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Flashcards in Journals Deck (25):
1

What were the main points of a case report by Lynch et al detailing acute tracheal compression in a large breed dog due to a dorsal tracheal membrane abscess?

 

Lynch et al. Acute tracheal compression in a large breed dog due to a dorsal tracheal membrane abscess. JVECC 2015 25 (6) 

Tracheal collapse/obstruction was identified on radiographs in this patient, determined to be static on tracheoscopy

Suppurative inflammation was found from an FNA of a fluid filled structure dorsal to the trachea identified with ultrasound

Surgical exploration revealed an abscess in the dorsal tracheal membrane

Post-operatively the dog developed a pneumothorax and pneumomediastinum, likely secondary to surgical approach worsened by PPV. 

Culture revealed Streptococcus. Dog recovered uneventfully. 

2

What were the primary points from a case report by Garber et al detailing the development of pneumothorax in a dog following heat stroke? 

 

Garber et al. Pneumothorax in a dog caused by necrotizing pneumonia secondary to heatstroke. JVECC 2015 25 (6)

Dog presented for respiratory distress 12 days after an episode of exertional heat stroke

CT showed bilateral pneumothorax and consolidation of lung lobes; sternotomy showed multifocal consolidation at the periphery of multiple lung lobes which was resected

Histopath confirmed necrotizing pneumonitis, grew Pseudomonas

Necrotizing myopathy was found on a pectoral muscle biopsy;

Multifocal necrotizing pneumonia with/without pneuothorax should be considered as a differential in dogs that develop respiratory distress following severe systemic illness. 

3

What were the major findings of a review by Stillion and Letendre regarding canine pneumothorax? 

(Not any of the pathophysiology necessarily...)

 

Stillion, Letendre. A clinical review of the pathophysiology, diagnosis and treatment of pyothorax in dogs and cats. JVECC 2014 35 (1)

Optimal treatment to ensure successful short and long-term outcome, including the avoidance of recurrence, is unknown

Prognosis can be good

83% survival in dogs, 62% in cats 

4

What were the primary points from a case series by Pigott et al regarding H1N1 in cats? 

 

Pigott et al. Acute bronchointerstitial pneumonia in two indoor cats exposed to the H1N1 influenza virus. JVECC 2014 24(6)

Two indoor DSH from the same household were presented for severe respiratory signs; managed aggressively with one requiring mechanical ventilation 

Both were ultimately euthanized. 

Histopath revealed severe diffuse bronchointerstitial pneumonia; 2009 influenza AH1N1 testing by real time PCR was positive in one cat. 

Domestic felids are susceptible to this strain; should be considered in the ddx list. Seems possible that human-to-cat transmission can occur. 

5

What were the major findings of a study by Holowaychuk et al evaluating a transcutaneous blood gas monitoring system in critically ill dogs?

 

Holowaychuk et al Evaluation of a transcutaneous blood gas monitoring system in critically ill dogs. JVECC 2014 24(5)

Agreement between transcutaneous and arterial PO2 and PCO2 measurements in the dogs studied were inferior to those reported in the human literature

 

The cutaneous monitor consistently overestimated both PO2 and PCO2 and should not be used to replace arterial blood gas monitoring

6

What were the major points of a retrospective study of feline secondary spontaneous pneumothorax by Liu et al?

 

Liu and Silverstein. Feline secondary spontaneous pneumothorx: a retrospective study of 16 cases. JVECC 2014 24 (3)

Secondary causes include asthma, heartworm, neoplasia, PTE, abscesses...

Asthma was the most common cause of SSP in this study (25%); had a good prognosis for survival to discharge with medical management only 

Clinical assessment, imaging and invasive diagnostics were required to differentiate AASSP from NAASSP

7

What were the major conclusions from a case series evaluating the use of autologous blood patch treatment for persistent pneumothorax in dogs? 

Oppenheimer et al. Retrospective evalution of the use of autologous blood patch treatment for persistent pneumothorax in 8 dogs. JVECC 2014 24 (2)

62.5% success after 1 round, 87% after 1-2 additional times

Success rate of thoracotomy/lobectomy for persistent pneumo is 88% in dogs; suggests that blood patch pleurodesis may be a viable alternative in dogs that are poor surgical candidates or for whom surgery is declined

MOA suggested-->eiter a true pleurodesis resulting in pleural adhesions (blood generates an inflammatory reaction that may contribute to adhesion between parietal and visceral pleura) versus sealing the site of the leakge with blood clots

Most common complication in people is empyema; documented in 2/8 dogs in this study, resolved in one and other was euthanized. 

