SIRS/sepsis articles

Question 1

Inflammatory cytokine and C-reactive protein concentrations in dogs with systemic inflammatory response syndrome

Gommeren et al JVECC 2018

Answer 1

Dogs with SIRS had sig. elevated CRP levels and decreased during tx and hospitalization

CRP, IL-6, TNF-a can’t predict outcome

Question 2

The influence of inflammation and hematocrit on clot strength in canine thromboelastographic hypercoagulability

Marschner et al JVECC 2018

Answer 2

HCT, CRP, and IL-8 (inflammation) associated w/ overall clot strength in hypercoagulable tracing.

Ratio between Cyt D TEG MA and standard TEG MA may reflect plt activity

Question 3

Retrospective evaluation of plasma cholesterol concentration in septic dogs and its association with morbidity and mortality: 51 cases (2005–2015)

Hardy et al JVECC 2018

Answer 3

55% survival

Cholesterol level was not diff. b/w survivors and all nonsurvivors

Low plasma cholesterol associated w/ poor prognosis – lower in those who died despite tx vs survivor
Cut off 174 mg/dL 75% Sp 50% Sn in predicting in hospital mortality

Question 4

Determining prognosis in canine sepsis by bedside measurement of cell-free DNA and nucleosomes

Letendre and Goggs jvecc 2018

Answer 4

In septic dogs, high cfDNA conc relative to neut count associated w/ nonsurvival

Question 5

Evaluation of the placement and maintenance of central venous jugular catheters in critically ill dogs and cats

Reminga et al 2018

Answer 5

51% placement complication- dysrhythmias, hematoma, CVJC placement failure and malposition

Risk factor associated w/ multiple attempts: incr aged (10.5 vs 7.5y), smaller size (4 vs 8kg), lower BCS (4/9 vs 5/9)

The longer it is in place, the greater # of complications.

Indwelling complications- mechanical obstruction, skin irritation, malposition, inflammation

Risk factor of indwelling complications: longer indwelling time (5v3 days) and admin of irritant meds

Question 6

A preliminary investigation into the prognostic relevance of symmetric dimethylarginine in critically ill dogs

Köster et al jvecc 2018

Answer 6

SDMA no diff in CI vs control, survivor vs non survivor

Question 7

Retrospective evaluation of 4 methods for outcome prediction in overt disseminated intravascular coagulation in dogs (2009–2014): 804 cases

Gogg et al jvecc 2018

Answer 7

In-house RI system accurately predicted mortality

• modified Wiinberg using IH RI
• 3/5 parameters: aPTT, PT, fibrinogen, D-dimer and platelet count
• 72%Sn and 81% Sp

Overall DIC mortality was 63%

Question 8

Comparison of biomarkers adiponectin, leptin, C-reactive protein, S100A12, and the Acute Patient Physiologic and Laboratory Evaluation (APPLE) score as mortality predictors in critically ill dogs.

Köster et al jvecc 2019

Answer 8

Leptin = only biomarker that correlated to APPLEcomplete

APPLEcomplete and illness <1d associated w/ outcome

APPLE highest in dogs w/ infectious, immune-mediated dz, and bite wounds

Question 9

Cardiovascular biomarkers in dogs with systemic inflammatory response syndrome.

Gommeren et al jvecc 2019

Answer 9

“myocardial hibernation” = increased end-diastolic and end-systolic ventricular volumes, and systolic and diastolic ventricular dysfunction
-protective mechanism of the body during systemic inflammation

proBNP and cTnT increased significantly in dogs with SIRS
Nonsurvivor had higher cTnT

Question 10

Postmortem evaluation of renal tubular vacuolization in critically ill dogs.

Schmid, et al jvecc 2019

Answer 10

RTV noted in 85% of dogs and mostly localized to medullary rays

Cumulative 6% HES dose and presenting Cr sig. predictors of RTV severity

Question 11

Retrospective evaluation of the route and timing of nutrition in dogs with septic peritonitis: 68 cases (2007-2016).

Kristin M Smith et al jvecc 2019

Answer 11

Patients receiving PN had higher % RER earlier on but had decr odds of survival and incr LOH

Dogs receiving PN were more severely ill which may have contributed to results

Question 12

Clinical use of cryopoor plasma continuous rate infusion in critically ill, hypoalbuminemic dogs.

Christine A Culler, et al jvecc 2019

Answer 12

Pre- and post-infusion alb correlated w/ CPP rate where COP correlated w/ HES rate

Survivors younger than nonsurvivors

Question 13

Successful management of persistent tachycardia using esmolol in 2 dogs with septic shock.

Beer et al jvecc 2019

Answer 13

Combo of esmolol + norepi can incr SV and maintain MAP, CO, and CI

Question 14

Retrospective evaluation of 24 cases of gastrostomy tube usage in dogs with septic peritonitis (2009-2016).

