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Cortellini S, DeClue AE, Giunti M, Goggs R, Hopper K, Menard JM, Rabelo RC, Rozanski EA, Sharp CR, Silverstein DC, Sinnott-Stutzman V, Stanzani G. Defining sepsis in small animals. J Vet Emerg Crit Care (San Antonio) 2024; 34:97-109. [PMID: 38351524 DOI: 10.1111/vec.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To discuss the definitions of sepsis in human and veterinary medicine. DESIGN International, multicenter position statement on the need for consensus definitions of sepsis in veterinary medicine. SETTING Veterinary private practice and university teaching hospitals. ANIMALS Dogs and cats. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Sepsis is a life-threatening condition associated with the body's response to an infection. In human medicine, sepsis has been defined by consensus on 3 occasions, most recently in 2016. In veterinary medicine, there is little uniformity in how sepsis is defined and no consensus on how to identify it clinically. Most publications rely on modified criteria derived from the 1991 and 2001 human consensus definitions. There is a divergence between the human and veterinary descriptions of sepsis and no consensus on how to diagnose the syndrome. This impedes research, hampers the translation of pathophysiology insights to the clinic, and limits our abilities to optimize patient care. It may be time to formally define sepsis in veterinary medicine to help the field move forward. In this narrative review, we present a synopsis of prior attempts to define sepsis in human and veterinary medicine, discuss developments in our understanding, and highlight some criticisms and shortcomings of existing schemes. CONCLUSIONS This review is intended to serve as the foundation of current efforts to establish a consensus definition for sepsis in small animals and ultimately generate evidence-based criteria for its recognition in veterinary clinical practice.
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Affiliation(s)
- Stefano Cortellini
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - Amy E DeClue
- Fetch Specialty and Emergency Veterinary Center, Greenville, South Carolina, USA
| | - Massimo Giunti
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Julie M Menard
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Elizabeth A Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Claire R Sharp
- School of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
| | - Deborah C Silverstein
- Department of Clinical Studies and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zorn CM, Walton RA, McKeen L, Mochel JP, Ward M, Blong AE. Retrospective comparison of outcomes in septic peritonitis with or without closed-suction abdominal drainage in 115 dogs (2009-2019). Vet Anim Sci 2023; 21:100304. [PMID: 37664411 PMCID: PMC10474222 DOI: 10.1016/j.vas.2023.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Septic peritonitis is a serious medical condition affecting veterinary patients and post-operative care remains controversial. This study aimed to evaluate and compare post-operative outcomes of dogs treated for septic peritonitis with and without surgically placed closed-suction abdominal drains. Medical records were retrospectively searched from the years 2009 through 2019 and one hundred and fifteen dogs with confirmed septic peritonitis treated with exploratory laparotomy were included. Twenty-two dogs had closed suction drains placed and ninety-three dogs were managed without post-operative drainage. Overall survival to discharge rate of patients in this study was 72%. The survival rate of patients with an abdominal drain was 53% compared to 77% in patients without a drain (P < 0.0001). Dogs with a higher APPLEfast score were significantly more likely to have a drain placed at the time of surgery (P = 0.0277). Dogs that had a closed-suction drain were significantly more likely to be given colloidal support compared to dogs managed without drainage (P = 0.0342). Based on this data, closed-suction drainage post-operatively for treatment of septic peritonitis was not associated with a more favorable survival outcome. The use of a severity of illness score, APPLEfast, did not show a correlation between severity of illness and survival outcome but did demonstrate a correlation between illness severity and placement of a closed-suction drain. Closed-suction drainage post-operatively increased the likelihood of receiving colloidal support, but due to the retrospective nature of the study and the lack of standardized post-operative nutritional support, definitive conclusion that post-operative drainage alone led to increased colloidal support cannot be made in this study.
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Affiliation(s)
- Chelsea M. Zorn
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Rebecca A.L. Walton
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Lauren McKeen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Jonathan P. Mochel
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Melody Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - April E. Blong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
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Human KP, Bleyaert HF, Iacovetta C. A feasibility study investigating the utility of a point-of-care rapid immunoassay for detecting septic peritoneal effusion in dogs. J Vet Emerg Crit Care (San Antonio) 2021; 31:691-697. [PMID: 34510700 DOI: 10.1111/vec.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy of a point-of-care urine bacterial rapid immunoassay (RIA) for a diagnosis of septic peritonitis, compared to more traditional diagnostic tools, such as cytology and bacterial culture. DESIGN Prospective, cross-sectional feasibility study conducted from October 2016 to June 2017. SETTING Four locations within a private practice referral hospital. ANIMALS Sixty-four dogs with peritoneal effusion of any etiology were enrolled. Four dogs were excluded due to absent RIA or bacterial culture results. Two additional dogs were excluded because of an inability to definitively classify them as having septic peritonitis. INTERVENTIONS Abdominocentesis was performed to obtain peritoneal effusion samples for aerobic and anaerobic bacterial culture, cytology, and RIA. Cytological slides were evaluated by a clinical pathologist following enrollment. MEASUREMENTS AND MAIN RESULTS Fifty-eight dogs were included in the study, 8 of which were classified as having septic peritonitis. Compared to final diagnosis of septic peritonitis, RIA had a low PPV (36.8%) but good NPV (97.4%) and was 77.5% accurate. SN of RIA (87.5%) to diagnose septic peritonitis was similar to cytology (85.7%) and bacterial culture (87.5%); however, SP was lower (76%, 100%, and 98%, respectively). Cytology had the best overall predictive values and accuracy for diagnosing septic peritonitis (PPV 100%, NPV 97.9%, and accuracy 98%) compared to RIA and bacterial culture. CONCLUSIONS RIA testing was similarly sensitive in identifying septic peritonitis compared to cytology and bacterial culture but was not very specific or accurate. As a stand-alone test, RIA commonly had false-positive test results, making it unreliable in identifying septic peritonitis. Cytology was the most accurate diagnostic test and had no false-positive results. Further investigation with a larger sample size and prevalence of septic peritonitis may prove beneficial.
