were enrolled. The most common reasons for transfusion
were surgical complications (15/37), IMHA (10/37), and neoplasia (9/37). Twenty‐one
cats were blood type A, 13 were B, and 1 was AB. Two cats were not blood typed. Median
PCV prior to transfusion was 11% (IQR = 5). Major and minor cross‐matches were incompatible
in 16/22 cases (72%) and 9/22 cases, respectively. Median volume transfused was 14.2
mL/kg (IQR = 8.7). Four cats had a febrile nonhemolytic transfusion reaction. Mean
PCV 12 hours posttransfusion was 24% (±9). Hemolytic serum was noted in 11 cats after
a median of 70.1 hours (IQR = 33) and icterus or icteric serum in 9 cats after a median
of 63.0 hours (IQR = 69).
Survival to discharge was 46% (17/37). Eight of these cats received a feline blood
transfusion after a median of 4 days (IQR = 2.25) postxenotransfusion, including 7
cats who had evidence of either hemolysis or icterus. Eleven cats were alive in January
2018 at a mean of 261 days (± 186) postxenotransfusion. All owners remembered their
cats had received a xenotransfusion and 8/11 remembered their cat could not receive
a repeat xenotransfusion.
Conclusion: Xenotransfusion of canine blood to cats is possible but hemolysis should
be expected between 1 and 4 days posttransfusion. Repeat transfusion with feline blood
is often required.
POSTOPERATIVE CARDIAC MONITORING AND INTENSIVE CARE TREATMENT AFTER PRECLINICAL XENOGENEIC
HEART TRANSPLANTATION
Mayr, TA
1, Bauer, A2, Reichart, B3, Längin, M1, Issl, L3, Ying, J3, Brenner, P1, Abicht, J1
1Ludwig Maximilian University, Munich, Germany
2RoMed Klinikum Rosenheim, Rosenheim, Germany
3Walter‐Brendel‐Centre, Munich, Germany
Introduction: Postoperative management is essential for the outcome of life‐supporting
pig‐to‐baboon cardiac transplantations, a preclinical model for future xenotransplantation
in people. Information about the use of baboons in complex experiments is scarce and
claims specific management in the cardiac posttransplant condition. Such a management
reaches beyond the usual treatment of laboratory animals, but a one‐to‐one transfer
of medical treatment of human patients is not possible neither.
Materials: Ten pig‐to‐baboon orthotopic heart transplantations were performed with
the use of cardiopulmonary bypass. Two days prior to transplantation animals received
a multilumen central venous catheter for continuous intravenous treatment and daily
laboratory measurement of organ function. During transplantation a telemetric device
was implanted to continuously transmit an epicardial electrocardiogram and systemic
blood pressure. Echocardiography served as an important tool for the comprehensive
evaluation of graft function.
Results: All baboons were male Papio anubis. Median (range) age and body weight were
4 years (4–12) and 16.5 kg (10.5–21), respectively. A continuous telemetric monitoring
was possible in all animals. Four animals could not be weaned from respirator due
to perioperative xenograft dysfunction. Arrhythmias were observed in 4/6 animals.
Ventricular extrasystoles were treated by administration of amiodarone and magnesium.
Electrolytes were closely monitored and substituted during the two first postoperative
weeks. Three animals needed blood transfusions during the postoperative period. A
reduced serum albumin concentration was observed in two animals. In these, human albumin
transfusions were performed. Echocardiographic evaluations were performed on a regular
basis at least twice a week. There were no adverse events in combination with sedation
and blood pressure was stable during all procedures. In three cases, catecholamine
support was necessary during echocardiographic evaluation, which revealed diastolic
failure 26, 29, 39 days, respectively, after xenotransplantation.
Conclusions: After preclinical cardiac xenotransplantation, intensive intra‐ and postoperative
monitoring and care is essential for the outcome of these experiments. In our experiments,
a postoperative intensive care treatment could be established, that leads to consistent
long‐term survival after orthotopic heart transplantation.
DEMONSTRATION OF ACUTE COAGULOPATHY OF TRAUMA (ATC) IN CATS FOLLOWING TRAUMA USING
ROTATIONAL THROMBOELASTOMETRY (ROTEM)
Sigrist, NE, Jud Schefer, R, Muri, B
Vetsuisse Faculty University of Zurich, Zürich, Switzerland
Introduction: Acute traumatic coagulopathy (ATC) has a prevalence of up to 34% in
people and is associated with mortality. A single study reported ATC in 1/19 (5%)
cats.
Objective: To determine the prevalence of ATC in acutely traumatized cats.
Methods: Cats presenting with acute (< 13 hours) trauma between March 2016 and December
2017 were prospectively enrolled. Rotational thromboelastometry (EXTEM‐S, INTEM‐S,
FIBTEM‐S, APTEM‐S), lactate, and animal trauma triage (ATT) score were determined
at presentation. ATC was defined as > 2 or more hypocoagabulable ROTEM parameters:
prolonged EXTEM or INTEM clotting time (CT) or clot formation time (CFT) and decreased
EXTEM‐S, INTEM‐S, or FIBTEM‐S maximum clot firmness (MCF) and increased EXTEM‐S or
INTEM‐S maximum lysis (ML).
Results: Thirty‐one cats were analyzed. Median time between trauma and presentation
was 180 minutes (range, 60–780 minutes). In two cats, the actual trauma time was not
known but estimated to be < 12 hours based on clinical signs. Median ATT score was
5 (range, 1–11) and median lactate concentration was 2.13 (range, 0.81–12.34) mmol/L.
