Respiratory articles Flashcards
Postoperative regurgitation and respiratory complications in brachycephalic dogs undergoing airway surgery before and after implementation of a standardized perianesthetic protocol
Renata S. Costa et al, javma 2020
Protocol:
- pre-op famotidine 1 mg/kg and reglan 0.5 mg/kg
- avoid peri-op opioids, admin 0.15 mg/kg IV dexSP before airway sx
- post-op recovery in ICU, delay extubation until fully alert, nasotracheal/HFNC to aid recovery, sedation PRN, monitor temp/c+/nasal d/c
Implementation reduced post-op regurgitation (35–>9%)
Hx of R+ pre-op was associated w/ development of post-op R+
Anesthetic risk during subsequent anesthetic events in brachycephalic dogs that have undergone corrective airway surgery: 45 cases (2007–2019)
Crystal R. Doyle, et al javma 2020
Having BOAS sx decreased post-ax complication by 79%
Intraop bradycardia increased risk of post-op complication
Every 15 minute increased in ax time increased odds of having intra-oax complication and post-ax complication
Effect of ultraviolet germicidal irradiation of the air on the incidence of upper respiratory tract infections in kittens in a nursery
Robyn A. Jaynes, et al javma 2020
UV irradiation - 1 within heating/ventilation/AC system and 1 within ceiling
Incidence of URI decreased by 87.1%
Short-, intermediate-, and long-term results for endoluminal stent placement in dogs with tracheal collapse
Chick Weisse et al javma 2019
93% survived to discharge, MST almost 3 years
Majority had improved goose-honking and dyspnea
Younger male dogs had longer MST
Mainstem bronchi collapse didn’t affect MST
Tracheal infection/pneumonia, stent fx and tissue ingrowth are most common complications
Long-term outcome and risk factors associated with death or the need for revision surgery in dogs with permanent tracheostomies
Janet A. Grimes et al javma 2019
- 35% revised; brachy more likely
- 61% had major complications: aspiration pneumonia, skinfold occlusion, stoma stenosis
- MST shorter if received steroids before trach, had tracheal collapse or older
usually for LC or LarPar
Lung ultrasonography findings in dogs with various underlying causes of cough
Jessica L. Ward et al javma 2019
- Bacterial pneumonia -> subpleural shred signs
- Neoplasia -> subpleural nodule signs
- Dogs with CPE had higher total B-line scores and higher numbers of LUS sites strongly positive for B lines (> 3 B lines/site) than other dogs
- B lines >10 and >2 sites strongly +ve for B-lines was 92% Sn and 94% Sp for cardiogenic PE
Distribution of alveolar-interstitial syndrome in dogs and cats with respiratory distress as assessed by lung ultrasound versus thoracic radiographs
Jessica L. Ward et al jvecc 2018
LUS and TXR were both useful
-LUS more useful in cranial and TXR more useful in caudal quadrant
LUS detected high incidence of AIS compared to TXR
CPE = diffuse AIS Pneumonia = Unilateral Airway/neuro = absence of AIS in all quadrants
Risk factors, characteristics, and outcomes of acute respiratory distress syndrome in dogs and cats: 54 cases.
Ludivine Boiron, et al jvecc 2019
Dogs= more pulmonary causes, main risk factor pneumonia Cats= mixed direct/indirect causes, main risk SIRS
49% vented
Mortality: 84% in dogs 100% in cats
Comparison of high flow nasal cannula oxygen administration to traditional nasal cannula oxygen therapy in healthy dogs.
Tiffany A Jagodich, et al jvecc 2019
CPAP achieved at 1-2 L/kg/min (recommended)
FiO2 at all HF rate > 1L/kg/min achieved 95%
Complication =aerophagia
**Nasal cannula at 100 ml/kg/min only achieve FiO2 0.27 (SACCM reports 0.37) –> need at least 100+ ml/kg/min
Evaluation of pulse oximetry as a surrogate for PaO2 in awake dogs breathing room air and anesthetized dogs on mechanical ventilation.
Kate S Farrell, et al jvecc 2019
SpO2 is not a surrogate for PaO2 though better with ventilated patient
Cutoff of PaO2 <80 mmHg for hypoxemia correlated to SpO2 of 95% with 77% sp and 89.5 Sn
–7% of the time SpO2 can’t detect hypoxemia and false +Ve for SpO2
Continuous positive airway pressure (CPAP) provision with a pediatric helmet for treatment of hypoxemic acute respiratory failure in dogs
Gianila Ceccherini, et al jvecc 2020
Able to deliver CPAP for those w/ hypoxemic resp failure
PaO2, A-a gradient, PF ratio, %SO2 improved 1h post helmet
Development of a tension pneumomediastinum during mechanical ventilation of a young Irish Wolfhound
Kristin M. Zersen et al jvecc 2020
In people 2dry pneumomediastinum most commonly caused by blunt force trauma or MV
Progressive CVS collapse despite -ve pressure obtained through chest tube
Suspect 2ry to overdistension + alveoli rupture –> dissection of air into perivascular space and tracking of air to the pulmonary hilum and mediastinum (Mackin effect)
High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure in 22 dogs requiring oxygen support escalation
Tiffany A. Jagodich et al jvecc 2020
High flow decreased RR at 1h and dyspnea score, and increased SpO2.
