Today's Veterinary Practice

TVP_JUL-AUG2018

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PEER REVIEWED 50 JULY/AUGUST 2018 todaysveterinarypractice.com may dramatically reduce the dose of propofol required needed to achieve intubation. It is also sensible to examine laryngeal function in dogs with upper airway obstruction under a light plane of anesthesia. In cases of upper respiratory obstruction associated with laryngeal paralysis, only a short period of intubation is typically necessary because the patient should retain the capacity to ventilate spontaneously ( FIGURE 9 ). During this period of intubation, additional diagnostic and therapeutic measures then can be performed (e.g., chest radiography, external cooling, administration of corticosteroids). If the abnormality present is nonreversible or severe, intubation may be necessary for a prolonged period until a curative solution (e.g., surgery) has been performed. In some situations, the upper airway may be bypassed via placement of a temporary tracheostomy tube. This allows the pet to be recovered from anesthesia and potentially obviates the need for supplemental oxygen if the remaining respiratory tract is functioning normally. Intubation With Positive- Pressure Ventilation Mechanical ventilation should be considered ( FIGURE 10 ) in the following circumstances: ■ Hypoxemia refractory to the standard measures, typically indicating lung failure with poor oxygen saturation (e.g., partial pressure of oxygen in arterial blood <50 mmHg) ■ Progressive severe hypercapnia associated with ventilatory failure ■ Impending respiratory fatigue associated with severe underlying cardiopulmonary disease ■ Cardiovascular instability, such as that noted in animals recovering from successful cardiopulmonary resuscitation Long-term oxygen supplementation is associated with the risk for oxygen toxicity. One advantage of using mechanical ventilators is the ability to control the FiO 2 accurately to as low as 21%. Mechanical ventilators also offer some other options for improving pulmonary function, including the provision of positive end-expiratory pressure to facilitate airway opening and improved gas exchange. SUMMARY Supplementing oxygen reliably and safely is a vital and potentially life-saving intervention in small animal medicine. The specific techniques used depend on the situation at hand, as well as the equipment available. An awareness of several techniques is clinically helpful. References 1. Mazzaferro EM. Ox ygen therapy. In Silverstein DC, Hopper K (eds). Small Animal Critical Care Medicine, 2 nd ed. St. L ouis, MO: Elsevier Saunders, 2015, pp 77-80. 2. L ee JA. Nonrespiratory look-alikes. In Silverstein DC, Hopper K (eds). Small Animal Critical Care Medicine, 2 nd ed. St. Louis, MO: Elsevier Saunders, 2015, pp 157-160. 3. Sumner C, Rozanski E. Management of respiratory emergencies in small animals. Vet Clin Small Anim Pract 2013;43(4):799-815. 4. Senn D, Sigrist N, Forterre F, Howard J, Spreng D. Retrospective evaluation of postoperative nasotracheal tubes for oxygen supplementation in dogs following surgery for brachycephalic syndrome: 36 cases (2003-2007). J Vet Emerg Crit Care (San Antonio) 2011;21(3):261-267. FIGURE 10. Puppy with pulmonary contusions after being hit by a car receiving mechanical ventilation. Alex Lynch Alex Lynch is an Assistant Professor in Emergency and Critical Care at North Carolina State University, Raleigh, NC. He graduated with honors from the University of Bristol in 2009. After a period in first opinion and referral practice in the United Kingdom, he moved to Tufts University in North Grafton, Massachusetts, to undertake further clinical training in emergency and critical care. He became a diplomate of the American College of Veterinary Emergency and Critical Care in 2015. He worked as a faculty member in ECC before moving to NC State in 2017. His particular interests are coagulation, transfusion medicine, respiratory disease, and trauma.

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