ATC was demonstrated in 6/31 (19%) of cats. One of the cats with ATC showed hyperfibrinolysis.
Five of 6 cats with ACT showed EXTEM‐S, INTEM‐S, and APTEM‐S CT prolongation. The
presence of ATC was not associated with the ATT score (P = 0.190) or lactate (P = 0.478).
Less cats (40% vs 85%) with ATC were discharged from the hospital; however, this was
not statistically significant (P = 0.161).
Discussion: Our study identified ATC in 19% of cats with acute trauma. The higher
prevalence of ATC found in our cats may be associated with earlier evaluation after
trauma. Association with survival, trauma severity, and hypoperfusion requires future
and larger studies.
Conclusions: ATC seems to be more prevalent in traumatized cats than previously thought
and should be considered in cats with acute trauma.
TETANUS SEASONALITY IN DOGS
Starybrat, DM
1, Burkitt‐Creedon, JM2, Ellis, J1, Rozanski, EA3, Humm, K1
1Department of Clinical Science and Services, The Royal Veterinary College, Hatfield,
United Kingdom
2School of Veterinary Medicine, University of California, Davis, CA, USA
3Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
Introduction: Canine tetanus is a rare neuromuscular disorder caused by neurotoxins
produced by Clostridium tetani. Diagnosis of the disease is based on the patient's
characteristic clinical signs. A small number of studies investigating tetanus in
human patients noted a seasonal variability in its incidence. This has been postulated
to be due to variation in weather. Seasonality of canine tetanus has not been investigated.
Objective: To evaluate the seasonality in diagnosis of canine tetanus in the United
Kingdom (UK) and the United States of America (USA).
Methods: The medical records of three referral hospitals (one in the UK, one on the
Northeast Coast of the USA, and one on the West Coast of the USA) were reviewed. Dogs
diagnosed with tetanus by a diplomate in either Emergency and Critical Care, Neurology,
or Internal Medicine between January 2006 and June 2017 were included in the study.
Both localized and generalized tetanus cases were included. A Kruskal–Wallis test
was used to assess for significant difference in distribution of tetanus cases between
months, as well as between the 4 seasons of the year, with P‐value of < 0.05 considered
significant.
Results: Eight cases from the Northeast Coast referral hospital, 24 cases from the
West Coast referral hospital, and 49 cases from the UK referral hospital were included.
Localized tetanus was documented on presentation in 12% (1/8), 8.3% (2/24), and 24.5%
(12/49) of dogs admitted to the veterinary hospitals, respectively. No seasonality
was noted in either of the USA referral hospitals. Monthly seasonality in diagnosis
of tetanus was confirmed in the United Kingdom referral hospital (P value = 0.048)
with the highest number of cases recorded in February. Incidence of tetanus was significantly
higher in winter months when compared with summer (P value = 0.002) and autumn (P
value = 0.024).
Conclusions: The incidence of canine tetanus in the United Kingdom referral hospital
showed seasonal variation with higher number of cases noted in winter months, especially
in February. This was not seen in the USA referral hospitals, but may have been due
to a type II statistical error, or due to differences in weather patterns.
Posters
ESTABLISHMENT OF THE REFERENCE INTERVALS OF CAUDAL VENA CAVA:AORTA RATIO MEASURED
BY THE SAV PROTOCOL: PRELIMINARY RESULTS FROM 20 NONSEDATED HEALTHY DOGS
Barthélemy, A, Dupanloup, A, Gillet, B, Cambournac, M, Pouzot‐Nevoret, C, Goy‐Thollot,
I
VetAgro Sup, Campus vétérinaire de Lyon, Marcy l'etoile, France
Introduction: The sonographic measurement of the caudal vena cava:aorta (CVC:Ao) ratio
has been previously suggested as a useful tool in emergency and critical care settings
for non‐invasive bedside and serial assessment of intravascular volume status in dogs.
However, no reference intervals (RI) has been established in dogs.
Objectives: (1) To determine the RI of CVC/Ao ratio in nonsedated healthy dogs using
the sonographic assessment of volemia (SAV) protocol, (2) to evaluate intra‐ and interoperator
variability of Ao, CVC, and CVC:Ao ratio measurements, and (3) to determine if the
sonographic Ao, CVC, and CVC:Ao ratio measurements were correlated with systolic blood
pressure (SBP) and heart rate (HR).
Method: A prospective study was conducted in nonsedated healthy dogs. Each dog was
positioned in the right lateral recumbency. SBP was measured three times consecutively
using a Doppler system. The left kidney was identified on the spleno‐renal view of
the abdominal FAST technique, using a 5‐ to 8‐mHz ultrasound convex transducer. CVC,
Ao, and CVC:Ao ratio measurements were performed twice by two different operators
on a transverse view of the CVC and Ao. RI were defined from the 2.5–97.5% percentiles.
Intra‐ and interoperator variability was assessed by the Bland–Altman method. Simple
linear correlations based on Spearman coefficient determination were performed between
the sonographic measurements, SBP, and HR.
Results: Twenty healthy dogs were included. Mean age was 2.6 (± 1.8) years, and mean
bodyweight 20.9 (± 6.1) kg. RI were defined as: 0.71–1.20 cm for Ao, 0.73–1.29 cm
for CVC, and 0.97–1.26 for CVC:Ao ratio. Intra‐ and interoperator variability was
within the limit of agreement for the vast majority of measurements. No significant
correlation was found between any sonographic measurement and SBP or HR.
