Impact of cytidine diphosphocholine on oxygenation in client‐owned dogs with aspiration pneumonia

Abstract

Background: New drugs for veterinary patients with acute respiratory distress syndrome (ARDS) are urgently needed. Early or late postinfection treatment of influenzainfected mice with the liponucleotide cytidine diphosphocholine (CDP-choline) resulted in decreased hypoxemia, pulmonary edema, lung dysfunction, and inflammation without altering viral replication. These findings suggested CDP-choline could have benefit as adjunctive treatment for ARDS in veterinary patients (VetARDS). Objectives: Determine if parenterally administered CDP-choline can attenuate mildVetARDS in dogs with aspiration pneumonia.Animals: Dogs admitted to a veterinary intensive care unit (ICU) for aspiration pneumonia.Methods: Subjects were enrolled in a randomized, double-blinded, placebocontrolled trial of treatment with vehicle (0.1 mL/kg sterile 0.9% saline, IV; n = 8) or CDP-choline (5 mg/kg in 0.1 mL/kg 0.9% saline, IV; n = 9) q12h over the first 48 hours after ICU admission.Results: No significant differences in signalment or clinical findings were found between placebo-and CDP-choline-treated dogs on admission. All dogs exhibited tachycardia, tachypnea, hypertension, hypoxemia, hypocapnia, lymphopenia, and neutrophilia. CDP-choline administration resulted in rapid, progressive, and clinically relevant increases in oxygenation as determined by pulse oximetry and ratios of arterial oxygen partial pressure (P a O 2 mmHg) to fractional inspired oxygen (% F i O 2 ) and decreases in alveolar-arterial (A-a) gradients that did not occur in placebo (saline)treated animals. Treatment with CDP-choline was also associated with less platelet consumption over the first 48 hours, but had no detectable detrimental effects.Conclusions and Clinical Importance: Ctyidine diphosphcholine acts rapidly to promote gas exchange in dogs with naturally occurring aspiration pneumonia and is a potential adjunctive treatment in VetARDS patients.

Change over time and agreement between clinical markers of disease resolution in dogs with aspiration‐induced lung injury

“…Compared to the previous reports evaluating markers of disease recovery in dogs with pneumonia or aspiration pneumonia, this cohort of dogs is an older population, with many of the dogs having a more complicated clinical course due to their concurrent systemic or focal neuropathy. [21][22][23][24][25][26]28,38 The studies to date have primarily focused on cohorts of younger dogs, with reported median ages ranging from 5 to 5.5 years, and of the combined total of 46 dogs studied, only three dogs were described to have concurrent GLOPP (n = 1) or megaoesophagus (2). 21,22,24 This study population therefore represents a subpopulation of dogs at risk for A-ILI that is not well represented in the recent studies investigating acute-phase protein monitoring in dogs with aspiration pneumonia.…”

“…The dogs in this study had a median age of 12 years, with over half of the dogs (18 of 26) diagnosed with concurrent GOLPP or megaoesophagus as the underlying risk factor for an aspiration event. Compared to the previous reports evaluating markers of disease recovery in dogs with pneumonia or aspiration pneumonia, this cohort of dogs is an older population, with many of the dogs having a more complicated clinical course due to their concurrent systemic or focal neuropathy 21–26,28,38 . The studies to date have primarily focused on cohorts of younger dogs, with reported median ages ranging from 5 to 5.5 years, and of the combined total of 46 dogs studied, only three dogs were described to have concurrent GLOPP ( n = 1) or megaoesophagus (2) 21,22,24 .…”

“…The calculated PE scores were based on the dog's vital signs (body temperature, heart rate and respiratory rate), percentage oxygen saturation in room air, respiratory pattern and pulmonary auscultation adapted from respiratory scoring previously reported in dogs, and a validated acute respiratory infection severity score used in infants and children. 21,[28][29][30] The clinical scoring system used to calculate PE scores is shown in Table 1. A single clinician (M.C.)…”

Positive Airway Cultures in Dogs and Cats Receiving Mechanical Ventilation for Tick Paralysis

“…Additional details of the clinical course, including radiographic evidence of aspiration, specific lung function markers (ratio of partial pressure of oxygen in the arterial circulation [PaO 2 ] to fraction of inspired oxygen [FiO 2 ][P:F ratio], oxygen saturation [SpO 2 ]), and outcome were also recorded. A diagnosis of aspiration pneumonia was made from a positive airway culture together with a clinical course of worsening lung function, indicated by hypoxaemia (P:F ratio ≤ 350 [ 13 ], or SpO 2 < 95% with FiO 2 ≥ 0.21), with or without thoracic radiographic evidence of aspiration pneumonia [ 14 , 15 , 16 ]. At the time of initial retrospective data collection the primary author (ST) interpreted all thoracic radiographs.…”