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Affiliation(s)
- Kelsey P Human
- Surgery Department, BluePearl Veterinary Partners, Tampa, Florida, USA
| | - Helga F Bleyaert
- Surgery Department, BluePearl Veterinary Partners, Tampa, Florida, USA
| | - Christine Iacovetta
- Critical Care Department, BluePearl Veterinary Partners, Queens, New York, USA
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Gill SS, Buote NJ, Peterson NW, Bergman PJ. Factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs. J Am Vet Med Assoc 2020; 255:569-573. [PMID: 31429652 DOI: 10.2460/javma.255.5.569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs. ANIMALS 170 client-owned dogs that underwent gastrointestinal surgery from 2010 to 2016. PROCEDURES Medical records of all included dogs were reviewed to collect information on preoperative (breed, sex, age, body weight, American Society of Anesthesiologists [ASA] physical status classification, emergency status, and plasma lactate concentration), intraoperative (indication for surgery, type of surgery, and whether bacterial peritonitis was identified), and postoperative (development of dehiscence and survival status at 2 weeks after surgery) factors. Preoperative and intraoperative factors were evaluated for associations among each other and with postoperative factors. RESULTS Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L). Multivariate analysis controlling for age, body weight, and plasma lactate concentration revealed that dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06). Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs. CONCLUSIONS AND CLINICAL RELEVANCE These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis.
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Mullen KM, Regier PJ, Ellison GW, Londoño L. A Review of Normal Intestinal Healing, Intestinal Anastomosis, and the Pathophysiology and Treatment of Intestinal Dehiscence in Foreign Body Obstructions in Dogs. Top Companion Anim Med 2020; 41:100457. [PMID: 32823156 DOI: 10.1016/j.tcam.2020.100457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022]
Abstract
Small intestinal anastomoses are commonly performed in veterinary medicine following resection of diseased or devitalized intestinal tissue. Traditionally, suture has been employed to anastomose intestinal ends. However, use of intestinal staplers has become increasingly popular due to the ability to produce a rapid anastomosis with purported superior healing properties. Under normal conditions, intestinal healing occurs in three phases: inflammatory, proliferative, and maturation. Dehiscence, a devastating consequence of intestinal anastomosis surgery, most often occurs during the inflammatory phase of healing where the biomechanical strength of the anastomosis is almost entirely dependent on the anastomotic technique (suture or staple line). The resulting septic peritonitis is associated with a staggering morbidity rate upwards of 85% secondary to the severe systemic aberrations and financial burden induced by septic peritonitis and requirement of a second surgery, respectively. Intraoperative and postoperative consideration of the multifactorial nature of dehiscence is required for successful patient management to mitigate recurrence. Moreover, intensive postoperative critical care management is necessitated and includes antibiotic and fluid therapy, vasopressor or colloidal support, and monitoring of the patient's fluid balance and cardiovascular status. An understanding of anastomotic techniques and their relation to intestinal healing will facilitate intraoperative decision-making and may minimize the occurrence of postoperative dehiscence.
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Affiliation(s)
- Kaitlyn M Mullen
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA.
| | - Gary W Ellison
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
| | - Leonel Londoño
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
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Scotti KM, Koenigshof A, Sri-Jayantha LSH, Kato M, Bishop M, Barr JW, Pashmakova MB. Prognostic indicators in cats with septic peritonitis (2002-2015): 83 cases. J Vet Emerg Crit Care (San Antonio) 2019; 29:647-652. [PMID: 31654546 DOI: 10.1111/vec.12896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 12/25/2017] [Accepted: 01/11/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify physical exam findings, clinicopathological parameters, time to surgery, empirical antimicrobial use, and culture results that could be associated with outcome in cats with septic peritonitis (SP). DESIGN Retrospective cohort study of cats from 2002 to 2015. SETTING Four university teaching hospitals. ANIMALS Eighty-three cats diagnosed with SP by cytology or culture. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: Fifty-eight cats survived to discharge (69.9%); 1 cat was euthanized in surgery; 20 were euthanized postoperatively; 4 cats suffered cardiac arrest after surgery. The most common etiology of SP was secondary SP due to gastrointestinal perforation (49.4%), followed by primary SP (22.3%). Mean blood glucose concentration was significantly different between survivors and nonsurvivors (P = 0.006). Cats that received appropriate empirical antibiotic therapy were 4.4 times more likely to survive than cats that did not receive appropriate antibiotics (P = 0.018). CONCLUSIONS As previously documented, SP secondary to gastrointestinal leakage was the most common etiology. In this population, cats with a higher blood glucose concentration on presentation had a worse prognosis. Cats that received appropriate empirical antimicrobial therapy were more likely to survive.
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Affiliation(s)
| | - Amy Koenigshof
- Michigan State University Veterinary Medical Center, East Lansing, Missouri
| | - Loren S H Sri-Jayantha
- Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Michael Kato
- William R. Pritchard Veterinary Medical Teaching Hospital, Davis, California
| | - Micah Bishop
- WAVE Veterinary Internal Medicine, Naples, Florida
| | - James W Barr
- BluePearl Veterinary Partners, Grand Rapids, Michigan
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Abstract
Septic peritonitis (SP) is common in dogs and is associated with high mortality. Early recognition is essential to maximizing survival and may be aided by biomarker measurement. The present study aimed to evaluate the ability of biomarkers to discriminate septic peritonitis from non-septic ascites (NSA). Eighteen dogs with SP and 19 age-matched controls with NSA were enrolled. Contemporaneous blood and peritoneal effusion samples were obtained. Concentrations of cell-free DNA (cfDNA), cytokines, glucose, lactate, N-terminal pro-C-type natriuretic peptide (NT-proCNP), nucleosomes, and procalcitonin (PCT) were measured using commercial reagents and assays. Paired biomarker concentrations were compared with the Wilcoxon matched-pairs signed rank test, and biomarker concentrations between groups were compared with the Mann-Whitney U-test. P-values were adjusted for multiple comparisons using the Bonferroni correction. Receiver operating characteristic curves were generated to assess the ability of the above biomarkers to discriminate SP from NSA. Dogs with SP had significantly greater blood CCL2 concentrations than dogs with NSA (P = 0.032). Dogs with SP had significantly greater effusion CCL2, IL-6, IL-10, and lactate concentrations than dogs with NSA (P ≤ 0.0121). Blood-effusion concentration gradients of CCL2, glucose, IL-6, IL-10, and lactate were significantly different in dogs with SP compared to dogs with NSA (P ≤ 0.0165). Effusion lactate concentration had the highest AUROC value (0.866, 95% CI 0.751–0.980, P = 0.0001), although other biomarkers performed similarly. An effusion lactate concentration of 4.2 mmol/L was 72.2% (95% CI 46.5–90.3%) sensitive and 84.2% (95% CI 60.4–96.6%) specific for the diagnosis of SP.