Conclusion: The low intra‐ and interoperator variabilities in the sonographic Ao,
CVC, and CVC:Ao measurements confirm their reliability and operator independency using
the SAV protocol. A CVC:Ao ratio < 0.97 may suggest an hypovolemic state whereas a
CVC:Ao ratio > 1.26 may suggest an hypervolemic state in dogs. This result has to
be confirmed in hypo‐ or hypervolemic dogs.
THE EFFECT OF IMPLEMENTATION OF STANDARDIZED MEDICATION ORDER WRITING ON DOSING ERRORS
IN A REFERRAL HOSPITAL
Buckley, GJ, Eide, M, Sanchez, LC, Allen, LS, Zimmel, DN
University of Florida, College of Veterinary Medicine, Gainesville, FL, USA
Introduction: A problem of misinterpretation of written orders was identified. Errors
included administration of whole tablets when fractions of tablets were ordered, and
confusion arising from use of total milligram of drug versus milligrams per kilogram
bodyweight. Varying formats were used by clinicians and this was hypothesized to contribute
to errors. Examples of orders commonly misinterpreted included “aspirin ½ tablet once
daily” and “methadone 0.1 mg/kg intravenously every 4 hours.”
Objective: To reduce errors associated with misinterpretation of written orders.
Methods: A standardized format for written orders was introduced as follows: “drug
name, total mg dose, route of administration, frequency.” IDInc was used to record
medication errors. This was searched to identify total errors reported in the year
before and after the policy change as well as total medication errors and medication
errors resulting from misinterpretation of clinician orders. Chi‐square was used to
compare categorical variables before and after implementation.
Results: There were 16 total reports per 1,000 patient visits in 2016 compared with
24 per 1,000 patient visits in 2017 reflecting an increase in overall reporting. During
this period caseload increased from 32,984 in 2016 to 36,621 in 2017. There were 113
and 205 medication errors in 2016 and 2017, respectively. In 2016, 32 of 113 errors
resulted in an error in the dose administered to the patient of which 13 (40%) resulted
in harm to the patient. In 2017, 58 of 205 errors resulted in an error in dosage of
which 19 (18%) resulted in patient harm, this was not significantly different to 2016
(P = 0.45). In 2016, 10 of 32 dosing errors were attributable to misinterpretation
of a written order; in 2017 this fell to 6 of 58 (P = 0.013). In 4 of these 6 cases,
the protocol was not followed. In only two instances where the protocol was followed
did a misinterpretation of the order occur.
Conclusion: Implementation of standardized order writing resulted in significant reduction
in dosing errors related to misinterpretation. Two‐thirds of the errors resulting
from misinterpretation of orders seen postprotocol were associated with failure to
follow standardized format. Vigilance in addressing compliance may result in further
improvement.
ELEVEN AUTOLOGOUS BLOOD TRANSFUSIONS IN SEVEN CATS WITH INTRACAVITARY HAEMORRHAGE
Cole, LP, Humm, K
Department of Clinical Science and Services, The Royal Veterinary College, Hatfield,
United Kingdom
Introduction: The objectives of this study were to describe the clinical use and outcome
of autologous transfusion in cats.
Methods: A retrospective descriptive study was performed. Medical records of a single
referral centre were searched for cats receiving autotransfusion as part of their
case management. Underlying disease process or injury, autotransfusion technique,
transfusion volume, time period over which the transfusion was given, PCV pre‐ and
posttransfusion, percentage rise in PCV, use of other blood products, and any complications
of the procedure were recorded. Survival to discharge and any follow‐up information
was also documented.
Results: Between July 2012 and July 2017, a total of 11 autotransfusions were performed
in 7 cats. The median weight of the cats undergoing autotransfusion was 3.83 kg (range
1.38–5.5 kg). All patients were diagnosed with haemoperitoneum. Four cats were diagnosed
with abdominal neoplasia, 2 had postoperative haemorrhage, and 1 had a traumatic haemoperitoneum.
During hospitalization, 2/7 cats received multiple autotransfusions; 1 cat received
2 autotransfusions for preoperative stabilization and 1 cat received 3 autotransfusion;
both intra‐ and postoperatively. One cat received a repeat autotransfusion at a later
hospital admission date. Blood was collected using a 23 Ga butterfly catheter and
20 mL syringe in 7/11 collections, a 23 Ga needle, three‐way tap, and 20 mL syringe
in 2/11 collections, and directly into syringes from the open abdomen at the time
of surgery in 2/11 collections. A median volume of 55 mL (range 25–80 mL) was collected
and administered, equivalent to a median dose of 17 mL/kg (range 9–26 mL/kg). Blood
was given over a median of 3.5 hours (0.25–6 hours). Four cats were given another
blood product alongside the autotransfusion. The median percentage PCV increase postautotransfusion
was 5% (range 1–7%). Anticoagulant was used in 5/11 autotransfusions. No clinically
relevant adverse effects were reported. Five of 7 patients survived to discharge.
Cause of death in those patients was euthanasia due to the underling condition and
continued haemorrhage.
Conclusion: Autologous transfusion appears to be a safe and effective technique for
stabilizing cats with haemoperitoneum. This technique allows rapid and cheap provision
of blood and avoids the need for an allogenic blood donor.
PLASMA CHOLESTEROL AND TRIGLYCERIDES MONITORING DURING INTRAVENOUS LIPID THERAPY IN
PATIENTS INTOXICATED WITH NSAIDS
Daza González, MA, Fragio, C, Portero, M, Fermin, M, Pelaez, P, Garcia, R, González,
A, Wuhrmann, B
Hospital Clínico Veterinario Complutense, Madrid, Spain
Introduction: Intravenous Lipid Therapy (IVLT) is the administration of a high‐rate
infusion of an Intravenous Lipid Emulsion (ILE) over a short period of time to ameliorate
clinical syndromes caused by lypophylic drugs overdose or toxins.
