Search

Background: Venous blood gas and acid-base analysis is often performed in cats and requires appropriate reference intervals (RIs) for interpretation. The currently available RIs were created from small numbers of cats, while current guidelines suggest that a minimum number of 40 samples is required for the creation of an accurate/appropriate RI., Key Findings: In 41 healthy awake cats, pH, P v CO 2 , P v O 2 , sodium, potassium, ionized calcium, chloride, glucose, and plasma lactate concentrations were measured, while bicarbonate, standardized base excess, and anion gap were calculated. These data were used to calculate RIs, using a statistical approach that conforms to the American Society for Veterinary Clinical Pathology guidelines., Significance: RIs for venous blood gas and traditional acid-base analysis from a relatively large population of healthy cats are now available for clinical use and standardized for future research studies., (© Veterinary Emergency and Critical Care Society 2025.)

Objective: To describe the acid-base balance of diabetic animals with ketosis and to identify underlying mechanisms of acid-base changes using semiquantitative analysis., Design: Retrospective study., Setting: University teaching hospital., Animals: Eighty-one client-owned dogs and 15 client-owned cats with diabetes and concurrent ketosis presented to a university teaching hospital., Interventions: None., Measurements and Main Results: The medical records database was searched from January 2017 through December 2021 for dogs and cats with diabetes mellitus and ketones present in urine or blood samples that also had venous blood gas and serum biochemical assays performed within 24 hours of each other. Traditional analysis identified normal acid-base status in 20% of dogs and 7% of cats. A simple metabolic acidosis with an elevated anion gap was observed in 17% of dogs and 20% of cats, and a metabolic alkalosis was present in 4% of dogs and 7% of cats. The semiquantitative approach identified metabolic acid-base disorders in all animals. One or more acidifying processes were evident in 100% of dogs and 100% of cats, 1 or more alkalotic processes in 93% of dogs and 100% of cats, concurrent alkalotic and acidotic processes in 85% of dogs and 100% of cats, and unmeasured anions in all cases., Conclusions: Dogs and cats with diabetic ketosis can have variable and complex acid-base disorders that may be better recognized using semiquantitative analysis. Diagnostic criteria such as low pH or a high anion gap may prevent the clinical recognition of diabetic ketoacidosis., (© Veterinary Emergency and Critical Care Society 2025.)

Objective: To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps., Design: Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization., Setting: Transdisciplinary, international collaboration in university, specialty, and emergency practice., Results: Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation., Conclusions: These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area., (© 2024 The Authors. Journal of Veterinary Emergency and Critical Care published by Wiley Periodicals LLC on behalf of Veterinary Emergency and Critical Care Society.)

Objective: To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to re-evaluate the scientific evidence relevant to CPR in small and large animals, to newborn resuscitation, and to first aid and to formulate the respective consensus-based clinical guidelines., Design: This report describes the evidence-to-guidelines process employed by RECOVER that is based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and includes Information Specialist-driven systematic literature search, evidence evaluation conducted by more than 200 veterinary professionals, and provision of clinical guidelines in the domains of Preparedness and Prevention, Basic Life Support, Advanced Life Support, Post-cardiac Arrest Care, Newborn Resuscitation, First Aid, and Large Animal CPR., Setting: Transdisciplinary, international collaboration in academia, referral practice, and general practice., Results: For this update to the RECOVER 2012 CPR guidelines, we answered 135 Population, Intervention, Comparator, and Outcome (PICO) questions with the help of a team of Domain Chairs, Information Specialists, and more than 200 Evidence Evaluators. Most primary contributors were veterinary specialists or veterinary technician specialists. The RECOVER 2024 Guidelines represent the first veterinary application of the GRADE approach to clinical guideline development. We employed an iterative process that follows a predefined sequence of steps designed to reduce bias of Evidence Evaluators and to increase the repeatability of the quality of evidence assessments and ultimately the treatment recommendations. The process also allowed numerous important knowledge gaps to emerge that form the foundation for prioritizing research efforts in veterinary resuscitation science., Conclusions: Large collaborative, volunteer-based development of evidence- and consensus-based clinical guidelines is challenging and complex but feasible. The experience gained will help refine the process for future veterinary guidelines initiatives., (© 2024 The Authors. Journal of Veterinary Emergency and Critical Care published by Wiley Periodicals LLC on behalf of Veterinary Emergency and Critical Care Society.)

