ICU Research & Clinical Studies
Title: Glucose Monitoring in Dogs with Peritonitis: A Pilot Study
Description: The goal of the prospective, observational study proposed here is to use a continuous glucose monitoring system to continuously monitor glucose in a cohort of critically ill non-diabetic dogs with peritonitis to identify aberrations in glucose metabolism during hospitalization. The degree of hyperglycemia or hypoglycemia will be analyzed to determine whether there is an association with morbidity and/or mortality in this patient population.
Qualifications/prerequisites:
- Inclusion criteria: Dogs with a diagnosis of peritonitis of any etiology, identified within 24 hours of the diagnosis will be eligible for enrollment.
- Exclusion criteria: Dogs with concurrent diabetes mellitus, confirmed hyperadrenocorticism, or prior corticosteroid administration will be excluded from evaluation because these factors would be expected to independently influence plasma glucose concentrations.
Contact information: Dr. Erica Reineke, (215) 573-9345
Title: Relationship between Doppler blood pressure and survival or response to treatment in critically ill cats: 83 Cases (2003-2004)
Description: The objective of this study was to retrospectively evaluate the relationship between Doppler blood pressure (DBP) and survival or response to treatment in critically ill cats.
Qualifications/prerequisites:
- Inclusion criteria: Cats that were admitted to the intensive care unit of the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania from 2003 to 2004 and that had at least two recorded DBP measurements while hospitalized were included.
- Exclusion criteria: Cats were excluded from the study if < 2 DBP measurements were recorded, or if the medical record was not available for evaluation.
Findings/Conclusions:
Hypotensive cats had increased mortality rate with lower rectal temperatures and lower PCV, compared with normotensive critically ill cats. The implications of these findings with regard to treatment remain to be elucidated, but addressing these abnormalities may be appropriate.
Contact/application information: Dr. Deborah Silverstein, 215-898-3303
This study was recently completed.
Title: The Prognosis of Linear vs. Non-Linear Gastrointestinal Foreign Bodies in Dogs
Objective: To compare and contrast clinical course and outcome in dogs with linear and non-linear foreign bodies of the gastrointestinal tract.
Inclusion Criteria – Dogs were included in the study if a foreign body was
- Associated with clinical signs (e.g., anorexia, lethargy, vomiting) necessitating hospitalization, endoscopy, or surgery
- Detected by imaging techniques. e.g., radiography or ultrasonography;
- Localized to the stomach, intestine, or colon
- Confirmed by surgical or endoscopic removal, or necropsy.
Exclusion Criteria – Medical records were reviewed for evidence of concurrent disease processes that could potentially result in clinical signs similar to those of gastrointestinal foreign body. Dogs were excluded from the study if other primary causes of clinical signs (e.g., neoplasia, parasite infestation, enteric bacterial infection, renal failure, or common toxicoses) were identified. Patients were also excluded from the study if the medical record
was incomplete or the foreign body could not be identified due to lack of surgical, endoscopic, or necropsy evidence.
Contact information: Garret Pachtinger VMD, (215) 573-0265
Title: Effect of treatment with low doses of hydrocortisone on pressor dependence and mortality in dogs with septic shock
Description: This is a prospective, multi-center, placebo-controlled, randomized, double-blind, parallel-group trial. The objectives of this study are threefold:
- To determine whether a 5-day course of low-dose hydrocortisone decreases pressor dependency in dogs with septic shock.
- To determine whether a 5-day course of low-dose hydrocortisone improves 28-day survival in dogs with septic shock.
- To determine whether there is a difference in response to hydrocortisone in septic dogs with relative adrenal insufficiency compared to those with appropriate HPA axis function.
Qualifications/prerequisites:
Inclusion criteria: Dogs with septic shock will be included in the study. Septic shock will be defined using the following criteria:
- Infectious underlying disease, either documented by culture or cytology, or highly suspected based on strict criteria (such as radiographic cranioventral pulmonary infiltrates in a dog with megaesophagus; or a vegetative lesion diagnosed on echocardiography in a dog with a new heart murmur) –AND –
- Two of the following four parameters:
- Rectal temperature < 100.0 F or > 103.0 F
- Heart rate > 120 beats / minute
- PCO2 (arterial or venous) < 32 mmHg –OR— non-panting respiratory rate > 40 breaths / minute
- A CBC performed by a REFERENCE LABORATORY (not an in-house machine) within 24 hours of inclusion showing EITHER:
- Total WBC < 6,000/?L –OR—
- Total WBC > 16,000/?L –OR—
- >3% immature neutrophils
–AND –
- Hypotension (MAP ≤ 60mmHg or SBP ≤ 80mmHg) refractory to fluid loading. Fluid-replete status must be documented by a central venous pressure ≥ 8 cmH2O. Patients must require pressor support to maintain MAP ≥ 60mmHg or SBP ≥ 80mmHg.