Background: Potential adverse effects of IVLT include microvascular fat embolization
and pancreatitis.
Objective: The objective of this study was to monitor plasmatic levels of cholesterol
(Ch) and triglycerides (Tg) after IVLT. We hypothesized that values pre‐ and after
IVLT would not be different.
Methods: Patients were diagnosed of NSAID intoxication based on history and clinical/laboratory
signs. In addition to decontamination and supportive measures, a 20% ILE (Lipofundina)
was administered (initial bolus 1.5 mL/kg over 15 minutes followed by CRI 0.25 mL/kg/min
for 1 hour). Plasma Ch and Tg were measured prior to IVLT (D0), 1 hour (D1), and 3
hours (D2) posttherapy. Given a nonparametric distribution of data, a Friedmann test
was used to analyze results (significance set at P < 0.05).
Results: Two cats (1 M, 1 F, European shorthair) and 6 dogs (5 M, 2 F, various breeds)
intoxicated with meloxicam (n = 3), ibuprofen (n = 2), carprofen (n = 2), and diclofenac
(n = 1) were enrolled.
Ch values were not significantly different (P = 0.607) (values are expressed as median
and [interquartile range]): ChD0 (192.50 [167.5] mg/dL), ChD1 (227 [154] mg/dL), ChD2
(234 [147.5] mg/dL); significant differences were observed for Tg between D0 (103
[97] mg/dL) and D1 (427 [1293] mg/dL) (P = 0.008), but not between D0 and D2 (176
[182.5] mg/dL). At D2, 75% (n = 6) of patients had Tg values < 2× the upper limit
of reference range.
Discussion: These results indicate that in patients receiving IVLT, measuring plasma
Tg levels at 3 hours may be useful when evaluating potential risks of giving a second
dose of ILE (for example, in animals intoxicated with substances with enterohepatic
circulation). Ch levels monitoring is not useful since they do not change significantly
during treatment. These preliminary results should be confirmed in a larger patients’
sample.
Conclusions: In patients intoxicated with substances with enterohepatic circulation,
determination of plasma triglycerides 3 hours after starting IVLT may be helpful in
deciding if it is safe to administer a second dose of ILE.
RETROSPECTIVE STUDY OF USE OF CANINE PLASMA PRODUCTS IN 170 PATIENTS
Elias, N, Lewis, D
Vets Now Referrals Glasgow, Glasgow, United Kingdom
Introduction: The use of plasma transfusions continues to grow in veterinary medicine,
but plasma transfusion reactions (TR) are poorly characterized in compared to reactions
secondary to administration of packed red blood cells.
Objectives: To describe the population receiving plasma products (PP) in a 2‐year
period, report the incidence of TR and to identify whether this is higher when nontype‐matched
plasma is administered.
Methods: A search of computerized records was performed, identifying any patients
that received PP between 2016 and 2018; these products included frozen plasma (FP),
fresh frozen plasma (FFP), and cryoprecipitate (Cryo). Patients were excluded if records
were incomplete or if the blood type of the plasma was not recorded.
Results: A total of 195 cases were reviewed, of which 170 were included in the study.
A total of 413 PP transfusions were analyzed, of which 351 were given to blood typed
patients.
A total of 17 TR (4.1%) were noted. Six TR were identified following FFP transfusion
(8.1%), 10 after administration of FP (3.8%), and none following administration of
Cryo. All TR were mild and only one required discontinuation of the transfusion.
Of the TR identified after PP administration, a greater proportion were in type‐matched
transfusions than nontype‐matched, although this difference was not statistically
significant.
Sixty‐one patients received 1 unit of PP and 109 received 2 or more units. Three TR
occurred in patients that received 1 unit (18%) and 14 in patients that received 2
or more units (82%), P = 0.1161.
A total of 7 (41%) TR occurred in patients that also received pRBC transfusions, P = 0.07.
Discussion: Overall, the incidence of TR is low, and invariably mild in nature. There
appears to be no evidence that administering blood‐type‐matched PP affects the rate
of TR. There is a trend that shows the more PP patients receive, the more likely they
are to have a TR.
Conclusion: Administration of canine PP is a safe procedure that carries a low risk
of transfusion reactions. Type‐matching PP appears unneccesary. There is evidence
of a strong trend indicating an increasing risk of TR with increasing number of PP
administered.
NEUTROPHIL TO LYMPHOCYTE RATIO IN CANINE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
Gori, E, Pierini, A, Lippi, I, Ceccherini, G, Lubas, G, Marchetti, V
Department of Veterinary Science, University of Pisa, San piero a grado, Pisa, Italy
Introduction: The neutrophil to lymphocyte ratio (NLR) has been proposed as a readily
accessible and independent predictor parameter of poor survival in human patients
with tumors, cardiovascular diseases, and critically illness. As far as we know NLR
has been evaluated only in oncological veterinary patients.
Objective: To evaluate NLR in dogs with systemic inflammatory response syndrome (SIRS)
and its association with the severity of illness, outcome, and sepsis. BLR (band neutrophil‐to‐lymphocyte
ratio) and BLNR (band‐to‐neutrophil‐to‐lymphocyte ratio) were evaluated as well.
Methods: Data were retrospectively collected and enrolled animals subsequently divided
in 3 groups: 90 with SIRS, 50 healthy, and 50 with chronic diseases as control groups.