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Affiliation(s)
- Pia Martiny
- College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Robert Goggs
- College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Fontenot RL, Crabtree NE, Hollier HD, Mochal-King CA, Eddy AL. Management of a Traumatic Penetrating Abdominal Wound and Associated Complications in a Horse. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hodgson N, Llewellyn EA, Schaeffer DJ. Utility and Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Dogs with Septic Peritonitis. J Am Anim Hosp Assoc 2018; 54:351-359. [PMID: 30272478 DOI: 10.5326/jaaha-ms-6808] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Systemic inflammation is known to cause WBC abnormalities, specifically neutrophilia and lymphopenia. The neutrophil-to-lymphocyte ratio (NLR) is a simple and affordable biomarker that has been used in human clinical settings of sepsis but has not been investigated in veterinary species. We evaluated NLR in dogs with septic and nonseptic systemic inflammatory diseases and compared with a healthy dog population. An NLR ≥6 had an 84.39% sensitivity and 86.95% specificity to identify dogs with systemic inflammatory states; however, no ratio distinguished septic and nonseptic causes. The NLR was not associated with length of hospitalization, morbidity based on the acute patient physiologic laboratory evaluation scoring system, or mortality. The disassociation may be due to the retrospective nature of the study, including a restricted population size and acquisition of only a one-time blood sample. NLR is currently of limited use for diagnosis and prognosis in systemic inflammatory states in dogs, and larger, prospective studies are necessary to further evaluate NLR.
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Affiliation(s)
- Natasha Hodgson
- From the College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Efa A Llewellyn
- From the College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - David J Schaeffer
- From the College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois
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Kalafut SR, Schwartz P, Currao RL, Levien AS, Moore GE. Comparison of Initial and Postlavage Bacterial Culture Results of Septic Peritonitis in Dogs and Cats. J Am Anim Hosp Assoc 2018; 54:257-266. [PMID: 30040445 DOI: 10.5326/jaaha-ms-6651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Septic peritonitis is a common, life-threatening condition encountered in dogs and cats. Efficacy of peritoneal lavage has not been proven in veterinary studies. Our objective was to evaluate differences in bacterial identity and susceptibility in samples obtained pre- and postlavage in animals who underwent laparotomy for treatment of septic peritonitis and to assess the effect of empirical antimicrobial selection on survival. Culture samples were collected from the peritoneal surface pre- and postlavage from dogs and cats treated surgically for septic peritonitis. Culture results were compared for each patient with regard to bacterial isolates and bacterial susceptibility profiles. Survival to discharge was evaluated.
Microbial growth occurred in at least one culture in 88.6% of patients. There was no significant difference in bacterial isolates or susceptibility profiles pre- versus postlavage. Positive culture pre- or postlavage and appropriate antimicrobial selection did not significantly affect survival. For individual animals, culture results differed between pre- and postlavage samples, although no definitive effect of peritoneal lavage was seen for the population as a whole. Antimicrobials most commonly effective against isolates were Cefotaxime, Ceftazidime, and Imipenem. If prompt surgical source control is employed, antibiotic choice may not affect clinical outcome.
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Affiliation(s)
- Sarah Ruth Kalafut
- From The Animal Medical Center, New York, New York (S.R.K., P.S.); Veterinary Specialists of Connecticut, West Hartford, Connecticut (R.L.C.); Veterinary Specialists of Sydney, Sydney, Australia (A.S.L.); and Purdue University College of Veterinary Medicine, West Lafayette, Indiana (G.E.M.)
| | - Pamela Schwartz
- From The Animal Medical Center, New York, New York (S.R.K., P.S.); Veterinary Specialists of Connecticut, West Hartford, Connecticut (R.L.C.); Veterinary Specialists of Sydney, Sydney, Australia (A.S.L.); and Purdue University College of Veterinary Medicine, West Lafayette, Indiana (G.E.M.)
| | - Rachael Leigh Currao
- From The Animal Medical Center, New York, New York (S.R.K., P.S.); Veterinary Specialists of Connecticut, West Hartford, Connecticut (R.L.C.); Veterinary Specialists of Sydney, Sydney, Australia (A.S.L.); and Purdue University College of Veterinary Medicine, West Lafayette, Indiana (G.E.M.)
| | - Andrew Scott Levien
- From The Animal Medical Center, New York, New York (S.R.K., P.S.); Veterinary Specialists of Connecticut, West Hartford, Connecticut (R.L.C.); Veterinary Specialists of Sydney, Sydney, Australia (A.S.L.); and Purdue University College of Veterinary Medicine, West Lafayette, Indiana (G.E.M.)
| | - George E. Moore
- From The Animal Medical Center, New York, New York (S.R.K., P.S.); Veterinary Specialists of Connecticut, West Hartford, Connecticut (R.L.C.); Veterinary Specialists of Sydney, Sydney, Australia (A.S.L.); and Purdue University College of Veterinary Medicine, West Lafayette, Indiana (G.E.M.)