8

What were the major conclusions of a retrospective study by Wormser at al regarding TAPS for partial/complete lung lobectomy in dogs and cats? 

 

Wormser et al. Thoracoscopic-associated pulmonary surgery for partial and complete lung lobectomy in dogs and cats: 11 cases (2008-2013). JAVMA 2014 245

11 animals underwent successful TAPs for lung lobectomy without observed intraoperative complication. 

 

TAPS may offer a more technically feasible approach as compared to thoracotomy because it provides the benefits of minimally invasive thoracic surgery without the necessity of 1 lung ventilation. 

9

What were the major conclusions of a study by Woods et al comparing the fluid obtained by manual aspiration with a syringe versus via a suction device during BAL?

 

Woods et al. Comparison of BAL fluid obtained by manual aspiration with a handheld syringe with that obtained by automated suction pump aspiration from health dogs. JAVMA 2014 75. 

BAL by SPA resulted in a significantly higher percentage of fluid retrieval and samples with higher TNCC than did MA. 

 

 

10

What were the primary findings of a study by Rubin et al examining dynamic pharyngeal collapse in dogs? 

 

Rubin et al. Signalment, clinical presentation, concurrent diseases and diagnostic findings in 28 dogs with dynamic pharyngeal collapse. JVIM 2015 29.

Pharyngeal collapse is a complex disease process that is likely secondry to long-term negative pressure gradients and anatomic/functional abnormalities. 

The most common concurrent disease processes in these dogs were mainstem bronchi collapse, tracheal collapse, and brachycephalic airway syndrome. 

 

Pharyngeal fluoroscopy may be a useful diagnostic test. 

11

What were the major findings of a study by Viitanen et al examining co-infections with respiratory viruses in dogs with bacterial pneumonia? 

 

Viitanen et al. Co-infections with respiratory viruses in dogs with bacterial pneumonia. JVIM 2015. 

Canine parainfluenza virus and canine respiratory coroonavirus were identified in 8/20 dogs with bacterial pneumonia. 

In dogs with bordatella tracheobronchitis, no respiratory viruses were dectected. 

Clinical variables and disease severity did not differ in dogs with BP with and without viral coinfection. 

12

What was the major conclusion of a study by Viitanen et al evaluating serum CRP as a biomarker in dogs with bacterial respiratory disease?

 

Viitanen et al. Serum CrP as a diagnostic biomarker in dogs with bacterial respiratory distress. JVIM 2014 28.

Dogs with bacterial pneumonia had significantly higher CRP concentrations (121) as compared to dogs with bacterial tracheobronchiis (23), chronic bronchitis, eosinophilic bronchopneumoathy, cardiogenic pulmonary edema or healthy controls. 

CRP is a major acute phase protein in dogs and has potential use as an additional biomarker when diagnosing BP.

13

What were the major conclusions of a study by Papazian et al evaluating the use of NMB in early ARDS?

 

Papazian et al. Neuromuscular blockers in early acute respiratory distress syndrome. NEJM 2010. 363 (12)

*supplemental article list

  • Treatment with the NMB cisatricurium for 48 hours early in the course of severe ARDS improved the adjusted 90-day survival rate, increased the numbers of ventilator free days and days outside the ICU and decreased the incidence of barotruama during the first 90 days.
  • It did not significantly improve the overall 90 day mortality. 

14

What were the major findings of a study by Pang et al evaluating the ETCO2 sampled via a nasal catheter in comparison to PaCO2 in dogs? 

 

Pang et al. Partial pressure of EtCO2 sampled via an intranasal catheter as a substitute for partial pressure of arterial CO2 in dogs. JVECC 2007 17.

*Supplemental article

  • The results of this study demonstrate that EtCO2 monitoring via a nasal catheter is a clinically acceptable substitute to arterial blood gas analysis as a means of monitoring ventilation in healthy, sedated dogs. 
  • In both the group receiving nasal O2 supplementation and the group not receiving nasal O2 supplementation, the EtCO2 measurement underestimated for the PaCO2, however, the limits of agreement were found to be within acceptable limits. 

15

What were the major findings of the ALIEN study?

 

Villar et al. The ALIEN study: incidence and outcome of ARDS in the era of lung protective ventilation. Intensive Care Med 2011. 37. 

*Supplemental article

  • The incidence of ARDS was identified to be 7.2/100,000 population/year
  • Pneumonia and sepsis were the most common causes of ARDS
  • Overall ARDS ICU and hospital mortality were 43% and 48% respectively (despite the use of lung protective ventilation)

16

What were the major conclusions of a study by Foronda et al regarding the impact of daily SBT on the duration of pediatric MV?