A SIRS grading was obtained based on how many criteria were fulfilled. The APPLEfast
score was applied to the SIRS group. The survival rate was assessed at day 7 and 15
after their admission. Dogs with cytology or positive culture for active bacterial
infections were recorded as septic. Mann–Whitney U‐test, Kruskal–Wallis test, and
Dunn's multiple comparison test were used to compare groups using statistical software.
Results: In the SIRS group, 39 dogs (43%) died during the study period. APPLEfast
score > 25 (P = 0.03) and SIRS grading > 2 (P = 0.001) were associated with poor outcome.
NLR was higher in the SIRS group compared to the control groups (P < 0.0001 and P
< 0.0001, respectively) and not associated with outcome. NLR was not statistically
different between SIRS grading groups or APPLEfast score groups. NLR was lower in
septic dogs than in nonseptic group (P = 0.016). Dogs with SIRS grading > 2 showed
a higher BLR than dogs with SIRS grading = 2 (P = 0.04). Any association of BLR and
BLNR with outcome, sepsis and APPLEfast groups was found.
Conclusions: Our results demonstrate the utility of NLR evaluation in dogs with SIRS
(higher) and in septic dogs (lower). Further prospective, large‐scale studies investigating
the role of BLR and BLNR in canine SIRS are warranted.
NORMAL VALUES FOR ROTATIONAL VISCOELASTOMETRY EVALUATED VIA ROTEM IN THE PIG (SUS
SCROFA) AND EFFECTS OF PREANALYTICAL SAMPLE AGITATION ON ROTEM RESULTS
Hoareau, GL, Grayson, JK
Clinical Investigation Facility, Fairfield, CT, USA
Introduction: Pigs are commonly used in translational research and accurate assessment
of coagulation is essential. We sought to establish porcine ROTEM normal values for
pigs following the American Society for Veterinary Clinical Pathology reference interval
guidelines.
Methods: Sixty‐five healthy Yorkshire cross pigs (39 males and 26 females) were anesthetized
with an intramuscular injection of tiletamine and zolazepam. Using a 18 Ga needle
attached to a Vacutainer, blood was acquired from the cranial vena cava. Tubes were
filled in the following order: evacuation clot tube, EDTA tube, heparin tube, and
2 citrate tubes. The citrate tubes were randomly assigned to 30 minutes with or without
constant agitation on a rocker. The following Intem and Extem parameters were reported
according to manufacturer's recommendations: CT, CFT, alpha, A10, A20, MCF, ML, LI30,
and LI45. Reference intervals were reported as 2.5th and 97.5th percentile of the
population's results. The effects of sex, sampling order, and agitation on ROTEM results
were analyzed via linear regression.
Results: Sex, sampling order, or agitation did not influence any of the ROTEM parameters.
Pooled reference intervals were established for each Rotem parameter combining data
from male and female animals from the nonagitated tubes.
Conclusion: This is the first study establishing ROTEM reference intervals in a large
number of both male and female adult pigs, while also providing detailed preanalytical
sample processing. Our results provide valuable information for researchers utilizing
porcine models.
ESTABLISHMENT OF A REFERENCE INTERVAL FOR A NOVEL VISCOELASTIC COAGULOMETER AND COMPARISON
TO THROMBOELASTOGRAPHY IN HEALTHY CATS
Jandrey, KE, Rosati, T, Burges, JW, Kent, MS
University of California, Davis, CA, USA
Introduction: Viscoelastic tests are uncommonly available to provide information about
overall hemostasis. A novel viscoelastic point‐of‐care device [Portable Coagulation
Monitor (PCM)] is intended to have a larger veterinary audience since it is more cost‐effective,
simple to use, and portable than thromboelastography (TEG) and rotational thromboelastometry
(ROTEM). This is the first study that evaluates PCM in a population of healthy cats.
Background: The clinical application of viscoelastic testing is limited by their high
cost, technical knowledge and skills required, and access.
Objective: The aims of this study are to establish PCM reference interval in a population
of healthy cats and to evaluate data correlation with TEG.
Methods: Healthy, university‐owned, group‐housed domestic shorthaired cats (n = 59)
were assessed in this study. Blood from direct venipuncture was immediately analyzed
on the PCM. Anticoagulated blood [sodium citrate (for TEG) and EDTA (for CBC)] was
analyzed within 2 hours. Statistical analysis was completed using commercially available
software (Stata v13. and Microsoft Excel Reference Value Advisor v2.1).
Results: Blood was obtained from 59 cats [35 female, 24 male; median = 1 year (range
0.5–13)]. All CBC parameters were within normal reference intervals. The measured
reference intervals [range(median) for non‐normal or mean(standard deviation) for
normal distributions] for each PCM measurement are: Clot Time (CT, seconds), 104–430
(296); Clot Formation Time (CFT, seconds), 117–477 (172); Alpha Angle (AA, degrees),
35–67 (54); Maximum Clot Firmness (MCF, PCM units), 31.9 (5.1); and Lysis Index 30
(lysis 30 minutes after CT) (LI30, %), 96.5 (2.0). TEG measurements were [respectively,
range(median)]: Reaction Time (R, minutes), 1.0–11.0 (2.1); Kinetics (K, minutes),
0.8–9.6 (2.4); Alpha Angle (AA, degrees), 3.6–78.9 (73.5); Maximum Amplitude (MA,
millimeters), 2.5–69.4 (58.6); Lysis 30 (LY30, %, 0–74.3 (11.4).
Discussion: Data in 59 healthy cats suggests that the PCM measurements are not directly
comparable to TEG measurements. These two devices assess viscoelastic properties of
blood differently and data appear to be not directly comparable. However, PCM analysis
may still be used to evaluate hemostasis in healthy cats. Further studies are required
to ensure application of PCM in the clinical setting.