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Spillebeen AL, Robben JH, Thomas R, Kirpensteijn J, van Nimwegen SA. Negative pressure therapy versus passive open abdominal drainage for the treatment of septic peritonitis in dogs: A randomized, prospective study. Vet Surg 2017; 46:1086-1097. [PMID: 28862743 DOI: 10.1111/vsu.12703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 02/14/2017] [Accepted: 05/22/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare passive open abdominal drainage (POAD) and negative-pressure abdominal drainage (NPAD) using the ABThera™ system in the treatment of septic peritonitis. STUDY DESIGN Randomized prospective clinical trial. ANIMALS Dogs (n = 16) with septic peritonitis. METHODS Dogs with septic peritonitis were randomly assigned to one of two treatment protocols: NPAD versus POAD. Anesthesia time, operating time, duration of drainage, costs, survival, and complications were compared between techniques. Hematological and biochemical parameters in blood and abdominal fluid, and histopathological findings of omentum and abdominal wall tissue samples were compared between NPAD and POAD at time of initial surgery and at time of closure. RESULTS Overall survival was 81%. Treatment costs, anesthesia and operating time, drainage time, survival, and postoperative complications were similar between techniques. Loss of total plasma protein and decreased inflammation-related factors in abdominal fluid at time of closure were noted in all patients. Neutrophilic inflammation was greater in abdominal wall samples after NPAD. POAD patients showed discomfort during bandage changes and had frequent leakage of abdominal fluid outside of the bandage. CONCLUSION NPAD is an effective alternative to POAD for treatment of septic peritonitis, based on costs and survival. NPAD resulted in less abdominal fluid leakage, and evidence of superior healing on histological evaluation of abdominal tissues.
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Affiliation(s)
- Anneleen L Spillebeen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
| | - Joris H Robben
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
| | - Rachel Thomas
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
| | - Jolle Kirpensteijn
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
| | - Sebastiaan A van Nimwegen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, the Netherlands
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Mouat EE, Davis GJ, Drobatz KJ, Wallace KA. Evaluation of data from 35 dogs pertaining to dehiscence following intestinal resection and anastomosis. J Am Anim Hosp Assoc 2016; 50:254-63. [PMID: 24855087 DOI: 10.5326/jaaha-ms-6111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objectives of this study were to evaluate blood and abdominal fluid lactate and glucose, fluid cytology, culture, and volume 24 and 48 hr following intestinal resection and anastomosis in dogs with and without closed-suction drains and to correlate findings with survival. Thirty-five client-owned dogs that underwent intestinal resection and anastomosis were prospectively enrolled in the study. Abdominal fluid was submitted for culture at surgery and again 24 hr postoperatively. Twenty-four and 48 hr postoperatively, blood and abdominal fluid glucose and lactate were measured and fluid was submitted for cytology. Abdominal fluid was collected either from a closed-suction drain or by abdominocentesis. Patients were followed either for 14 days or until death. Comparisons were made based on development of dehiscence and presence or absence of a drain. Patients with dehiscence were more likely to have positive cultures at 24 hr and to have had more bowel resected. Surviving patients without drains had significantly smaller differences in blood and fluid glucose and lactate both 24 and 48 hr postoperatively than surviving patients with drains. The significant differences identified between patients with and without drains suggests a need for further research into the effect of drains on abdominal fluid values.
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Affiliation(s)
- Emily E Mouat
- Surgery Department, Red Bank Veterinary Hospital, Tinton Falls, NJ (E.M., G.D.); and Section of Critical Care, Department of Clinical Studies (K.D.) and Laboratory of Pathology and Toxicology (K.W.), Matthew J. Ryan Teaching Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA
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Barfield DM, Tivers MS, Holahan M, Welch K, House A, Adamantos SE. Retrospective evaluation of recurrent secondary septic peritonitis in dogs (2000-2011): 41 cases. J Vet Emerg Crit Care (San Antonio) 2015; 26:281-7. [DOI: 10.1111/vec.12413] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 09/05/2014] [Accepted: 10/26/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Dominic M. Barfield
- Department of Clinical Science and Services; The Royal Veterinary College; Hawkshead Lane North Mymms Hatfield Herts AL9 7TA UK
| | - Michael S. Tivers
- Department of Clinical Science and Services; The Royal Veterinary College; Hawkshead Lane North Mymms Hatfield Herts AL9 7TA UK
| | - Matthew Holahan
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; Michigan State University; East Lansing MI 48824
| | - Kristin Welch
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton MA 01536 USA
| | - Arthur House
- Department of Clinical Science and Services; The Royal Veterinary College; Hawkshead Lane North Mymms Hatfield Herts AL9 7TA UK
| | - Sophie E. Adamantos
- Department of Clinical Science and Services; The Royal Veterinary College; Hawkshead Lane North Mymms Hatfield Herts AL9 7TA UK
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15
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Elliott RC. Bile peritonitis secondary to projectile trauma from an air gun pellet. Vet rec case rep 2015. [DOI: 10.1136/vetreccr-2015-000236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dickinson AE, Summers JF, Wignal J, Boag AK, Keir I. Impact of appropriate empirical antimicrobial therapy on outcome of dogs with septic peritonitis. J Vet Emerg Crit Care (San Antonio) 2014; 25:152-9. [PMID: 25545023 DOI: 10.1111/vec.12273] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 11/08/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether appropriate empirical antimicrobial therapy influenced survival in dogs with septic peritonitis. DESIGN Retrospective case series (2003-2011). SETTING University teaching hospital. ANIMALS Eighty-six dogs with cytological confirmation or positive bacterial culture of abdominal sepsis and subsequent surgical intervention. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS Forty-nine of 86 dogs (57%) survived to hospital discharge. Thirty-seven of 86 dogs were classified as having ''abdominal infection,'' 31/86 as ''severe sepsis,'' and the remaining 18/86 as in ''septic shock.'' Mortality was greatest in the ''septic shock'' category (94%). Empirical antimicrobial treatments were appropriate in 41/78 dogs (52.6%). Appropriateness was not associated with treatment outcome overall or when compared between sepsis severity groups. Antimicrobials had been given in the 30 days before admission in 63/86 (73.3%) dogs. Prior therapy with antimicrobials showed no association with outcome (P = 0.512) but was associated with subsequent inappropriate empirical antimicrobial selection (P = 0.031). Recent abdominal surgery was associated with subsequent inappropriate empirical antimicrobial selection (P = 0.021). CONCLUSIONS In this population, appropriateness of empirical antimicrobial choice was not associated with survival to discharge. Previous antimicrobial administration or abdominal surgery was associated with subsequent inappropriate empirical antimicrobial selection.
