Today's Veterinary Practice

TVP_JUL-AUG2018

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PEER REVIEWED 48 JULY/AUGUST 2018 todaysveterinarypractice.com for potentially fatal decompensation with stressful handling. Observation from a distance can also be helpful to characterize abnormal breathing patterns that may be missed with close hands-on examination. Characteristic breathing patterns may help to localize the anatomic location of respiratory disease in the specific patient (e.g., short, shallow breaths are common with pleural space disease, and increased expiratory effort is common with lower airway disease). More sophisticated oxygen cages frequently enable the clinician to adjust the approximate FiO 2 administered to the patient, ranging from room air (21%) to approximately 60%. The actual concentration achieved will depend on the integrity of the cage itself, with air leakage reducing the concentration. This is also true when the cage door is opened, resulting in a rapid drop of the oxygen concentration. This also limits the usefulness of this approach when frequent patient reassessment would be ideal. Another convenience of the oxygen cage is the ability to perform nebulization without close handling. Oxygen cages are limited by their relative expense (including setup costs and requirement for oxygen cylinders); patient size also limits their utility (e.g., larger dogs are not ideal candidates for oxygen cages). For neonates and pediatric patients, incubators can be used in a similar manner, either with already piped-in oxygen or through placement of oxygen tubing into the incubator itself ( FIGURE 5 ). Nasal Oxygen For larger dogs, oxygen cages may be too confining to be comfortable. The placement of nasal lines can be convenient in such dogs. Nasal prongs can be used but reasonably are relevant only in nonbrachycephalic breeds. The FiO 2 achieved via nasal prongs is not well established but may be similar to that seen with longer nasal catheters, provided the patient does not dislodge the prongs. In most circumstances, nasal lines can be placed easily by using 5- to 8-French red rubber catheters. Local analgesia should be instilled in the nose (e.g., proparacaine eye drops), before a lubricated red rubber catheter is inserted via the ventral meatus to the level of the medial canthus. The catheter can then be sutured to the nostrils and face to secure the tube ( FIGURES 6 AND 7 ). Alternatively, the catheter can be measured to the level of the mandible for the placement of a nasopharyngeal catheter ( FIGURE 8 ). FIGURE 5. Incubator used for neonatal and pediatric patients. FIGURE 6. Labradoodle with spontaneous pneumothorax demonstrating correct securement of a red rubber nasopharyngeal line. Oxygen cages are a very convenient and efficient method of supplementing oxygen to small animal patients.

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