Hansen et al jvecc 2019

Answer 14

75% survived to discharge
50% had complications, 33% had GT- related complications

Nonsurvivors had longer time b/w GT placement to eating and GT dwell time

Question 15

Effect of peritoneal lavage on bacterial isolates in 40 dogs with confirmed septic peritonitis.

Marshall et al jvecc 2019

Answer 15

87.5% survival
1/3 less likely to develop MDR aerobic bacteria post-lavage
98% received appropriate ABX
Organisms: Escherichia coli, Clostridium perfringens, and Enterococcus faecalis

Question 16

Evaluation of the host cytokine response in dogs with sepsis and noninfectious systemic inflammatory response syndrome.

Robert Goggs and Jo-Annie Letendre. jvecc 2019

Answer 16

Septic dogs had increased concentrations of HMGB-1 and inflammatory cytokines (IL-6, CXCL8, and KC-like)

Increased CCL2 concentration is a negative prognostic indicator in dogs with sepsis

Question 17

Prognostic indicators in cats with septic peritonitis (2002-2015): 83 cases.

Scotti et al jvecc 2019

Answer 17

70% survival
Mostly GI perf (49%) rest primary SP (22%)

Higher BG = worse px
Appropriate ABX 4.4x more likely to survive

Question 18

Retrospective evaluation of outpatient canine parvovirus treatment in a shelter-based low-cost urban clinic

Kimberly Perley ScB, et al jvecc 2020

Answer 18

83% survival with outpatient tx

Increasing # of days w/ Cx prior to tx and incr BW during tx were associated w/ survival

Hypothermia (<37C) @ presentation associated w/ nonsurvival

Question 19

Identification of risk factors for recurrent secondary septic peritonitis following initial surgical treatment of secondary septic peritonitis in dogs

Fink et al 2020 jvecc

Answer 19

10% had RSSP - had lower albumin and higher PCV prior to 1st sx.

Dog @ higher risk of RSSP if more likely to be GI sepsis and if d/t GIFB.

RSSP survival rate 42.9%

Question 20

A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units

Galina M. Hayes BVSc, PhD, DACVS, DACVECC, et al jvecc 2020

Answer 20

Maintaining ICU patient:technician ratio at ≤4 to reduce errors

Question 21

Clinical evaluation of hyperimmune plasma for treatment of dogs with naturally occurring parvoviral enteritis

Rachel A. Acciacca et al, jvecc 2020

Answer 21

HIP 10 mL/kg vs saline 10 mL/kg during first 6h then tx’d with standard protocol

HIP had lower SI @ 24h, lower plasma lactate @ 24h. No diff in LOH or mortality.

Question 22

Delayed type III hypersensitivity reaction with acute kidney injury in two dogs following administration of concentrated human albumin during treatment for hypoalbuminemia secondary to septic peritonitis

Mazz et al, jvecc 2020

Answer 22

2 septic peritonitis dogs with delayed-type III hypersensitivity after 25% HSA

11 and 18 days after initial infusion –> inappetence, V+, lameness to urticaria, peripheral angioedema, petechiae; both developed azotemia, hypoAlb, proteinuria

Histopath = immune complex deposit and vasculitis

Question 23

Noise levels in an academic veterinary intensive care unit

Dornbusch et al jvecc 2020

Answer 23

Average decibel level is 77 – higher than WHO recommended levels

Loudest 6-9a and 6-9p

Question 24

Prognostic value of dyslipidemia for sick dogs hospitalized in the intensive care unit of a veterinary teaching hospital

Austin K. Viall et al, javma 2018

Answer 24

Hypocholesterolemia and hypertriglyceridemia, alone or in combination were negative prognostic indicators for survival of dogs

Question 25

Evaluation of serum cortisol concentration as a prognostic indicator for nonsurvival to hospital discharge in critically ill dogs

Harry Swales, et al javma 2020

Answer 25

Nonsurvivor had higher serum cortisol (8.5 vs 4.5) – cutoff at 7.6

Multifactorial cause in incr SC: incr activity of HPA, incr catecholamine release, proinflammatory cytokines, ACTH-independent adrenal steroidogenesis

Question 26

Prognostic value of serum total thyroxine concentration at admission to an intensive care unit for critically ill dogs

Dana J. Neiman et al javma 2020

Answer 26

No sig. association b/w serum TT4 and survival to discharge or LOH
Older dogs less likely to survive than young dogs

Question 27

Evaluation of a new chest physiotherapy technique in dogs with airway fluid accumulation hospitalized in an intensive care unit

Céline Pouzot-Nevoret et al, jvecc 2018

Answer 27

Prolonged slow expiration (PSE): manual compression of thorax aimed at achieving distal airway flow limitation at low lung volume to facilitate lung clearance

Assisted cough (AC)- brief pressure applied to trachea to facilitate large airway clearance

No sig. in SpO2 before or after CP session
No different in survival b/w group
Well tolerated w/ minimal discomfort

Question 28

Incidence of hypochloremic metabolic alkalosis in dogs and cats with and without nasogastric tubes over a period of up to 36 hours in the intensive care unit

Annie Chih et al jvecc 2018

Answer 28

Intermittent NGT aspiration was not associated w/ development of HCMA up to 36h post placement

Question 29

Evaluation of serum 25-hydroxyvitamin D (25-OH-D) concentrations in a heterogeneous canine ICU population.