Objective: After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring., Design: These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks., Setting: Transdisciplinary, international collaboration in university, specialty, and emergency practice., Results: A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided., Conclusions: While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats., (© 2024 The Author(s). Journal of Veterinary Emergency and Critical Care published by Wiley Periodicals LLC on behalf of Veterinary Emergency and Critical Care Society.)

Objective: To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time., Design: Experimental study., Setting: Small animal research facility., Animals: Twenty-four purpose-bred research dogs., Interventions: Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (T 0 ), at 3 minutes (T 3 ), and at 6 minutes (T 6 ) into BLS., Measurements and Main Results: The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pao 2 , anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (P < 0.03). By T 6 , arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous Po 2 , ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from T 0 (P < 0.05)., Conclusions: Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical role of POC testing during CPR., (© Veterinary Emergency and Critical Care Society 2024.)

Objective: To report the prevalence of initial shockable cardiac arrest rhythms (I-SHKR), incidence of subsequent shockable cardiac arrest rhythms (S-SHKR), and factors associated with I-SHKRs and S-SHKRs and explore their association with return of spontaneous circulation (ROSC) rates in dogs and cats undergoing CPR., Design: Multi-institutional prospective case series from 2016 to 2021, retrospectively analyzed., Setting: Eight university and eight private practice veterinary hospitals., Animals: A total of 457 dogs and 170 cats with recorded cardiac arrest rhythm and event outcome reported in the Reassessment Campaign on Veterinary Resuscitation CPR registry., Measurements and Main Results: Logistic regression was used to evaluate association of animal, hospital, and arrest variables with I-SHKRs and S-SHKRs and with patient outcomes. Odds ratios (ORs) were generated, and significance was set at P < 0.05. Of 627 animals included, 28 (4%) had I-SHKRs. Odds for I-SHKRs were significantly higher in animals with a metabolic cause of arrest (OR 7.61) and that received lidocaine (OR 17.50) or amiodarone (OR 21.22) and significantly lower in animals experiencing arrest during daytime hours (OR 0.22), in the ICU (OR 0.27), in the emergency room (OR 0.13), and out of hospital (OR 0.18) and that received epinephrine (OR 0.19). Of 599 initial nonshockable rhythms, 74 (12%) developed S-SHKRs. Odds for S-SHKRs were significantly higher in animals with higher body weight (OR 1.03), hemorrhage (OR 2.85), or intracranial cause of arrest (OR 3.73) and that received epinephrine (OR 11.36) or lidocaine (OR 18.72) and significantly decreased in those arresting in ICU (OR 0.27), emergency room (OR 0.29), and out of hospital (OR 0.38). Overall, 171 (27%) animals achieved ROSC, 81 (13%) achieved sustained ROSC, and 15 (2%) survived. Neither I-SHKRs nor S-SHKRs were significantly associated with ROSC., Conclusions: I-SHKRs and S-SHKRs occur infrequently in dogs and cats undergoing CPR and are not associated with increased ROSC rates., (© 2023 The Authors. Journal of Veterinary Emergency and Critical Care published by Wiley Periodicals LLC on behalf of Veterinary Emergency and Critical Care Society.)

