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Frontiers in Veterinary Science - Section of Veterinary Emergency and Critical Care Medicine
No full textFrontiers in Veterinary Science is a global, peer-reviewed, Open Access journal that bridges animal and human health, brings a comparative approach to medical and surgical challenges, and advances innovative biotechnology and therapy.
Veterinary research today is interdisciplinary, collaborative, and socially relevant, transforming how we understand and investigate animal health and disease. Fundamental research in emerging infectious diseases, predictive genomics, stem cell therapy, and translational modelling is grounded within the integrative social context of public and environmental health, wildlife conservation, novel biomarkers, societal well-being, and cutting-edge clinical practice and specialization. Frontiers in Veterinary Science brings a 21st-century approach—networked, collaborative, and Open Access—to communicate this progress and innovation to both the specialist and to the wider audience of readers in the field.
Frontiers in Veterinary Science publishes articles on outstanding discoveries across a wide spectrum of translational, foundational, and clinical research. The journal's mission is to bring all relevant veterinary sciences together on a single platform with the goal of improving animal and human health
Bilancio idrico e fluidoterapia nel paziente veterinario critico: fisiopatologia e monitoraggio del bilancio idrico
No full textIl paziente critico presenta comunemente alterazioni dell’omeostasi dei fluidi corporei ed è particolarmente sensibile agli effetti avversi di una fluidoterapia non appropriata. La disfunzione del glicocalice endoteliale è alla base di un'aumentata permeabilità vasale, che favorisce la formazione di edema interstiziale, la perpetuazione dello stato infiammatorio e di conseguenza contribuisce all’ipoperfusione tissutale. La fluidoterapia deve essere quindi mirata alle esigenze del singolo paziente e contestualizzata sull'andamento clinico della patologia critica, riconoscendo solitamente tre fasi d’intervento: una fase iniziale di rianimazione fluida; una fase successiva di mantenimento, volta garantire un bilancio idrico equilibrato; una potenziale fase di "tossicità" della fluidoterapia, in cui provvedere alla rimozione dei fluidi in eccesso. L’andamento delle fasi sopradescritte non è sempre consequenziale, e obbliga il medico ad una frequente e metodica rivalutazione del paziente, basata sulla combinazione di indici clinici e di diagnostica collaterale, e finalizzata a guidare in maniera appropriata la strategia d’intervento terapeutico.The critically ill patient frequently suffers from fluid balance abnormalities, and is extremely sensitive to the complications of inappropriate fluid therapy. The endothelial glycocalyx dysfunction during critical illness is the main contributing factor for the development of capillary leakage, systemic inflammation and interstitial edema, ultimately leading to tissue hypoperfusion. According to the dynamic clinical status of the intensive care patients, intravenous fluid therapy must be tailored to the individual clinical condition. "Context-sensitive" fluid therapy usually recognizes three interventional phases: a rescue phase to correct intravascular volume depletion; a stabilization phase aimed at matching fluid losses and requirements and optimizing fluid balance homeostasis; and a de-escalation phase when minimization of fluid therapy and mobilization of extra fluids can be considered to avoid their toxicity. Several clinical and diagnostic tools can be used to choose the appropriate strategy of fluid administration, and to optimize fluid balance in the course of the critical illness
Prospective evaluation of the acute patient physiologic and laboratory evaluation score and an extended clinicopathological profile in dogs with systemic inflammatory response syndrome
No full textOBJECTIVE:
To investigate the prognostic value of the acute patient physiologic and laborartory evaluation (APPLE) score and relevant clinicopathological markers in dogs with systemic inflammatory response syndrome (SIRS).
DESIGN:
Prospective observational cohort study.
SETTING:
Veterinary teaching hospital.
ANIMALS:
Thirty-three dogs with SIRS admitted to the intensive care unit (ICU) were compared to 35 healthy control dogs. Dogs with SIRS were divided into septic (n = 20) and nonseptic (n = 13) etiologies and as survivors (alive to discharge, n = 22) and nonsurvivors (n = 11: died, n = 6, or humanely euthanized, n = 5).
MEASUREMENTS AND MAIN RESULTS:
For all dogs, physiological and laboratory parameters were prospectively collected for the calculation of the APPLEfast score. No difference between septic and nonseptic SIRS dogs was detected for any parameter evaluated. Survivors had significantly higher total protein, albumin concentrations, antithrombin activity (ATA), and base excess (BE), as well as significantly lower lactate, urea, creatinine concentrations, urinary protein to creatinine ratio and APPLEfast score compared to nonsurvivors. Higher values of creatinine, lactate, anion gap, alanine transaminase (ALT), and APPLEfast score were significantly associated with an increased risk of death in SIRS dogs, while higher values of total protein, albumin, ATA, and BE were associated with a significantly reduced risk of mortality. When a multivariate binary logistic regression analysis was performed, the APPLEfast score was the only significant parameter retained.
