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July/August 2014 Today's Veterinary Practice 35 Bordetella BronchiSeptica & CanIne Influenza VIRus (H3n8) | tvpjournal.com MANAGING CRITICALLY ILL DOGS When managing critically ill dogs with B bronchiseptica and/or CIV, implement the following supportive therapy: 1. Provide Increased Oxygen Concentrations severe cases of B bronchiseptica and CIV may present in respiratory distress and require oxygen supplementation. assess oxygenation via pulse oximetry and/ or arterial blood gas analysis. Pulse oximetry is noninvasive and available in most practices, but does not always provide an accurate measurement. Provide oxygen supplementation to patients with an: • spO 2 of < 92% to 94% or PaO 2 < 80 mm Hg, especially if signs of respiratory difficulty are present • Increase in respiratory effort, even if the patient is oxygenating appropriately. Common methods of oxygen supplementation in hospital include oxygen cage, tent, nasal cannula(s), and nasal prongs. nasal cannula or prongs may work best for highly contagious patients that must be iso- lated, but require supervision to ensure the catheter does not become dislodged (Figure 4). 2. Improve Clearance of Respiratory Secretions Critical patients often lose fluids through the respiratory tract, especially if they are febrile, leading to increased viscosity of secretions and reduced ciliary clearance. Initiate IV fluids to replace fluids lost and improve clearance of respiratory secretions. nebulization with sterile saline (6–10 ml) results in a liquid particulate suspension that improves clearance of tracheal and bronchial secretions. nebulization followed by coupage may be performed for 15 to 20 minutes every 4 to 8 hours in hospitalized patients; owners may rent or purchase a handheld jet nebulizer for use at home. 3. Treat Primary or Secondary Bacterial Pathogens antibiotic therapy is essentially the same for all patients (see anTIMICRObIal THeRaPY); however, injectable antibiotics should be considered for critically ill patients, due to associated gastrointestinal upset and poor bioavailability of oral antibiotics in anorexic patients. fluoroquinolones (enrofloxacin, ciprofloxacin) may be preferred for injection because, compared to doxycycline, they provide more broad spectrum coverage for gram-negative organisms, are unlikely to result in phlebitis, and are less expensive. Figure 4. Dog with nasal cannula in place. Note that tetracyclines and fluoroquinolones readily cross the blood–bronchus barrier, but penicillins and cephalosporins do not and, therefore, may be associ- ated with treatment failure in some cases. Although fluoroquinolones are less desirable in young animals due to their effects on cartilage development, this risk may be of less concern in patients with life-threaten- ing infections. 16 ADDITIONAL THERAPIES Glucocorticoids & Cough Suppressants Anti-inflammatory glucocorticoids and/or cough sup- pressants may be indicated for patients with infectious