Objective: To characterize the clinical features of noncardiogenic pulmonary edema (NCPE), etiology, and outcome in dogs and cats. The study also aimed to evaluate associations with mortality., Design: Retrospective study., Setting: University teaching hospital., Animals: Thirty dogs and 1 cat, all client owned., Interventions: None., Measurements and Main Results: Data collected included animal characteristics, clinical history, evaluation of oxygenation, radiographic features, treatments, and outcomes. Causes of NCPE included upper airway obstruction, electrocution, drowning, neurogenic etiology, and unknown. The etiology was known in 21 of 31 cases (68%), while the etiology of the remaining 10 cases (32%) was classified as unknown. The most common cause for NCPE was upper airway obstruction, found in 14 of 31 cases (45%). The majority of thoracic radiographs showed a mixed interstitial-to-alveolar pulmonary pattern with a diffuse distribution (52%). Oxygen therapy was administered to 27 dogs (90%). Furosemide was administered to 12 dogs (40%). The median duration of hospitalization was 48 hours (range: 1-192). Twenty-three animals (74%) survived to discharge. Six dogs were mechanically ventilated, with only 2 of them (33%) surviving to discharge. The requirement for mechanical ventilation was the only parameter associated with mortality (P = 0.03)., Conclusions: NCPE is a heterogenous disease process that is most common in dogs. There are a variety of causes, but upper airway obstruction appears to be the most common. The overall prognosis is good in animals that do not require mechanical ventilation., (© Veterinary Emergency and Critical Care Society 2023.)

Objective: To investigate the association of point-of-care biochemical variables obtained during CPR or within 24 hours of return of spontaneous circulation (ROSC) with patient outcomes., Design: Retrospective study., Setting: University teaching hospital., Animals: Ninety-four dogs and 27 cats undergoing CPR according to the Reassessment Campaign on Veterinary Resuscitation guidelines., Interventions: None., Measurements and Main Results: Blood gas, acid-base, electrolyte, glucose, and plasma lactate values obtained during CPR or within 24 hours of ROSC were retrospectively evaluated and are described. The blood sample type and collection time with respect to CPR initiation and ROSC were recorded. Measured variables, collection times, and species were included in a multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval of ROSC, sustained ROSC (≥20 min), and survival to hospital discharge. Significance was set at P < 0.05. Seventy-two venous blood samples obtained during CPR and 45 first venous and arterial blood samples obtained after ROSC were included in logistic regression analysis. During CPR, PvO 2 (1.09 [1.036-1.148], P = 0.001) and venous standard base excess (SBE) (1.207 [1.094-1.331], P < 0.001) were associated with ROSC. PvO 2 (1.075 [1.028-1.124], P = 0.002), SBE (1.171 [1.013-1.353], P = 0.032), and potassium concentration (0.635 [0.426-0.946], P = 0.026) were associated with sustained ROSC. Potassium concentration (0.235 [0.083-0.667], P = 0.007) was associated with survival to hospital discharge. Following ROSC, pH (69.110 [4.393-1087], P = 0.003), potassium concentration (0.222 [0.071-0.700], P = 0.010), and chloride concentration (0.805 [0.694-0.933], P = 0.004) were associated with survival to hospital discharge., Conclusions: Biochemical variables such as PvO 2 , SBE, and potassium concentration during CPR and pH, potassium, and chloride concentration in the postarrest period may help identify dogs and cats with lower odds for ROSC or survival to hospital discharge following CPR., (© Veterinary Emergency and Critical Care Society 2022.)