60% of dogs responded to HFNC by 30 mins. 45% of responder survived.
Successful tracheoscopy-assisted reconstruction of traumatic tracheal avulsion in a cat
Michelle R. Joffe et al jvecc 2020
Intrathaoracic tracheal avulsion after HBC –> tracheoscopic assisted tracheal anastomosis –> did well
Preliminary evaluation of the use of high-flow nasal cannula oxygen therapy during recovery from general anesthesia in dogs with obstructive upper airway breathing
Tiffany A. Jagodich, et al jvecc 2020
HFNC reduced dyspnea score and stertor post-ax –> IMPROVED AIRFLOW
Can cause aerophagia and hypercapnia
Hypercapnia? Increased sedation/opioid OR increased resistance to exhalation during high gas flow.
Usually normocapnia maintained in BAS dog from improved airflow + nasopharyngeal washout by HF
Evaluation of the effects of helmet continuous positive airway pressure on laryngeal size in dogs anesthetized with propofol and fentanyl using computed tomography
Vincenzo Rondelli DVM et al jvecc 2020
CPAP 5 cmH2O
Laryngeal volume and cross-sectional area increased during CPAP
Helmet CPAP may be helpful to maintain upper airway patency in non-intubated dogs
Seizure activity following atracurium continuous rate infusion in three mechanically ventilated juvenile dogs
Rebekah E Donaldson et al jvecc 2020
2-3 months old
Post-atracurium CRI for vent had seizures in first 24h post extubation
atracurium degraded into laudanosine which has been associated w/ CNS excitement + sz in people – maybe this is what caused it
Quality of life following mechanical ventilation in dogs and cats
Rebekah E. Donaldson, et al jvecc 2020
Minimal change to QoL, more likely in those vented for neuro reasons
All pet owners said would vent again
Immediate, short-, and long-term changes in tracheal stent diameter, length, and positioning after placement in dogs with tracheal collapse syndrome
Matthew Raske, jvim 2018
Intraluminal tracheal stenting associated w/ minimal, acceptable and predictable stent shortening and no clinically relevant migration
Malformed tracheas have less stent shortening - maybe d/t abnormal cartilage rings limiting expansion
Clinical features of canine pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis.
Carol R Reinero, et al jvim 2019
Acute onset resp distress
TXR: enlarged pulmonary arteries, right cardiomegaly and patchy or diffuse interstitial to alveolar patterns
MST 3 days
Recurrent bacterial pneumonia in Irish Wolfhounds: Clinical findings and etiological studies.
Sanna J Viitanen et al jvim 2019
Recurrent BP affects middle-aged IWH (median 5y) w/o immune deficit or primary ciliary defects
focal bronchiectasis is a common finding and likely contributes to development of pneumonia
Evaluation of metabolic profile and C-reactive protein concentrations in brachycephalic dogs with upper airway obstructive syndrome.
Paola Gianella, et al jvim 2019
BOAS dog have obstructive sleep apnea like syndrome
76% had GI signs
Esophageal deviation, cardia atony, distal esophagitis
87% laryngeal collapse
Incr glucose, fructosamine, triglyceride, CRP, lipoproteins, and chylomicrons
Correlations among tracheal dimensions, tracheal stent dimensions, and major complications after endoluminal stenting of tracheal collapse syndrome in dogs.
Nathaniel P Violette, et al jvim 2019
Complication (56%): stent fx, obstructive tissue growths, and progressive TC
Stent fx associated w/ nonsurvival
Higher taper in tracheal diameter may lead to increased stent fx in intrathoracic location
Dogs w/ tracheal malformation have higher risk of tracheal inlet fx and development of obstructive tissue growth
Eosinophilic bronchitis, eosinophilic granuloma, and eosinophilic bronchopneumopathy in 75 dogs (2006-2016).