Conclusions: A novel viscoelastic coagulometer can be used for analysis in healthy
cats but does not correlate to thromboelastography.
TISSUE PLASMINOGEN ACTIVATOR‐MODIFIED THROMBOELASTOGRAPHY DIAGNOSED SIGNIFICANT HYPERFIBRINOLYSIS
IN A GROUP OF CANINE CANCER PATIENTS
Langhorn, R*
, Poulsen, MK, Heidemann, PL, Bochsen, L, Kristensen, AT, Nielsen, LN
Department of Veterinary Clinical Sciences, University of Copenhagen, Copenhagen,
Denmark
*Winner of best original study poster.
Introduction: Hyperfibrinolysis is a possible cause of bleeding in canine cancer patients;
however, its diagnosis and therapy remains challenging. As standard thromboelastography
may be too robust to detect canine hyperfibrinolysis, this study evaluated tissue
plasminogen activator‐modified thromboelastography (tPA‐TEG) for detection of hyperfibrinolysis
and aimed to establish the concentration of the antifibrinolytic agent tranexamic
acid (TXA) needed for normalizing the fibrinolytic potential in vitro.
Methods: Canine patients with sarcomas and a normocoagulable thromboelastography were
included along with a healthy control group. For each dog a whole blood tPA‐TEG, and
four tPA‐TEGs with added TXA (20, 40, 60, and 80 μg/mL) were performed. Lysis parameters
LY30/60 (lysis at 30/60 minutes following maximal amplitude (MA)), CL30/60 (clot lysis
index at 30/60 minutes following MA), maximum rate of lysis (MRL), and total lysis
(L) were investigated. The in vitro TXA concentration needed to inhibit 90% of the
fibrinolytic potential (IC90) was calculated.
Results: Nine patients with cancer (5 hemangiosarcomas, 3 soft‐tissue‐sarcomas, 1
osteosarcoma), of which 5 had clinical bleeding, and 11 healthy dogs were included.
Significant hyperfibrinolysis (LY30 (P = 0.0001), LY60 (P = 0.003), CL30 (P = 0.01),
and L (P = 0.02)) was detected in sarcoma patients. The TXA IC90 for normalizing of
LY30 and LY60 was 8.61 μg/mL and 37.99 μg/mL for healthy dogs and 30.98 μg/mL and
59.65 μg/mL for patients with sarcomas.
Conclusion: Significant hyperfibrinolysis was detected by tPA‐TEG in a group of canine
patients with sarcomas. The in vitro concentration of TXA necessary for normalizing
LY30/60 was markedly increased in this group compared to healthy dogs.
SERIAL EVALUATION OF HAEMOSTASIS BY ROTATIONAL THROMBOELASTOMETRY (ROTEM) IN DOGS
WITH ACUTE TRAUMA
Sigrist, NE, Muri, B, Herrero, Y, Jud Schefer, R
Vetsuisse Faculty University of Zurich, Zürich, Switzerland
Introduction: Acute traumatic coagulopathy (ATC) has been described in up to 34% of
human trauma patients and hyperfibrinolysis is common. ATC has been identified in
only a few dogs and the prevalence in dogs may be time‐dependent.
Objective: To prospectively describe changes in ROTEM parameters over time and determine
prevalence of ATC and hyperfibrinolysis in dogs with acute trauma.
Methods: Dogs presenting with acute (< 4 hours) trauma were included. EXTEM‐S, INTEM‐S,
FIBTEM‐S, and APTEM‐S parameters, thrombocyte count, animal trauma triage (ATT) score,
and lactate were evaluated within 4 hours after trauma and 6 and 24 hours after presentation.
ROTEM tracings were defined as hypo‐ or hypercoagulable if ≥ 2 of the following parameters
were above or below in‐house reference intervals: clotting time, clot formation time,
maximum clot firmness, maximum lysis, or maximum clot elasticity. ATC was defined
as ≥ 2 hypocoagulable ROTEM tracings.
Results: Twenty‐six dogs were included at presentation, 12 and 15 of these were analyzed
at 6 and 24 hours, respectively. At presentation, 6/26 dogs (23%) presented with ATC,
1 dog (4%) was hypercoagulable, 11/19 dogs (58%) were thrombocytopenic, and 4/25 dogs
showed hyperfibrinolysis (16%). At 6 hours, 1/12 (8%) dogs showed ATC. At 24 hours,
none of the dogs showed ATC, 6/15 (40%) were hypercoagulable, 5/10 (50%) were thrombocytopenic,
and 1/15 showed hyperfibrinolysis. In this preliminary data set, ATC was not associated
with trauma severity, hyperlactatemia, or survival.
Discussion: This study found a higher prevalence of ATC in dogs with trauma than previously
reported. As described in people, a hypocoagulable phase with hyperfibrinolysis shortly
after trauma is followed by a hypercoagulable phase after stabilization. Association
with trauma severity and shock remains to be investigated with larger studies.
Conclusion: Changes in coagulation parameters after trauma in dogs change over time.
Early after trauma, ATC including hyperfibrinolysis is present while hypercoagulability
predominates 24 hours after trauma.