Dava M Cazzolli et al jvecc 2019

Answer 29

25-OH-D = Calcifediol

Low level found in 25% of CI dogs and esp. in nonsurvivors

Weak correlation b/w 25-OH-D to APPLEfast, albumin,

Question 30

Immune Function in Critically Ill Dogs

D. Hoffman et al jvim 2018

Answer 30

Evaluated constitutive + LPS induced TNF-a, IL-6 and IL-10 production, phagocytosis of E. coli and resp burst capacity

CI have immune dysfunction- reduced respiratory burst function and cytokine production despite upregulation of TLR-4

Question 31

Use of 2-dimensional speckle-tracking echocardiography to assess left ventricular systolic function in dogs with systemic inflammatory response syndrome.

Andrea Corda, jvim 2019

Answer 31

SIRS dog had lower ejection fraction, compared to healthy dog

Question 32

Evaluation of plasma angiopoietin-2 and vascular endothelial growth factor in healthy dogs and dogs with systemic inflammatory response syndrome or sepsis.

Maya König, et al jvim 2019

Answer 32

Ang-2 and VEGF are regulator of endothelial permeability

Found that Ang-2 was higher in SIRS and septic dogs, higher in non-survivor, predicted -ve outcome reasonably (AUC 0.75)
-cutoff plasma concentration of 25.3 ng/mL

Plasma VEGF higher in septic than SIRS dog, and higher in non-survivor, poor ability to predict -ve outcome

Question 33

Serum procalcitonin concentrations in dogs with induced endotoxemia

Frankie Easley et al jvim 2020

Answer 33

PCT increased after experimentally induced sepsis

Why? Incr CALC-I gene expression and incr PCT production by extra-thyroidal tissues

Question 34

Serum D‐lactate concentrations in dogs with parvoviral enteritis

Emilee C. Venn et al jvim 2020

Answer 34

D-lactate higher in dogs w/ CPV compared to healthy control

Question 35

NEJM 2018

Adjunctive glucocorticoid therapy in patients with septic shock

Answer 35

hydrocortisone CRI didn’t lower 90d mortality compared to placebo in septic shock patients undergoing MV

Question 36

NEJM 2018

CRIC-TRIGGERSEP: Hydrocortisone + fludrocortisone for adults with septic shock

Answer 36

90d all cause mortality lower in those who received hydrocortisone + fludrocortisone than placebo

Question 37

SPICE III: Early Sedation with Dexmedetomidine in Critically Ill Patients.

NEJM 2019

Answer 37

For those undergoing MV, those who received early dexmed had similar 90d mortality than those who didn’t

More adverse event in dexmed group (bradycardia, hypotension)

Question 38

CCM 2019
Renal Outcomes of Vasopressin and Its Analogs in Distributive Shock: A Systematic Review and Meta-Analysis of Randomized Trials.

Answer 38

Use of vasopressin or its analogue associated w/ reduced need for RRT and AKI incidence
Highly biased

Question 39

CCM 2019
Vasopressin Versus Norepinephrine for the Management of Septic Shock in Cancer Patients: The VANCS II Randomized Clinical Trial.

Ludhmila Abrahão Hajjar et al

Answer 39

In cancer patients with septic shock, vasopressin as first-line vasopressor therapy was not superior to norepinephrine in reducing 28-day mortality rate.

Question 40

CCM 2019

Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock.

Answer 40

Failure to reach 30by3 was associated with increased odds of in-hospital mortality, irrespective of comorbidities

Predictors of inadequate resuscitation: elderly, obese, end-stage renal dz, heart dz, or documented volume overload

Question 41

CCM 2019

The Restrictive IV Fluid Trial in Severe Sepsis and Septic Shock (RIFTS): A Randomized Pilot Study.

Answer 41

restrictive <60 mL/kg IV

restrictive therapy can reduce the amount of IVF given
small sample size but no diff in mortality, organ failure or adverse effects

Question 42

CCM 2020

Beneficial Effects of Vasopressin Compared With Norepinephrine on Renal Perfusion, Oxygenation, and Function in Experimental Septic Acute Kidney Injury

Answer 42

Using vasopressin had more sustained improvement in renal function w/o worsening renal ischemia, hypoxia, or reducing mesenteric BF compared to norepi