Lynelle R Johnson, et al jvim 2019
EBP based on TXR, yellow-green mucus in airway, mucosal change + airway collapse
Dogs w/ EB less likely to have bronchiectasis or peripheral eosinophilia, lower TncC in BAL, and lower eosinophil % in BAL
EG= intraluminal mass or bronchoscopically diagnosed, had long survival (>55mo)
Clinical features and outcome in 25 dogs with respiratory‐associated pulmonary hypertension treated with sildenafil
Lynelle R. Johnson Joshua A. Stern jvim 2020
Syncope, c+, resp distress
PH-induced tracheobronchomalacia, PF, inflammatory airway dz, BOAS
Sildenafil responsiveness was variable but improved QoL in dogs surviving >1 month
Bacterial infection before and after stent placement in dogs with tracheal collapse syndrome
Sylvia Lesnikowski et al jvim 2020
No diff pre- and post-stent
Decr bacterial infection rate in geriatric dogs and stented dogs w/ traditional collapse
Risk factors for infection: hx of pneumonia and cardiac dz in older dogs; hepatomegaly in young dogs
Clinical features and radiographic findings in cats with eosinophilic, neutrophilic, and mixed airway inflammation (2011‐2018)
Elizabeth A. Lee et al jvim 2020
BAL samples
C+ is the most common presenting compliant
Eosinophilic inflammation in younger cats than those w/ neutrophilic or mixed inflammation
Survival characteristics and prognostic importance of echocardiographic measurements of right heart size and function in dogs with pulmonary hypertension
Lance C. Visser et al jvim 2020
RA area, RV function (TAPSE<3.23) and right-sided heart failure were independently associated w/ shorter survival
Clinical response to 2 protocols of aerosolized gentamicin in 46 dogs with Bordetella bronchiseptica infection (2012‐2018)
Aude Morgane Canonne et al jvim 2020
aerosolized 4mg/kg gentamicin >10 min q12h x 3 weeks
Aerosolized gentamicin works, undiluted 5% solution had better clinical response
CCM 2018
Nebulized vs IV amikacin as adjunctive ABX for hospital and VAP postcardiac sx
nebulized amikacin had better cure rates, less ICU stay, fewer days to reach complete recovery compared to IV amikacin
less nephrotoxic if nebulized
Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome.
NEJM 2019
no significant difference in mortality at 90 days between patients who received an early and continuous cisatracurium infusion
CCM2019
Incidence and Outcomes of Acute Laryngeal Injury After Prolonged Mechanical Ventilation.
Justin R Shinn et al
acute laryngeal injury occurred in 57% patients
Associated w/ sig. worse breathing and voicing 10w after extubation
NEJM 2020
PSP trial: Conservative versus Interventional Treatment for Spontaneous Pneumothorax
conservative was non-inferior with lower risk of adverse effects
conservative = no active chest tube
NEJM 2020
ICU-ROX: Conservative Oxygen Therapy during Mechanical Ventilation in the ICU
use of conservative O2 didn’t change vent-free days
conservative O2 = FiO2 decr to 0.21 and supplemental O2 d/c in patients who had been extubated if SpO2 above acceptable limit (90%)
NEJM 2020
Liberal or Conservative Oxygen Therapy for Acute Respiratory Distress Syndrome
ARDSnet rec target of PaO2 55-80 mmHg
liberal O2 (PaO2 90-105 mmHg) vs conservative (PaO2 55-70 mmHg) - no diff in survival
CCM 2020
Mechanical Ventilation Redistributes Blood to Poorly Ventilated Areas in Experimental Lung Injury
In experimental atelectasis with minimal tidal recruitment/derecruitment, mechanical inspiratory breaths redistributed blood volume away from well-ventilated areas, worsening PF ratio
CCM 2020
Mean Airway Pressure As a Predictor of 90-Day Mortality in Mechanically Ventilated Patients
Mean airway pressure different in survivor vs nonsurvivors (12 vs 13) and was predictive of 90d mortality
Assessment of the percutaneous dilatational tracheostomy technique in experimental manikins and canine cadavers.
Mariana A Pardo, et al jvecc 2019
Done via seldinger technique
No stat sig diff b/w procedure time and final test trach tube placement in PDT vs ST
Characterization of and factors associated with causes of pleural effusion in cats
Marina Domínguez Ruiz, javma 2018
23% mortality rate
Cause: CHF, neoplasia»_space; pyothorax, idiopathic chylothorax, trauma, FIP, non-traumatic DH
Cats w/ trauma or FIP were young.
Cats w/ LSA was younger than carcinoma.
Cats w/ CHF had lower rectal temp than all other cats
Risk of anesthesia-related complications in brachycephalic dogs
Michaela Gruenheid javma 2018
Brachycephalic dogs had higher pre and post-op ax complications
- Factors associated w/ high peri-ax complication: brachycephalic, longer duration of ax
- -> risk lowered w/ increasing BW and ortho/radiologic procedure (vs STSx)
-Higher post-ax complication: brachycephalic status, increasing ASA status, use of ketamine + BDZ (vs propofol +/- lidocaine), invasive procedures
Retrospective analysis of incidence, clinical features, potential risk factors, and prognostic indicators for aspiration pneumonia in three brachycephalic dog breeds
Hannah P. Darcy, javma 2018
Pugs had lower risk compared to bulldogs
Pugs had more neuro signs
Hx of GI signs most common risk factor
Increased age, male sex, obtundation, hypoalbuminemia, azotemia, and ELE were associated with nonsurvival
Risk factors for temporary tracheostomy tube placement following surgery to alleviate signs of brachycephalic obstructive airway syndrome in dogs
David B. Worth, javma 2018
Every 1 year incr in age incr odds of trach by 30%
Post-op use of steroids + presence of pneumonia associated w/ needing trach
(Resp distress + BCS NOT associated)
