Complications associated with long‐term positive‐pressure ventilation in dogs and cats: 67 cases

Cagle, Laura A.; Hopper, Kate; Epstein, Steven E

doi:10.1111/vec.13177

Cited by 6 publications

(9 citation statements)

References 77 publications

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“…Heavy sedation or a light plain of anesthesia is generally required to facilitate mechanical ventilation (16). A number of potential complications have also been reported in veterinary patients associated with mechanical ventilation including corneal and oral mucosal ulceration, hypothermia, positive fluid balance, ventilator-induced lung injury, ventilator-associated pneumonia and cardiovascular compromise (17)(18)(19). The prognosis for veterinary patients undergoing mechanical ventilation for conditions other than anesthesia-associated hypoventilation is variable and depends on the underlying condition (16).…”

Section: Figurementioning

confidence: 99%

Clinical review of high-flow nasal oxygen therapy in human and veterinary patients

Whitney¹,

Keir²

2023

Front. Vet. Sci.

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Oxygen therapy is the first-line treatment for hypoxemic acute respiratory failure. In veterinary medicine this has traditionally been provided via mask, low-flow nasal oxygen cannulas, oxygen cages and invasive positive pressure ventilation. Traditional non-invasive modalities are limited by the maximum flow rate and fraction of inspired oxygen (FiO2) that can be delivered, variability in oxygen delivery and patient compliance. The invasive techniques are able to provide higher FiO2 in a more predictable manner but are limited by sedation/anesthesia requirements, potential complications and cost. High-flow nasal oxygen therapy (HFNOT) represents an alternative to conventional oxygen therapy. This modality delivers heated and humidified medical gas at adjustable flow rates, up to 60 L/min, and FiO2, up to 100%, via nasal cannulas. It has been proposed that HFNOT improves pulmonary mechanics and reduces respiratory fatigue via reduction of anatomical dead space, provision of low-level positive end-expiratory pressure (PEEP), provision of constant FiO2 at rates corresponding to patient requirements and through improved patient tolerance. Investigations into the use of HFNOT in veterinary patients have increased in frequency since its clinical use was first reported in dogs with acute respiratory failure in 2016. Current indications in dogs include acute respiratory failure associated with pulmonary parenchymal disease, upper airway obstruction and carbon monoxide intoxication. The use of HFNOT has also been advocated in certain conditions in cats and foals. HFNOT is also being used with increasing frequency in the treatment of a widening range of conditions in humans. Although there remains conflict regarding its use and efficacy in some patient groups, overall these reports indicate that HFNOT decreases breathing frequency and work of breathing and reduces the need for escalation of respiratory support. In addition, they provide insight into potential future veterinary applications. Complications of HFNOT have been rarely reported in humans and animals. These are usually self-limiting and typically result in lower morbidity and mortality than those associated with invasive ventilation techniques.

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Section: Figurementioning

confidence: 99%

Clinical review of high-flow nasal oxygen therapy in human and veterinary patients

Whitney¹,

Keir²

2023

Front. Vet. Sci.

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“…Endotracheal intubation and general anesthesia are required to maintain MV in most veterinary patients ( 39 ). A recent retrospective study suggests TP dogs and cats can require several days of MV (median 4 days, range 1–10 days) ( 31 ), so care must be taken to mitigate complications associated with prolonged endotracheal (ET) intubation, which include pressure necrosis ( 40 ), obstruction or dislodgement of the tube and introduction of pathogens into the airway, with subsequent development of ventilator-associated pneumonia (VAP) ( 41 , 42 ). Incidence of VAP in dogs and cats with TP is reported as 3.8% (1/26) in a retrospective analysis of patients with positive airway cultures ( 31 ).…”

Section: Management Of the Ventilated Patientmentioning

confidence: 99%

“…In addition to decreased tear production, chemosis may develop in patients immobilized for long periods and can contribute to lagophthalmos and exposure keratopathy ( 98 ). Corneal ulceration has been reported in 5–36% of patients undergoing MV for all causes ( 41 , 42 ). Current recommendations are that ocular care be performed every 2 h and encompass gentle cleaning with saline-soaked swabs and administration of artificial tears ( 70 , 98 ).…”