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Affiliation(s)
- Amy E Dickinson
- Pittsburgh Veterinary Specialty and Emergency Center, 807 Camp Horne Road, Pittsburgh, PA 15237
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Cortellini S, Seth M, Kellett-Gregory LM. Plasma lactate concentrations in septic peritonitis: A retrospective study of 83 dogs (2007-2012). J Vet Emerg Crit Care (San Antonio) 2014; 25:388-95. [PMID: 25212787 DOI: 10.1111/vec.12234] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 05/17/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if absolute plasma lactate concentration or lactate clearance in dogs with septic peritonitis is associated with morbidity or mortality. DESIGN Retrospective cohort study from 2007 to 2012. SETTING University teaching hospital. ANIMALS Eighty-three dogs with septic peritonitis were included. Patients had at least 1 plasma lactate measurement during the course of the hospitalization. RESULTS Sixty-four percent of the patients survived to discharge, 22% were euthanized, and 14% died during hospitalization. Plasma lactate concentration >2.5 mmol/L on admission (29% of the patients) was associated with mortality (P = 0.001). Median admission plasma lactate concentration (n = 81) was significantly different between nonsurvivors (2.5 mmol/L, range 0.5-8.4) and survivors (1.4 mmol/L, range 0.5-9.7; P = 0.007). Admission plasma lactate concentration >4 mmol/L yielded a sensitivity of 36% and a specificity of 92% for nonsurvival. The inability to normalize plasma lactate concentration within 6 hours of admission (n = 10/24) yielded a sensitivity of 76% and specificity of 100% for nonsurvival. Postoperative hyperlactatemia (plasma lactate concentration >2 mmol/L; n = 18/76) had a sensitivity of 46% and specificity of 88% for nonsurvival. Persistent postoperative hyperlactatemia (n = 11/18) had a sensitivity of 92% and a specificity of 100% for nonsurvival. Lactate clearance less than 21% at 6 hours (n = 20) had a sensitivity of 54% and specificity of 91% for nonsurvival. Lactate clearance less than 42% at 12 hours (n = 18) had a sensitivity of 82% and a specificity of 100% for nonsurvival. CONCLUSIONS Admission plasma lactate concentration and lactate clearance were good prognostic indicators in dogs with septic peritonitis.
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Affiliation(s)
- Stefano Cortellini
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, United Kingdom
| | - Mayank Seth
- Animal Health Trust, Small Animal Centre, Kentford, Newmarket, Suffolk, CB8 7UU, United Kingdom
| | - Lindsay M Kellett-Gregory
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, United Kingdom
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Adams RJ, Doyle RS, Bray JP, Burton CA. Closed Suction Drainage for Treatment of Septic Peritonitis of Confirmed Gastrointestinal Origin in 20 Dogs. Vet Surg 2014; 43:843-51. [DOI: 10.1111/j.1532-950x.2014.12258.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/01/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ronan S. Doyle
- Davies Veterinary Specialists; Higham Gobion United Kingdom
| | - Jonathan P. Bray
- Massey University Veterinary Teaching Hospital; Palmerston North New Zealand
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Abstract
Barium peritonitis is extremely rare, but is difficult to treat and may be
life-threatening. Barium suspension leakage from the gastrointestinal tract into the
abdominal cavity has a time-dependent and synergistically deleterious effect in patients
who have generalized bacterial peritonitis. The severity of barium peritonitis is
dependent on the quantity of barium in the abdominal cavity. Barium sulfate leakage
results in hypovolemia and hypoproteinemia by worsening the exudation of extracellular
fluid and albumin. Abdominal fluid analysis is a useful and efficient method to diagnose
barium peritonitis. Serial radiographs may not be a reliable or timely diagnostic
technique. Initial aggressive fluid resuscitation and empirical broad-spectrum antibiotic
treatment should be instituted promptly, followed quickly by celiotomy. During exploratory
surgical intervention, copious irrigation and direct wiping with gauze are employed to
remove as much barium as possible. Omentectomy should be considered when needed to
expedite barium removal. Despite aggressive medical and surgical treatments, postoperative
prognosis is guarded to poor due to complications, such as acute vascular shock, sepsis,
diffuse peritonitis, hypoproteninemia, electrolyte imbalance, cardiac arrest, small bowel
obstruction related to progression of granulomas and adhesions in the abdominal cavity.
Therefore, intensive postoperative monitoring and prompt intervention are necessary to
maximize chances for a positive outcome. For those that do survive, small bowel
obstruction is a potential consequence due to progression of abdominal adhesions.