QUALITY CONTROL ANALYSIS DURING STORAGE OF CANINE PACKED RED BLOOD CELLS (PRBC) UNITS
Soares, R
1, Ferreira, RRF1, Cardoso, IM1, Correia, S1, Mesa‐Sanchez, I1, Gopegui, RR2, Matos,
AJF3
1Animal Blood Bank, Porto, Portugal
2Department of Animal Medicine and Surgery, Veterinary Faculty, Barcelona, Spain
3Institute for Biomedical Sciences of Abel Sala, Porto, Portugal
Introduction: Packed cell volume, bacterial contamination and hemolysis during storage
are important pRBC quality parameters. A single report addressed this subject before,
however the significantly lower number of units tested was an important limitation.
Objectives: This study aims to evaluate a quality control program of stored canine
pRBCs with SAG‐MAN and the need for quality control analysis before administration
of units with more than 4 weeks, according the criteria established by Council of
Europe guidelines for human blood blanking.
Methods: According to the quality control protocol of a private blood bank, 20% of
the units produced (total of 1,114) were randomly evaluated until 6 hours after processing
(t = 0). Bacterial culture was determined, using aerobic culture bottles with specific
growth medium, along with hematocrit and hemolysis percentage. In order to ensure
the quality of stored units not yet used during the first 4 weeks, after 28–35 days
of storage (t = 1) and after 36–42 days (t = 2), a total of 1,244 and 697 pRBC units
were, respectively, tested.
Results: Two blood cultures tested positive to bacterial growth and a contaminant
Staphylococcus sp. was isolated. Mean hematocrit at t = 0 was 60.12%, 58.32% at t = 1,
and 58.55% at t = 2. Mean hemolysis at t = 0 was 0.1%, at t = 1 was 0.55%, and it
increased up to 0.65% at t = 2. In addition, 7.15% and 3.87% of pRBC units exceeded
0.8% hemolysis at t = 1 and t = 2, respectively.
Discussion/Conclusion: According to the Council of Europe's guidelines for human blood
banking, it is recommended that a maximum of 0.8% hemolysis be present in stored blood
units. The low number of positive cultures validates the sterility of the canine's
collection and pRBC production, confirming the safety of its use in transfusional
medicine. The low values of hemolysis and the hematocrit found after processing, also
validate the processing protocols used to produce this canine component. The pRBCs
units stored for more than 28 days should be tested for hemolysis before its use,
since 3.87% units exceeded the 0.8% limit of hemolysis.
ACVECC VetCOT Abstracts presented April 6–8, 2018, in Las Vegas, Nevada, USA At ACVECC
VetCOT Veterinary Trauma & Critical Care Conference
UTILIZATION OF THE VETMOUSE TRAP FOR WHOLE BODY COMPUTED TOMOGRAPHY IN POLYTRAUMA
PATIENTS
Dozeman, ET, Prittie, JE, Fischetti, AJ
The Animal Medical Center, New York, NY
Introduction: Trauma is a common presenting complaint to the emergency room (ER) and
rapid assessment of injuries is necessary. Imaging of trauma patients is important
to guide interventions, but should not delay resuscitative efforts. Use of whole body
computed tomography (WBCT) has become common practice within human emergency departments,
but less common within veterinary medicine. This is likely due to cost, accessibility,
and concern for general anesthesia in critical patients. VetMouse Trap was developed
to allow CTs to be performed in veterinary patients with minimal sedation and manipulation.
This advantage may circumvent concerns in polytrauma patients where excessive sedation
or anesthesia is ill‐advised, while allowing advanced imaging to be performed with
reduced stress to the patient.
Objective: Determine the safety, feasibility, and utility of the VetMouse Trap for
WBCT in polytrauma patients.
Methods: A prospective, observational study in a high volume private practice. Any
cat or dog weighing < 20 kg that presented to the ER following a polytrauma was eligible.
Patients were given analgesia and sedation per a proposed protocol prior to placement
in the VetMouse Trap. A WBCT was then performed.
Results: A total of 16 patients met inclusion criteria, with 8 dogs and 8 cats. All
patients presented with blunt trauma; 3 also had evidence of penetrating wounds. Five
(31.25%) patients met inclusion criteria for WBCT based on their neurological evaluation.
Five (31.5%) were nonambulatory with suspicion of orthopedic injury, and 37.5% met
additional criteria for WBCT. The most common areas of injury in this patient population
were head (43.7%), lungs (25%), and pelvis (25%). Four patients (25%) had evidence
of cavitary effusion that was not seen on FAST scan. No patient had any adverse events
during the CT.
Conclusion: This study demonstrated successful WBCT imaging of the sedated small animal
polytrauma patient with the VetMouse Trap.
CONCENTRATIONS OF PLASMA NUCLEOSOMES ARE PROGNOSTIC IN DOGS FOLLOWING TRAUMA
Letendre, JA1, Goggs, R
2
1Centre DMV, Montréal, Quebec, Canada
2Cornell University College of Veterinary Medicine, Ithaca, NY
Introduction: Trauma is common in dogs and causes significant morbidity and mortality,
but it remains a challenge to predict the prognosis of dogs with traumatic injuries.
Objective(s): To investigate plasma cell‐free DNA (cfDNA) and nucleosome concentrations
as prognostic biomarkers in canine trauma.
Methods: Forty‐nine dogs with trauma were consecutively enrolled and followed to hospital
discharge. Dogs were eligible for enrollment if they had an animal trauma triage (ATT)
score ≥ 3 at presentation. Dogs < 3 kg and those with pre‐existing coagulopathies
were excluded. Thirty‐three healthy control dogs were also enrolled. Illness and injury
severity scores were calculated. Plasma cfDNA was measured in triplicate using a benchtop
fluorometer. Plasma nucleosome concentrations were determined in duplicate by ELISA.