CONCLUSIONS:
The determination of the APPLEfast score in clinical setting, as well as the measurement of APP, ATA, lactate, BE, anion gap, ALT, urinary proteins, and electrolytes may be beneficial for a better assessment of dogs with SIRS. Identified parameters were significantly related with the presence of SIRS and their evaluation should be considered for the assessment of disease severity, and guidance of the decision-making process in critically ill dogs
Plasma Lactate Concentration: is it a reliable prognostic factor in dogs with gastric dilatation volvulus?
No full textPlasma procalcitonin concentrations predict organ dysfunction and outcome in dogs with sepsis
Full text linkAbstract Background Procalcitonin (PCT) is a valuable prognostic biomarker in human sepsis that is predictive of organ dysfunction, septic shock and mortality. Data on PCT in dogs is limited. This study aimed to investigate the prognostic value of baseline and serial PCT measurements in dogs with sepsis and to determine the association between PCT and sepsis severity and the presence of organ dysfunction. PCT concentrations were measured in citrated plasma samples collected from 53 dogs with sepsis at the time of admission (T0, n = 53) and at 24 h (T1, n = 35) and 48 h (T2, n = 30) post-admission using a commercial ELISA. Dogs were classified by sepsis severity (sepsis without organ dysfunction; severe sepsis; septic shock) and outcome (survivors; non-survivors). Organ dysfunctions were recorded at T0 and during hospitalization, and the APPLEfast score calculated at T0. Healthy dogs (n = 12) were used as controls. Results There were 18 septic dogs without organ dysfunction, 24 dogs with severe sepsis and 11 with septic shock. Baseline PCT concentrations were significantly greater in dogs with sepsis compared to healthy controls (P < 0.0001), and in dogs with septic shock compared to dogs without cardiovascular compromise (P = 0.01). Baseline PCT was significantly correlated with organ dysfunction (P = 0.003). Declining PCT concentrations were documented in survivors at T1 and T2 compared to PCT at T0 (P = 0.0006), and PCT clearance at 24 h was significantly higher in survivors (n = 38) compared to non-survivors (n = 15) (P = 0.037). Canine APPLEfast score was not predictive of sepsis severity, the development of MODS or outcome. Conclusion In dogs with sepsis, PCT concentrations at hospital admissions are predictive of organ dysfunction and septic shock. Serial procalcitonin monitoring may offer valuable prognostic information in canine sepsis, wherein early decreases in PCT concentrations are associated with survival
Cell-Free DNA, High-Mobility Group Box-1, and Procalcitonin Concentrations in Dogs With Gastric Dilatation–Volvulus Syndrome
Full text linkCanine gastric dilatation–volvulus (GDV) is a life-threatening disease characterized by extensive tissue ischemia, tissue hypoperfusion, and systemic inflammation. Biomarkers that better reflect the severity of gastric necrosis and systemic inflammation would aid clinicians in the management of these patients. This study aimed to investigate the prognostic significance of cell-free DNA (cfDNA), high-mobility group box-1 (HMGB1), and procalcitonin (PCT) in dogs with GDV. Concentrations of cfDNA, HMGB1, and PCT were measured in citrated plasma samples collected from 29 dogs with GDV at hospital admission. Additional data collected included baseline lactate concentrations, APPLEfast score, evidence of gastric necrosis, occurrence of postoperative complications, and outcome. Twenty-four healthy dogs were sampled as controls. Continuous variables between groups were compared with the Mann–Whitney U and correlations between continuous variables were assessed by calculation of Spearman’s correlation coefficient. Alpha was set at 0.05. Dogs with GDV had significantly greater concentrations of cfDNA, HMGB1, and PCT compared to controls (P = 0.0009, P = 0.004, and P = 0.009, respectively). PCT concentrations were significantly higher in non-survivors compared to survivors (P = 0.008). Dogs with gastric necrosis had significantly greater lactate concentrations compared to dogs without gastric necrosis (P = 0.0005). The APPLEfast score was not prognostic. Lactate and PCT concentrations were moderately, positively correlated (rs 0.51, P = 0.0005). Concentrations of the inflammatory biomarkers cfDNA, HMGB1, and PCT are increased in canine GDV. Only lactate and PCT concentrations were prognostic in this population of GDV dogs and were predictive of the presence of gastric necrosis and of non-survival to hospital discharge, respectively