Exclusion criteria: Dogs will be excluded from the study if they have had glucocorticoid administration of > 1 week’s duration any time in the 6 weeks prior to the study, or glucocorticoid administration at any time in the 7 days prior to study initiation. Dogs will also be excluded if they are being treated with ketoconazole, etomidate, or any other drug known to affect the HPA axis; if they have known or suspected hyper- or hypoadrenocorticism; or if the primary clinician in charge of the dog refuses participation.
Contact/application information: Deborah Silverstein, 215-898-3303
Title: The measurement of microvascular perfusion in normal and critically ill dogs using orthogonal polarization spectral imaging
Description: The objective of this study is to determine normal microvascular parameters using a novel technology, the MicroScan®, in dogs. The reference ranges will be determined using specialized software and visual quantitative measurements. We hope to then use this information to further study critically ill dogs. We hypothesize that normal dogs have excellent microvascular blood flow.
Qualifications/prerequisites:
Inclusion criteria: Anesthetized dogs that are healthy based on physical examination and pre-anesthetic labwork and that are cardiovasculary stable during anesthesia will be included.
Exclusion criteria: Dogs that are unstable during anesthesia or those with any abnormal physical examination or laboratory parameters will be excluded.
Contact/application information: Deborah Silverstein, 215-898-3303
Title: The Evaluation of Microcirculation and Macrocirculation in Veterinary Patients with Septic Peritonitis
Description: This study is evaluating the macrocirculatory and microcirculatory parameters post-operatively in dogs diagnosed with septic peritonitis. We hypothesize that abnormalities will persist in the microcirculation even when hemodynamic measures of the function of the macrocirculation are within acceptable limits.
Qualifications/prerequisites:
Inclusion criteria: Post-operative dogs with septic peritonitis will be included.
Exclusion criteria: Post-operative dogs that do not tolerate the MicroScan probe on their gingival mucosa, those with heavy pigmentation of the mucosa, or the presence or oral lesions will be excluded.
Contact/application information: Dr. Dana Clarke, 215-746-6106
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Title: The Effects of Red Blood Cell Transfusion on Morbidity and Mortality in Critically Ill Dogs: A Pilot Study
Description: The objective of this study is to determine differences in morbidity (defined as organ failure), duration of hospitalization, and mortality (defined as survival at day 30) in moderately anemic dogs with critical illness that receive transfusions of packed red blood cells (pRBCs) in comparison with those with a similar degree of anemia that do not receive pRBCs. We would also like to determine if there is an association between RBC storage lesions (based upon the age, hemolysis, and lactate concentration of transfused RBCs) or transfusion reactions (defined by clinical observations and post-transfusion immunological testing) and morbidity and mortality.
We hypothesize that although pRBC transfusions result in improved tissue oxygen delivery, they may be independently associated with complications and increased morbidity and mortality in dogs in the ICU. We will test the null hypothesis: there is no difference in morbidity and mortality between moderately anemic dogs who receive pRBCs and those who do not. Furthermore, we hypothesize that pRBC storage lesions have an effect on morbidity and mortality, and we will be testing the null hypothesis: there is no association between the age of transfused blood products and morbidity and mortality in dogs in the ICU.
Qualifications / prerequisites:
Inclusion criteria:
Client owned dogs that present to MJR – VHUP for admission to the emergency service (with intent for ICU transfer) or ICU with a PCV between 15% and 25%. Dogs will be admitted to the study whenever the PCV drops lower than 25%, which might be on the day of entry to ICU/ES or later during ICU hospitalization. The administration of pRBCs will be determined by the attending clinician. The target number of dogs will consist of 20 animals.
Exclusion criteria:
Animals will not be included in the study if: the PCV < 15% at any point during hospitalization, there is incomplete data collection, the animal has already received a pRBC transfusion prior to entry into the study, the animal weighs < 4 kg or is < 1 year of age.
Contact / application information: Dr. Melissa Java, (215) 573-3312
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Title: Vascular endothelial growth factor levels in conjunction with multifrequency bioimpedance analysis in critically ill dogs
Description: The objective of this study was to prospectively determine the relationship between plasma vascular endothelial growth factor (VEGF) levels and edema formation in critically ill dogs.
Qualifications/prerequisites:
Inclusion criteria: Dogs were included if they had an inflammatory disease process causing an increase or decrease in the WBC count (>20,000/μL or <5,000/μL) or >5% bands, weighed >5 kilograms, suffered from a critical illness requiring at least 24 hours in the intensive care unit, were receiving fluid therapy, and dogs whose owners agreed to include them in the study.
Exclusion criteria: Dogs were excluded from the study if they had any evidence of neoplasia, severe hypoxemia (PaO2 <60 mmHg or SpO2 < 90%), or clinical evidence of edema on presentation.
Findings/Conclusions:
A statistical relationship was not found between VEGF levels in the blood of dogs with inflammatory disease and their SPI, the presence of edema, the WBC count, medical versus surgical disease, or presence of sepsis. Dogs with a VEGF level >70 pg/ml were less likely to survive. Further studies are needed to determine the diagnostic and prognostic value of this cytokine in critically ill dogs.
Contact/application information: Deborah Silverstein, 215-898-3303
This study was recently completed.