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Affiliation(s)
- Jae Jin Ko
- Department of Veterinary Medicine and Surgery, University of Missouri-Columbia Veterinary Medical Teaching Hospital, Columbia, MO 65201, U.S.A
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Holt D, Agnello K. Peritoneum. Feline Soft Tissue and General Surgery 2014. [PMCID: PMC7149698 DOI: 10.1016/b978-0-7020-4336-9.00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dayer T, Howard J, Spreng D. Septic peritonitis from pyloric and non-pyloric gastrointestinal perforation: prognostic factors in 44 dogs and 11 cats. J Small Anim Pract 2013; 54:625-9. [DOI: 10.1111/jsap.12151] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T. Dayer
- Department of Small Animal Surgery, Vetsuisse Faculty; University of Bern; Bern Switzerland
| | - J. Howard
- Department of Clinical Pathology, Vetsuisse Faculty; University of Bern; Bern Switzerland
| | - D. Spreng
- Department of Small Animal Surgery, Vetsuisse Faculty; University of Bern; Bern Switzerland
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23
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Abelson AL, Buckley GJ, Rozanski EA. Positive impact of an emergency department protocol on time to antimicrobial administration in dogs with septic peritonitis. J Vet Emerg Crit Care (San Antonio) 2013; 23:551-6. [DOI: 10.1111/vec.12092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 08/01/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Amanda L. Abelson
- Department of Clinical Sciences; Cummings School of Veterinary Medicine; Tufts University; North Grafton; MA; 01536
| | - Gareth J. Buckley
- Department of Clinical Sciences; Cummings School of Veterinary Medicine; Tufts University; North Grafton; MA; 01536
| | - Elizabeth A. Rozanski
- Department of Clinical Sciences; Cummings School of Veterinary Medicine; Tufts University; North Grafton; MA; 01536
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24
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Bentley AM, Mayhew PD, Culp WTN, Otto CM. Alterations in the hemostatic profiles of dogs with naturally occurring septic peritonitis. J Vet Emerg Crit Care (San Antonio) 2013; 23:14-22. [DOI: 10.1111/vec.12013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 11/25/2012] [Indexed: 01/12/2023]
Affiliation(s)
- Adrienne M. Bentley
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania; Philadelphia; PA; 19104
| | - Philipp D. Mayhew
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania; Philadelphia; PA; 19104
| | - William T. N. Culp
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania; Philadelphia; PA; 19104
| | - Cynthia M. Otto
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania; Philadelphia; PA; 19104
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Cioffi KM, Schmiedt CW, Cornell KK, Radlinsky MG. Retrospective evaluation of vacuum-assisted peritoneal drainage for the treatment of septic peritonitis in dogs and cats: 8 cases (2003-2010). J Vet Emerg Crit Care (San Antonio) 2012; 22:601-9. [PMID: 22931241 DOI: 10.1111/j.1476-4431.2012.00791.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 07/16/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use of vacuum-assisted peritoneal drainage (VAPD) in dogs and cats with septic peritonitis. DESIGN Retrospective descriptive study. SETTING University Veterinary Teaching Hospital. ANIMALS Six dogs and 2 cats with septic peritonitis. INTERVENTIONS Application of VAPD after abdominal exploration. MEASUREMENTS Pre- and post-operative physical and clinicopathologic data, surgical findings, treatment, VAPD fluid production, outcome, and survival are reported. MAIN RESULTS Eight nonconsecutive cases of septic peritonitis, consisting of 6 dogs and 2 cats, were treated surgically and had VAPD applied post-operatively. The mean duration of clinical signs prior to surgical intervention was 4 ± 3 days. VAPD therapy was applied for a mean of 2 ± 1.1 days and collected a median of 27 mL/kg/d of abdominal effusate. The median time in hospital was 5 days and abdominal closure was completed in 5 of the 8 patients. All specimens collected at surgery cultured positive for bacteria, most commonly Enterococcus spp. The peritoneum of 4 animals was cultured at the time of abdominal closure; 1 was negative and 3 were positive for Escherichia coli, Enterococcus spp. or gram-positive cocci. Cultures before and after surgery differed in 2 patients. Hypoproteinemia was present in all patients postoperatively. Three patients were considered survivors, all of which were dogs. Five patients died or were euthanized due to cardiopulmonary arrest (n = 3), pyothorax (n = 1), and acute, severe, septic peritonitis (n = 1). CONCLUSIONS VAPD is available for maintaining abdominal drainage for the treatment of septic peritonitis after surgical intervention; however, similar to open abdominal drainage and closed suction drainage, nosocomial infection and hypoproteinemia remain challenges in the treatment of septic peritonitis.
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Affiliation(s)
- Krista M Cioffi
- Department of Small Animal Surgery at the University of Georgia Veterinary Teaching Hospital, Athens, GA 30602, USA
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Nielsen LK, Whelan M. Compartment syndrome: pathophysiology, clinical presentations, treatment, and prevention in human and veterinary medicine. J Vet Emerg Crit Care (San Antonio) 2012; 22:291-302. [PMID: 22554185 DOI: 10.1111/j.1476-4431.2012.00750.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 06/11/2011] [Accepted: 03/25/2012] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To review the human and veterinary literature pertaining to all forms of compartment syndrome (CS). DATA SOURCES Data sources included scientific reviews and original research publications from the human and veterinary literature. HUMAN DATA SYNTHESIS While CS affecting the extremities has been recognized in people for decades, other forms of CS in the abdominal and thoracic cavities are recently gaining more attention. The role of CS in critically ill people is a rapidly growing area of interest. More research on prevention and treatment of CS is being conducted in people because some studies have found mortality rates as high as 80% for those suffering from these conditions. VETERINARY DATA SYNTHESIS While a significant amount of experimental studies of CS have been performed on small animals, there is a marked lack of primary veterinary studies. The majority of the veterinary literature includes case reports and series, and many of these studies were published over a decade ago. However, the increased recognition of CS in people has sparked an interest in veterinary critical care medicine and this has been demonstrated by the recent increased evaluation of compartment pressures in veterinary patients. CONCLUSIONS CS is a complex clinical condition where increased pressure within a compartment can cause significant adverse effects within the compartment as well as throughout the body. Systemic inflammatory responses and local ischemia-reperfusion elements can contribute to the detrimental effects seen in CS. This cascade of events results in increased mortality rates and contributes to the development of CS elsewhere. A better understanding of CS will help veterinarians improve patient care and outcome. Future studies on incidence, prevention, and treatment of CSs in the critical care patient are needed in veterinary medicine.
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Abstract
The purpose of this study was to describe the appropriate surgical technique, postoperative monitoring, and complications encountered with use of vacuum-assisted closure (VAC) in six dogs with confirmed septic peritonitis. Initial diagnosis of septic peritonitis was performed by measuring either the blood-to-fluid lactate ratio and glucose concentration differences or cytologic verification of intracellular bacteria. After appropriate surgical procedures were performed to manage the primary cause of peritoneal sepsis, a VAC was performed. Serum and abdominal fluid protein levels were measured, and all complications were noted during the postoperative period. Three of the six dogs (50%) survived to the secondary closure and were subsequent discharged, which is similar to previous studies where the abdomen was either closed primarily or treated with open abdominal drainage. No major complications occurred with bandage management during hospitalization. The results of this study support VAC as a feasible technique for managing septic peritonitis.