Plasma procalcitonin concentrations are increased in dogs with sepsis
Full text linkSepsis, the life-threatening organ dysfunction caused by a dysregulated host response to infection, is difficult to identify and to prognosticate for. In people with sepsis, procalcitonin (PCT) measurement aids diagnosis, enables therapeutic monitoring and improves prognostic accuracy. This study used a commercial canine PCT assay to measure plasma PCT concentrations in dogs with gastric dilatation volvulus (GDV) syndrome and in dogs with sepsis. It was hypothesised that dogs with GDV syndrome and with sepsis have greater plasma PCT concentrations than healthy dogs and that dogs with sepsis have greater PCT concentrations than dogs with GDV syndrome. Before analysing canine plasma samples, the ability of the assay to identify canine PCT, in addition to assay imprecision and the lower limit of detection were established. The assay had low imprecision with coefficients of variation ≤4.5 per cent. The lower limit of detection was 3.4 pg/ml. Plasma PCT concentrations were measured in 20 dogs with sepsis, in 32 dogs with GDV syndrome and in 52 healthy dogs. Median (IQR) PCT concentration in dogs with sepsis 78.7 pg/ml (39.1-164.7) was significantly greater than in healthy dogs 49.8 pg/ml (36.2-63.7) (P=0.019), but there were no significant differences between PCT concentrations in dogs with GDV syndrome and controls (P=0.072) or between dogs with sepsis and GDV syndrome (P=1.000). Dogs with sepsis have significantly increased plasma PCT concentrations compared with healthy dogs, although considerable overlap between these populations was identified. Future investigations should confirm this finding in other populations and evaluate the diagnostic and prognostic value of PCT in dogs with sepsis
Complicazioni della chirurgia ortopedica nel gatto politraumatizzato
No full textComplicazioni della chirurgia ortopedica nel gatto politraumatizzato
Del Magno S, Foglia A, Cola V, Pinna S, Valentini S, Giunti M, Pisoni L.
Scopo del lavoro
Il presente lavoro mira a valutare la frequenza e il tipo di complicazioni in seguito a chirurgie ortopediche in corso di politrauma nel gatto.
Materiali e metodi
Gatti politraumatizzati in cui è stata eseguita almeno una chirurgia ortopedica dal 2012 al 2016 sono stati inclusi e classificati in base a sede e tipo di lesione, tipo di trattamento chirurgico e medico e tipo di complicazioni riscontrate.
Ai pazienti è stato attribuito uno score clinico, come precedentemente riportato (Vnuk et al, 2004).
L’analisi statistica delle variabili oggetto di studio è stata condotta mediante l’utilizzo di test per dati non parametrici. La significatività dei test è stata considerata per un valore di p< 0,05.
Risultati
Sono stati inclusi 42 gatti europei, 19 femmine e 23 maschi. L’età mediana era di 24 mesi (range 7 mesi-18 anni), il peso mediano era di 4 kg (range 2,2-6,6).
I traumi ortopedici localizzati allo scheletro appendicolare sono risultati i più frequenti (62%), seguiti dai traumi del bacino (33%), del distretto maxillo-facciale (29%) e della colonna vertebrale (12%).
In 31 gatti erano presenti lesioni in altre sedi anatomiche con un coinvolgimento significativamente più frequente dei distretti toracico e cranico.
Il valore mediano dello score attribuito alle lesioni traumatiche riportate è risultato essere pari a 6 (range 2-12). Tale punteggio è risultato essere positivamente correlato al numero di distretti interessati dal trauma.
Nel 57% dei casi era presente uno stato di shock all’ammissione, che è risultato essere significativamente più frequente nei soggetti con lesioni traumatiche localizzate a più di due distretti corporei.
Nel periodo post-operatorio le complicazioni verificatesi più frequentemente sono state: anemia grave (17%, 7/42 pazienti), parziale fallimento dell’intervento (12%, 5/42), peggioramento dei deficit neurologici secondari ad osteosintesi del bacino (7%, 3/42) e infezioni del sito operatorio (14%, 6/42). Le infezioni erano associate a batteri multiresistenti (5/6), necrosi tissutale estesa (3/6) ed esposizione degli impianti di osteosintesi (2/6).
L’anemia si è sviluppata più frequentemente nei gatti che presentavano infezioni nel periodo post operatorio.
Una terapia antibatterica empirica è stata somministrata in tutti i pazienti come monoterapia (30/42 casi) o terapia combinata (12/42) a discrezione del medico curante. Lo sviluppo delle infezioni nel periodo post-operatorio è risultato significativamente più frequente in soggetti trattati con terapia combinata.