Mann–Whitney U tests were used to compare biomarker concentrations between groups
and between survivors and nonsurvivors. Associations between biomarkers were evaluated
using Spearman's correlation coefficients. Alpha was set at 0.05.
Results: Concentrations of cfDNA and nucleosomes were significantly higher in injured
dogs compared to controls (P ≤ 0.0001). Nucleosomes and cfDNA concentrations were
positively correlated (r
s 0.475, P < 0.001). Concentrations of both cfDNA and nucleosomes were correlated
with shock index (r
s 0.367, P = 0.010 and r
s 0.358, P = 0.012, respectively), but only nucleosomes were correlated with ATT (r
s 0.327, P = 0.022) and APPLE scores (r
s 0.356, P = 0.012). Median nucleosome, but not cfDNA concentrations, were significantly
higher in nonsurvivors 8.2 (3.1–26.4) than in survivors 1.6 (0.5–5.2) (P = 0.01).
Among illness severity scores, APPLE was most discriminant for survival (AUROC 0.912,
P < 0.001).
Conclusion: In moderately severely injured dogs, high nucleosome concentrations are
associated with nonsurvival.
CONCENTRATIONS OF HIGH MOBILITY GROUP BOX‐1 AND PROINFLAMMATORY CYTOKINES ARE INCREASED
IN DOGS FOLLOWING TRAUMA
Goggs, R
1, Letendre, JA2
1
Cornell University College of Veterinary Medicine, Ithaca, NY
2Centre DMV, Montréal, Quebec, Canada
Introduction: The pathophysiology of the response to trauma is complex, and the state
of the innate immune system following injury is poorly understood in dogs.
Objective(s): To quantify plasma cytokine concentrations in dogs after moderate‐to‐severe
trauma, and to evaluate them as potential prognostic markers.
Methods: Forty‐nine dogs with an animal trauma triage (ATT) score ≥ 3 at presentation
were consecutively enrolled and followed to hospital discharge. Dogs < 3 kg and those
with pre‐existing coagulopathies were excluded. Thirty‐three healthy control dogs
were also enrolled. Illness and injury severity scores were calculated. Plasma high‐mobility
group box‐1 (HMGB‐1) concentrations were measured by ELISA, and concentrations of
cytokines were measured using multiplex magnetic bead assays and with a canine‐specific
ELISA. All biomarkers were measured in duplicate. Mann–Whitney U tests were used to
compare biomarker concentrations between groups and between survivors and nonsurvivors.
Associations between biomarkers were evaluated using Spearman's correlation coefficients.
Independent outcome predictors were identified using multivariable logistic regression.
Alpha was set at 0.05.
Results: Plasma concentrations of HMGB‐1, interleukin‐6, C‐X‐C motif chemokine‐8,
keratinocyte chemoattractant‐like, and C‐C chemokine ligand‐2 were significantly greater
in injured dogs versus controls (all P ≤ 0.011). In univariate analyses, HMGB‐1 was
significantly greater in nonsurvivors compared to survivors 46.67 ng/mL (8.94–84.73)
versus 6.03 ng/mL (3.30–15.75) (P = 0.003). None of the cytokines was associated with
survival independent of illness severity as measured by the APPLE score, however.
Conclusion: Following moderate to severe injury, dogs have significantly increased
concentrations of HMGB‐1 and inflammatory cytokines. None of these cytokines are prognostic,
however.
ASSESSMENT OF A NOVEL PORTABLE VISCOELASTIC COAGULATION DEVICE IN DOGS SUFFERING POLYTRAUMA:
CASE SERIES EVALUATING INNOVATIVE BEDSIDE TECHNOLOGY
Mathis, JC, Acciacca, R
Colorado State University Veterinary Teaching Hospital, Fort Collins, CO, USA
Introduction: Viscoelastic testing provides information regarding the hypocoaguable
and hyperfibrinolytic tendencies of polytrauma. Bedside, point‐of‐care methods requiring
less skill and expense could revolutionize the clinical utility of this methodology.
Objective: Evaluate a novel bedside viscoelastic coagulation device, before and after
resuscitation, in 3 dogs suffering vehicular trauma.
Methods: Paired whole blood samples were obtained following vehicular trauma, pre‐
and postresuscitation for viscoelastic analysis. Viscoelastic variables reported were
clotting time (CT [seconds]), clot formation time (CFT), alpha angle (X), amplitude
at 10 minutes (A10) and 20 minutes (A20), maximum clot firmness (MCF), and lysis index
at 30 (LI30) and 45 (LI45) minutes.
Results: Preresuscitation CT, CFT, and pre‐α angles values were within normal limits
(mean pre‐CT = 182.3 s, mean pre‐CFT = 130.3 s, mean post‐CFT = 314.7 s). Postresuscitation
CT values were prolonged (mean = 589 s). All pre‐alpha angles, A10, and A20 values
were normal (mean pre‐alpha = 64.6°, mean pre‐A10 = 31.6, mean pre‐A20 = 37.6). Smaller
alpha angles and A10 and A20 values were noted at postresuscitation (mean post‐alpha = 37.3°,
mean post‐A10 = 20.3, mean post‐A20 = 30.7). Mean pre‐LI30 was 94.7% and post‐LI30
was 96%. Mean pre‐LI45 was 98% and mean post‐LI45 was 99.3%.
Conclusion: A trend toward hypocoaguability was seen following resuscitation and hospitalization.
This trend may be due to a combination of acute traumatic coagulopathy, loss of hemostatic
factors, as well as iatrogenic (ie, hemodilution). Further studies are necessary to
evaluate the utility of this novel viscoelastic device in veterinary patients.