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Affiliation(s)
| | - Marc E. Havig
- Surgery Department, The Animal Medical Center, New York, NY
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31
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Grimes JA, Schmiedt CW, Cornell KK, Radlinksy MAG. Identification of risk factors for septic peritonitis and failure to survive following gastrointestinal surgery in dogs. J Am Vet Med Assoc 2011; 238:486-94. [DOI: 10.2460/javma.238.4.486] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Abstract
A 6-year-old, spayed female Labrador retriever was presented 48 hours after an intestinal resection and anastomosis for management of a small intestinal foreign body. Abdominal ultrasound confirmed the presence of peritoneal effusion. Cytology of fluid collected by abdominocentesis revealed a large number of degenerate neutrophils with intracellular cocci. A diagnosis of septic peritonitis was made, presumably because of dehiscence of the anastomosis. Upon repeat exploratory celiotomy, the intestinal anastomosis (located 4 cm orad to the cecum) was found to be leaking intestinal contents into the abdomen. The distal ileum, cecum, and proximal colon were resected. An end-to-end, ileocolic anastomosis was performed and subsequently exteriorized into the subcutaneous space via a paramedian incision through the abdominal wall. The anastomosis was inspected daily for 4 days before it was returned to the abdomen and the subcutaneous defect was closed. Serial cytology of the peritoneal fluid, which was performed during this 4-day postoperative period, confirmed progressive resolution of peritonitis. The dog was discharged from the hospital 2 days following return of the anastomosis into the abdomen. Externalized intestinal anastomosis is used with good success in human medicine for repair of colonic injuries. In this case, externalization of the anastomosis permitted healing of the intestinal anastomosis in an environment isolated from the detrimental effects created by septic peritonitis. In addition, direct visualization of the anastomosis allowed assessment of healing. To our knowledge, this procedure has not been previously reported in companion animals.
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Affiliation(s)
- James Simcock
- Southpaws Specialty Surgery for Animals (Simcock), 3 Roper Street, Moorabbin, Victoria, 3189 Australia
- Southern Animal Emergency Centre (Kuntz, Newman), 248 Wickham Road, Highett, Victoria, 3190 Australia
- From the
| | - Charles A. Kuntz
- Southpaws Specialty Surgery for Animals (Simcock), 3 Roper Street, Moorabbin, Victoria, 3189 Australia
- Southern Animal Emergency Centre (Kuntz, Newman), 248 Wickham Road, Highett, Victoria, 3190 Australia
- From the
| | - Raquel Newman
- Southpaws Specialty Surgery for Animals (Simcock), 3 Roper Street, Moorabbin, Victoria, 3189 Australia
- Southern Animal Emergency Centre (Kuntz, Newman), 248 Wickham Road, Highett, Victoria, 3190 Australia
- From the
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33
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Abstract
The purpose of this paper is to describe the signalment, clinical signs, laboratory results, culture results, and response to treatment for primary septic peritonitis in cats. This is a retrospective study of 12 client-owned animals. Medical records were reviewed for clinical findings, laboratory results, microbial culture results, radiographic findings, diagnosis, treatment, and outcome. The overall mortality rate for this group of cats was 31%, consistent with previous reports of septic peritonitis in cats. All cats that were both bradycardic and hypothermic on presentation did not survive. Other clinicopathological findings were consistent with previously reported cases of septic peritonitis in cats. Results suggest that clinicopathological findings and outcomes in cats with primary septic peritonitis are similar to those in cats with septic peritonitis from a determined cause. A specific mechanism of inoculation has yet to be determined, but an oral source of bacteria is suggested for cats with primary bacterial septic peritonitis.
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Affiliation(s)
- Cassandra M Ruthrauff
- Veterinary Surgical Associates, 1410 Monument Boulevard, Suite 100, Concord, California 94520, USA
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35
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Parsons KJ, Owen LJ, Lee K, Tivers MS, Gregory SP. A retrospective study of surgically treated cases of septic peritonitis in the cat (2000-2007). J Small Anim Pract 2009; 50:518-24. [DOI: 10.1111/j.1748-5827.2009.00790.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
An 8-year-old domestic shorthair cat was evaluated for a several day history of anorexia and vomiting. Abdominal distention was noted on physical examination and diagnostics including abdominal radiographs and abdominal ultrasound demonstrated the presence of free fluid in the peritoneal cavity. Septic peritonitis was diagnosed on cytologic evaluation of the peritoneal fluid. The cat was taken to surgery and a foreign body composed of plant material was found embedded within the spleen. A splenectomy was performed and both open and active peritoneal drainages were used to successfully treat this case.
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Affiliation(s)
- William T.N. Culp
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, United States
| | - Lillian R. Aronson
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, United States
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37
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38
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39
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40
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Abstract
Planned relaparotomy is a technique in which two or more surgeries are planned before or during the initial surgery. Two dogs underwent planned relaparotomy for severe peritonitis secondary to gastric ulceration and linear foreign body. Both dogs had good outcomes, and unnecessary procedures that would likely have led to increased morbidity were avoided. This technique may be useful in avoiding unnecessary procedures as well as providing for better stabilization of the animal.