 

Foronda et al. The impact of daily evaluation and SBT on the duration of pediatric mechanical ventilation: a randomized controlled trial. CCM 2011.

**Supplemental article 

  • A daily evaluation to check readiness for weaning combined with a spontaneous breathing test reduced the MV duration for children on MV for >24 hours without increasing the extubation failure rate or the need for non-invasive ventilation

17

What were the primary findings of a study by Shulz et al examining respiratory viruses and bordetella bronchiseptica in dogs with acute respiratory tract infections? 

 

The Vet Jrnl 201 2014

  • Clinically healthy dogs carred CAV-2, CPIV, and B. bronchiseptica
  • Co-infections in affected dogs were common
  • Clinically healthy dogs can carry respiratory pathogens and act as infection sources for susceptible dogs

18

What were the findings in a study by Caivano et al of ultrasonographic findings and outcomes in dogs with suspected migrating intrathoracic grass awns? 

 

JAVMA 2016 248

  • Transthoracic or transesophageal US revealed grass awns in the pulmonary parenchyma or the pleural space of 23 of the 43 dogs in the study
    • Surgical removal was successful in these cases
  • 20 dogs with suspicion for migrating grass awn did not have identified fb on initial US and were treated medically, however, 16 of them ultimately developed draining fistulas and awns that were identified with US at follow up visits were removed from the sublumbar retion or thoracic wall. 
  • US may be considered a valuable and readily available diagnostic tool for monitoring dogs with suspected migrating intrathoracic grass awns

19

What were the findings of a study by Wilson and Monnet regarding risk factors for the development of aspiration pneumonia after unilateral arytenoid lateralization in dogs with lar par (232 cases)?

 

JAVMA 2016 248

  • The presence of pre-operative pneumonia was not a risk factor for post-operative development of aspiration
  • Postoperative megaesophagus and postoperative administration of opioid analgesics prior to discharge were significant risk factors for long term development of AP
  • Perioperative metoclopramide did not significantly decrease the risk for development of AP

20

What were the findings of a study by Grobman and Reinero regarding NK-1 receptor antagonism as a novel treatment for chronic bronchitis in dogs? 

 

JVIM 2016 

  • Neurogenic pathways mediated by tachykinins that bind NK1 receptors may induce cough and airway inflammation 
  • Maropitant seemed to have anti-tussive properties resulted in perceived clinical improvement, however, on repeated BAL, markers of airway inflammation were not decreased, therefore, it is not a suitable method to treat canine chronic bronchitis. 

21

What were the findings of a study by Herreria-Bustillo et al regarding the use of cervical ultrasound to confirm ET intubation in dogs? 

 

JVECC 2016 26 5

  • Cervical US has high sensitivity and moderate specificity for ET intubation and may be a useful tool to confirm intubation in dogs

22

What were the findings of a study by Hardie evaluating a translaryngeal percutaneous arytenoid lateralization technique in a canine cadaveric study? 

 

JVECC 2016 26 5

  • TPAL was effective at enlarging the rima glottidis in the canine cadaveric model 
  • It is rapid to perform and doesn't require specialized instrumentation 
  • May be an alternative to temporary trach in dogs with severe resp distress related to lar par

23

What were the results of a study by Keir et al regarding retrospective evaluation of the effect of high flow O2 therapy delivered by nasal cannula on PaO2 in dogs with moderate to severe hypoxemia?

 

JVECC 2016 26 4

  • High flow oxygen was delivered by high flow nasal prongs to dogs assessed clinically to be failing TOTs. 
  • HFOT was able to significantly improve PaO2 compared to TOT in severely hypoxemic dogs. 
  • Complications included discomfort requiring light sedation in 1/6 dogs and persistence of a pneumo in one dog 

24

What were the findings of a study by Fantoni et al comparing the cardiopulmonary effects of PCV and VCV in healthy anesthetized dogs? 

 

JVECC 2016 26 4 

  • Compared to spontaneous ventilation, both modes significantly improved gas exchange without hemodynamic impairment. 
  • PCV resulted in higher lung static compliance and lower PIP as compared to VCV 

25

What were the findings of a study by Carver et al evaluating PaO2/FiO2 and SaO2/FiO2 ratios in postop dogs recovering on room air or nasal oxygen insufflation?

 

JVECC 2016 26 3

  • PaO2/FiO2 and SaO2/FiO2 had excellent correlation. 
  • Further evaluation into the correlation between SaO2/FiO2 or pulse oximeter oxygen saturation (SpO2)/FIO2 with PaO2/FiO2 in healthy dogs and those with pulmonary dysfunction is warranted