Respiratory insufficiency and pulmonary health are important considerations in equine neonatal care. As the majority of foals are bred for athletic pursuits, strategies for respiratory support of compromised foals are of particular importance. The administration of supplementary oxygen is readily implemented in equine practice settings, but does not address respiratory insufficiency due to inadequate ventilation and is no longer considered optimal care for hypoxia in critical care settings. Non-invasive ventilatory strategies including continuous or bi-level positive airway pressure are effective in human and veterinary studies, and may offer improved respiratory support in equine clinical practice. The current study was conducted to investigate the use of a commercial bi-level positive airway pressure (BiPAP) ventilator, designed for home care of people with obstructive respiratory conditions, for respiratory support of healthy foals with pharmacologically induced respiratory insufficiency. A two sequence (administration of supplementary oxygen with, or without, BiPAP), two phase, cross-over experimental design was used in a prospective study with six foals. Gas exchange and mechanics of breathing (increased tidal volume, decreased respiratory rate and increased peak inspiratory flow) were improved during BiPAP relative to administration of supplementary oxygen alone or prior studies using continuous positive airway pressure, but modest hypercapnia was observed. Clinical observations, pulse oximetry and monitoring of expired carbon dioxide was of limited benefit in identification of foals responding inappropriately to BiPAP, and improved methods to assess and monitor respiratory function are required in foals.

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BackgroundThis study aimed to compare the distribution of ventilation measured by electrical impedance tomography (EIT), in foals under varying clinical conditions of sedation, postural changes, and continuous positive airway pressure (CPAP). To support the interpretation of EIT variables, specific spirometry data and F-shunt calculation were also assessed.Materials and methodsSix healthy Thoroughbred foals were recruited for this sequential experimental study. EIT and spirometry data was recorded: (1) before and after diazepam-sedation, (2) after moving from standing to right lateral recumbency, (3) in dorsal recumbency during no CPAP (CPAP0) and increasing levels of CPAP of 4, 7, and 10 cmH2O (CPAP4, 7, 10, respectively). Ventral to dorsal (COVVD) and right to left (COVRL) center of ventilation, silent spaces, tidal impedance variation, regional ventilation distribution variables and right to left lung ventilation ratio (R:L) were extracted. Minute ventilation was calculated from tidal volume (VT) and respiratory rate. F-Shunt was calculated from results of arterial blood gas analysis. Statistical analysis was performed using linear mixed effects models (significance determined at p < 0.05).Results(1) Respiratory rate was lower after sedation (p = 0.0004). (2) In right lateral recumbency (compared to standing), the COVVD (p = 0.0012), COVRL (p = 0.0057), left centro-dorsal (p = 0.0071) and dorsal (p < 0.0001) regional ventilation were higher, while the right ventral (p = 0.0016) and dorsal (p = 0.0145) regional ventilation, and R:L (p = 0.0017) were lower. (3) Data of two foals for CPAP10 was excluded from statistical analysis due to prolonged apnea. Stepwise increase of CPAP led to increases of COVVD (p = 0.0028) and VT (p = 0.0011). A reduction of respiratory rate was detected with increasing CPAP levels (p < 0.0001).Conclusions(1) In healthy foals, diazepam administration did not alter distribution of ventilation or minute ventilation, (2) lateral recumbency results in collapse of dependent areas of the lung, and (3) the use of CPAP in dorsal recumbency at increasing pressures improves ventilation in dependent regions, suggesting improvement of ventilation-perfusion mismatch.

Respiratory insufficiency and pulmonary health are important considerations in equine neonatal care, as the majority of foals are bred for athletic function. The administration of supplementary oxygen is readily implemented in equine practice settings, but this does not address respiratory insufficiency due to inadequate ventilation and is no longer considered optimal care for hypoxia in some settings. Non-invasive ventilatory strategies including continuous or bi-level positive airway pressure are effective in human and veterinary studies, and may offer improved respiratory support in equine clinical practice. The current study was conducted in two parts to investigate the use of a commercial bilevel positive airway pressure (biPAP) ventilator, designed for home care of people with obstructive respiratory conditions, for respiratory support of foals. In Part 1 a prospective observational study was conducted to evaluate the effect of sequential application of supplementary oxygen and then biPAP for respiratory support of five foals ≤ 4 days of age hospitalised with respiratory in sufficiency (Group 1) and four healthy, sedated foals < 28 days of age (Group 2). In Part 2, biPAP and supplementary oxygen were administered to six healthy foals with pharmacologically induced respiratory insufficiency in a two sequence, two phase, cross-over study (Group 3). Non-invasive ventilation by biPAP improved gas exchange and mechanics of breathing (increased tidal volume, decreased respiratory rate and increased peak inspiratory flow) in foals, but modest hypercapnia was observed in healthy, sedated foals (Groups 2 and 3). Clinical cases (Group 1) appeared less likely to develop hypercapnia in response to treatment, however the response in individual foals was variable, and close monitoring is necessary. Clinical observations, pulse oximetry and CO2 monitoring of expired gases were of limited benefit in identification of foals responding inappropriately to biPAP, and improved methods to assess and monitor respiratory function are required in foals.