Il tempo intercorso tra l’ammissione e il primo intervento chirurgico (mediana 1 giorno, 0-4) e/o il primo intervento ortopedico (mediana 2 giorni, 0-11) non sono risultati correlati all’insorgenza di complicazioni.
Un solo paziente con trauma facciale e trauma cranico è deceduto nel periodo post-operatorio.
La durata del ricovero (mediana 10 giorni) è risultato significativamente maggiore in caso d’infezione post-operatoria.
Discussione
Un paziente politraumatizzato risulta essere spesso un paziente critico e al momento non sono presenti linee guida sul tipo di approccio chirurgico e il tempo in cui intervenire (Peterson et al, 2015).
L’anemia è una complicazione frequente nel periodo post-operatorio, di solito di natura multifattoriale. La risposta infiammatoria sistemica secondaria alla presenza di infezione sembra contribuire ad aggravare lo stato di anemia nel periodo post-operatorio in questa popolazione.
L’infezione del sito chirurgico è una complicazione grave e rappresenta una spesa notevole per il proprietario vista la maggior durata dell’ospedalizzazione. La maggior incidenza di infezioni in pazienti trattati con una combinazione di antibatterici suggerirebbe di impostare un’iniziale monoterapia, solo se necessaria, da variare sulla base dell’esame colturale. L’esecuzione di esami batteriologici su potenziali siti d’infezione al momento dell’ammissione del paziente ed eventualmente la loro ripetizione durante il decorso è di fondamentale importanza per impostare una terapia antibatterica mirata e prevenire o ridurre lo sviluppo di antibioticoresistenza. Questa strategia terapeutica andrebbe associata ad un ottimale controllo dell’infezione, che includa la rimozione del tessuto necrotico dal sito di lesione.
Il fallimento seppure parziale dell’intervento riscontrato in alcuni pazienti è probabilmente ascrivibile ad una gestione non adeguata del paziente in sede chirurgica e/o post-operatoria.
L’aggravamento delle lesioni neurologiche secondarie ad osteosintesi del bacino risulta spesso temporanee (Meeson, 2015). Nei 3 casi del presente studio interessati da tali alterazioni, si è assistito ad un significativo miglioramento clinico al momento della dimissione.
Vnuk D et al, Feline high-rise syndrome: 119 cases (1998-2001). J Feline Med and Surg, 6:305-312, 2004
Peterson NW et al, The impact of surgical timing and intervention on outcome in traumatized dogs and cats. J Vet Emerg Crit Care, 25:63-75.
Meeson RL, Geddes AT, Management and long-term outcome of pelvic fractures: a retrospective study of 43 cats. J Feline Med Surg, Oct 7, pii:1098612X15606958 2015
New-onset organ dysfunction as a screening tool for the identification of sepsis and outcome prediction in dogs with systemic inflammation
Full text linkIntroduction: Sepsis in people is defined as a life-threatening organ dysfunction (OD) caused by a dysregulated host response to infection. In veterinary medicine, sepsis is still defined by the presence of systemic inflammation plus the evidence of infection. Based on recent veterinary studies, multiorgan dysfunction syndrome (MODS) has been associated with a worse outcome in sepsis. Thus, the screening for OD is warranted to identify the most critically ill patients. The aim of this study was to investigate the diagnostic value of new-onset OD for the prediction of sepsis and outcome in a population of critically ill dogs with systemic inflammation. Materials and methods: Dogs admitted to the Emergency Room and/or the Intensive Care Unit with systemic inflammation, defined by a serum C-reactive protein concentration > 1.6 mg/dL, were retrospectively included. Enrolled dogs were categorized according to the presence of sepsis or non-infectious systemic inflammation. The presence of newly diagnosed OD was assessed based on criteria adapted from human literature and previously reported canine criteria. Results: 275 dogs were included: 128 had sepsis and 147 had non-infectious systemic inflammation. The frequency of new-onset OD was not different between these groups. Only the presence of fluid-refractory hypotension was significantly associated with a diagnosis of sepsis (OR 10.51, 3.08-35.94; p < 0.0001). The frequency of at least two ODs was significantly higher in non-survivors compared to survivors, according to both the human and the veterinary criteria considered for the study (p = 0.0001 and p = 0.0004, respectively). Specifically, the presence of acute kidney injury, stupor or coma, prolonged Prothrombin Time and decreased Base Excess were associated with a higher risk of death in the multivariate binary logistic regression. Discussion: In this population of critically ill dogs with systemic inflammation, the detection of newly diagnosed ODs was not able to predict sepsis diagnosis, other than the presence of fluid-refractory hypotension. However, given the strong prognostic significance associated with ODs, our results support the early screening for ODs in any severe inflammatory critical care condition to identify high-risk patients and optimize their management
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