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Affiliation(s)
- Anna Kirsten Lawson
- Tacoma Animal Emergency Clinic, Puget Sound Veterinary Referral Center, 5608 South Durango, Tacoma, Washington 98409, USA
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42
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Beck JJ, Staatz AJ, Pelsue DH, Kudnig ST, MacPhail CM, Seim HB, Monnet E. Risk factors associated with short-term outcome and development of perioperative complications in dogs undergoing surgery because of gastric dilatation-volvulus: 166 cases (1992–2003). J Am Vet Med Assoc 2006; 229:1934-9. [PMID: 17173533 DOI: 10.2460/javma.229.12.1934] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate risk factors associated with death and development of perioperative complications in dogs undergoing surgery for treatment of gastric dilatation-volvulus (GDV). DESIGN Retrospective case series. ANIMALS 166 dogs. PROCEDURES Records of dogs with confirmed GDV that underwent surgery were reviewed. Logistic regression was performed to identify factors associated with development of complications (ie, hypotension, arrhythmias, gastric necrosis necessitating gastrectomy, disseminated intravascular coagulation, peritonitis, sepsis, postoperative dilatation, postoperative vomiting, and incisional problems) and with short-term outcome (ie, died vs survived to the time of suture removal). RESULTS Short-term mortality rate was 16.2% (27/166). Risk factors significantly associated with death prior to suture removal were clinical signs for > 6 hours prior to examination, combined splenectomy and partial gastrectomy, hypotension at any time during hospitalization, peritonitis, sepsis, and disseminated intravascular coagulation. Partial gastrectomy was not a significant risk factor for death but was for peritonitis, disseminated intravascular coagulation, sepsis, and arrhythmias. Age, gastrectomy, and disseminated intravascular coagulation were risk factors for development of hypotension. Use of a synthetic colloid or hypertonic saline solution was associated with a significantly decreased risk of hypotension. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that the prognosis for dogs undergoing surgery because of GDV is good but that certain factors are associated with an increased risk that dogs will develop perioperative complications or die.
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Affiliation(s)
- Jennifer J Beck
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523
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Lascelles BDX, Blikslager AT, Fox SM, Reece D. Gastrointestinal tract perforation in dogs treated with a selective cyclooxygenase-2 inhibitor: 29 cases (2002-2003). J Am Vet Med Assoc 2005; 227:1112-7. [PMID: 16220672 DOI: 10.2460/javma.2005.227.1112] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify factors associated with gastrointestinal tract perforation in dogs being treated with a selective cyclooxygenase-2 (COX-2) inhibitor (deracoxib). DESIGN Retrospective study. ANIMALS 29 dogs. PROCEDURE The Novartis Animal Health pharmacovigilance database was searched for records of dogs treated with deracoxib in which gastrointestinal tract perforation was documented. Results-16 of the 29 (55%) dogs had received deracoxib at a dosage higher than that approved by the FDA for the particular indication being treated, with 25 (86%) dogs having received deracoxib at a dosage > 2 mg/kg/d (0.9 mg/lb/d). Seventeen (59%) dogs had received at least 1 other nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid in close temporal association (within 24 hours) with deracoxib administration (ie, immediately before or following). In all, 26 (90%) dogs had received deracoxib at a higher-than-approved dosage or had received at least 1 other NSAID or corticosteroid in close temporal association with deracoxib administration. Twenty dogs died or were euthanatized, and 9 survived. CONCLUSIONS AND CLINICAL RELEVANCE In dogs with gastrointestinal tract perforation and that had been treated with deracoxib, perforation was most likely attributable to a number of factors. Deracoxib should only be used at approved dosages. Cortico-steroids and other less selective NSAIDs should not be administered in close temporal association with selective COX-2 inhibitors, including deracoxib. Further study is required to define this problem.
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Affiliation(s)
- B Duncan X Lascelles
- Comparative Pain Research Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
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44
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Costello MF, Drobatz KJ, Aronson LR, King LG. Underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis: 51 cases (1990-2001). J Am Vet Med Assoc 2005; 225:897-902. [PMID: 15485050 DOI: 10.2460/javma.2004.225.897] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis and identify differences between cats that survived following treatment and cats that did not survive despite treatment. DESIGN Retrospective study. ANIMALS 51 cats with septic peritonitis. PROCEDURE Medical records were reviewed for clinical findings; results of clinicopathologic testing, microbial culture, and radiography; diagnosis; treatment; and outcome. RESULTS Signs of pain during palpation of the abdomen were reported for only 29 of 47 (62%) cats. Eight (16%) cats had relative bradycardia (heart rate < 140 beats/min). The most commonly isolated organisms included Escherichia coli, Enterococcus spp, and Clostridium spp. The most common cause of peritonitis was gastrointestinal tract leakage (24 cats). No definitive source could be identified in 7 cats. Treatment, including exploratory surgery, was pursued in 23 cats, of which 16 (70%) survived and were discharged. There were no significant differences between survivors and nonsurvivors in regard to heart rate, age, rectal temperature, serum lactate concentration, WBC count, PCV, blood glucose concentration, or serum albumin concentration. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that clinicopathologic abnormalities and outcome in cats with septic peritonitis are similar to those reported for dogs. However, certain features may be unique, including an absence of signs of pain during abdominal palpation, relative bradycardia, and apparent spontaneous peritonitis in some cats.
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Affiliation(s)
- Merilee F Costello
- Section of Critical Care, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010, USA
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45
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Abstract
OBJECTIVE To identify the most common causes of pneumoperitoneum in dogs and cats and determine history, clinical features, and outcome of affected animals. DESIGN Retrospective study. ANIMALS 31 dogs and 8 cats. PROCEDURES Medical records were reviewed for signalment; history; abnormal physical, clinicopathologic, and radiographic findings; results of cytologic analysis and bacterial culture of abdominal fluid; gross and histologic findings at surgery or necropsy; and outcome. RESULTS Pneumoperitoneum was classified as spontaneous in 25 animals and traumatic in 14. Causes of traumatic pneumoperitoneum included vehicular impact, gunshot wounds, abdominal dog bite wounds, and iatrogenic pneumothorax. Spontaneous pneumoperitoneum was caused by gastrointestinal tract perforation in 23 animals; underlying causes included neoplasia, nonsteroidal anti-inflammatory drug administration, and corticosteroid administration. Two animals developed spontaneous pneumoperitoneum after bladder rupture. Animals with spontaneous pneumoperitoneum were significantly older and had clinical signs of longer duration than those with traumatic pneumoperitoneum. Sixteen animals survived, including 15 of 23 animals that underwent surgery. Animals that survived had significantly higher serum albumin concentrations than did animals that died or were euthanatized. CONCLUSIONS AND CLINICAL RELEVANCE Although pneumoperitoneum is most often attributable to perforation of a hollow viscus, other causes do exist. Early exploration is recommended for diagnosis and treatment of the underlying condition.
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Affiliation(s)
- W Brian Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37901-1071, USA
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