Section: Management Of the Ventilated Patientmentioning

confidence: 99%

“…If corneal ulceration is identified, broad spectrum topical antibiotics and atropine should be administered to prevent infection and the development of synechiae, respectively ( 98 ). Temporary tarsorrhaphy has been described in one patient with progressive bilateral corneal ulcers where protracted MV was anticipated ( 41 ). The ocular outcome in this case was not reported and there is no literature that directly evaluates the superiority of temporary tarsorrhaphy over standard medical care.…”

Section: Management Of the Ventilated Patientmentioning

confidence: 99%

“…Oral lesions have been reported in 37–90.5% of dogs receiving orotracheal MV ( 41 , 101 ). The most common lesions include erosions or ulceration of soft tissue structures subjected to continuous pressure from teeth, monitoring equipment, tube ties or mouth gags, as well as, swelling and ranulas of the tongue ( 41 , 101 ).…”

Section: Management Of the Ventilated Patientmentioning

confidence: 99%

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Mechanical ventilation in dogs and cats with tick paralysis

O'Keeffe¹,

Donaldson²

2023

Front. Vet. Sci.

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Respiratory failure from tick paralysis (TP) is an important cause of mortality in cats and dogs in Australia, occurring from a combination of respiratory muscle paralysis, upper respiratory tract obstruction and pulmonary disease. Patients may require positive-pressure ventilation in management of any combination of hypoxemia, hypoventilation or respiratory fatigue, but may also require airway management due to laryngeal paralysis. No single ventilation strategy is recommended due to the heterogenous disease presentations. Lung protective ventilation should be used in patients with pulmonary disease. Due to local and systemic effects of TP, patients are at higher risk of complications such as aspiration pneumonia and corneal ulceration and may have additional intravenous fluid and nutritional considerations. Treatment with hyperimmune serum is associated with improved outcomes. Prognosis is considered good with documented survival to discharge (STD) of 52.6–77% for animals with TP ventilated with lung disease and 90.5% for animals without lung disease. Median reported duration of ventilation for TP ranges from 23 to 48 h (range 3 h−10 days). The severity of individual neuromuscular signs and the presence of associated conditions such as aspiration pneumonia and laryngeal paralysis may necessitate longer periods of mechanical ventilation. This review aims to summarize the current recommendations regarding indications, management and prognosis of cats and dogs undergoing MV for TP and to identify areas for future research.

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Postoperative pharmacological ventilation in a dog following surgical stabilisation of the first and second cervical vertebrae

Teotino

Auckburally

Gomez³

et al. 2023

Vet Record Case Reports

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A 7‐month‐old, crossbreed dog presented for collapsing episodes and acute non‐ambulatory tetraparesis. Magnetic resonance imaging and computed tomography revealed absence of the dorsal arch of the first cervical vertebrae and displacement of the second cervical vertebrae, with severe spinal cord compression. Surgical spinal stabilisation was performed under general anaesthesia. Postoperatively, attempts to wean the animal from mechanical ventilation were unsuccessful. Despite the dog's efforts to breathe spontaneously, severe hypercapnia (EtCO2 11.4 kPa [85.5 mmHg]) developed. Due to a lack of appropriate resources, pharmacological support of ventilation was attempted, using doxapram (2 mg/kg intravenously), followed by a variable‐rate infusion (5–30 µg/kg/min) maintained for 48 hours. The dog was discharged 48 hours after doxapram discontinuation.

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Complications associated with long‐term positive‐pressure ventilation in dogs and cats: 67 cases

Abstract: Objectives:To determine the complications associated with positive-pressure ventilation (PPV) in dogs and cats.

Cited by 6 publications

References 77 publications

Clinical review of high-flow nasal oxygen therapy in human and veterinary patients

Clinical review of high-flow nasal oxygen therapy in human and veterinary patients

Mechanical ventilation in dogs and cats with tick paralysis

Postoperative pharmacological ventilation in a dog following surgical stabilisation of the first and second cervical vertebrae

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