Background: Multiple studies have evaluated the breed-specific prevalence of dog erythrocyte antigen (DEA) 1 in various geographic regions. However, few large-scale studies exist that describe breed prevalence of DEA 1 in the United States., Key Findings: From January 2000 to October 2020, 6469 dogs had their RBC antigen type determined and were included in the study. The overall prevalence of DEA 1 in all dogs was 61.2%. Of 50 breeds with sample sizes ≥20, 8 breeds had a high prevalence (≥90%) of DEA 1-positive blood type: Basset Hound, Bernese Mountain Dog, Brittany, Dachshund, Miniature Pinscher, Miniature Schnauzer, Pug, and Rottweiler. Four breeds had a high prevalence (≥90%) of DEA 1-negative blood type: Boxer, English Bulldog, Flat-Coated Retriever, and French Bulldog. Numerous breeds with a sample size <20 and ≥5 were found to have 100% prevalence of a DEA 1 blood type, although these findings need to be confirmed with a larger sample size. No statistical difference in any breed based on sex was found. The results in this study are consistent with previously reported data in other countries., Significance: Knowledge of regional breed differences in DEA 1 prevalence can help to improve selection and recruitment of appropriate blood donor dogs., (© Veterinary Emergency and Critical Care Society 2022.)

Objective: To describe the clinical and clinicopathological characteristics, treatment, and outcome for dogs and cats with a confirmed foxtail., Design: Retrospective study utilizing a medical records database over a 10-year period from January 1, 2009 to December 31, 2018., Setting: University teaching hospital., Animals: Seven hundred and fifty-four dogs and 37 cats with a diagnosis of foxtail foreign body. Cases with direct visualization by a clinician or on histopathology were included. Information extracted for each case included signalment; anatomical foxtail location; clinicopathological and imaging findings; treatments and interventions provided; and outcome., Measurements and Main Results: The prevalence of foxtail associated disease was 0.25% in dogs and 0.07% in cats over this time period. Most animals were young to middle-aged and presented in the summer months. The most common location in dogs was the aural canal, cutaneous/subcutaneous space, and nasal canal. In cats, ocular foxtails were most common (30/37). Blood work changes were nonspecific. Ultrasound supervised by a boarded radiologist was utilized in 114 cases, mainly for subcutaneous, sublumbar, and intracavitary foxtail locations, with successful location of a foxtail in 72.8% of cases scanned. Computed tomography was performed in 78 dogs with suspected intracavitary foxtail migration, and in all cases, structural changes related to the presence of the foxtail were found. Anerobic bacteria were most commonly isolated when a culture was submitted, with Actinomyces spp. rarely isolated. The most common of the 120 anaerobic isolates were Bacteroides/Prevotella spp. (n = 38), Fusobacterium spp. (n = 32), and Peptostreptococcus anaerobius (n = 30)., Conclusions: The short-term outcome for foxtail-associated lesions is good, and most cases can be managed on an outpatient basis. A minority of cases develop life-threatening disease and may require a multidisciplinary approach of multimodal imaging, endoscopy, or surgery., (© Veterinary Emergency and Critical Care Society 2022.)

Objectives: To determine the complications associated with positive-pressure ventilation (PPV) in dogs and cats., Design: Retrospective study from October 2009 to September 2013., Setting: University Teaching Hospital., Animals: Fifty-eight dogs and 9 cats., Measurements and Main Results: Medical records were retrospectively reviewed; signalment, complications associated with PPV, duration of PPV, and outcome were recorded. Complications most commonly recorded during PPV included hypothermia 41/67 (61%), hypotension 39/67 (58%), cardiac arrhythmias 33/67 (49%), a positive fluid balance 31/67 (46%), oral lesions 25/67 (37%), and corneal ulcerations 24/67 (36%). A definition of ventilator-associated events (VAE) extrapolated from the Center of Disease Control's criteria was applied to 21 cases that received PPV for at least 4 days in this study. Ventilator-associated conditions occurred in 5 of 21 (24%) of cases with infection-related ventilator-associated conditions and ventilator-associated pneumonia identified in 3 of 21 (14%) cases., Conclusions: Complications are common and diverse in dogs and cats receiving long-term PPV and emphasizes the importance of intensive, continuous patient monitoring and appropriate nursing care protocols. Many of the complications identified could be serious without intervention and suggests that appropriate equipment alarms could improve patient safety. Development of veterinary specific surveillance tools such as the VAE criteria would aid future investigations and allow for effective multicenter studies., (© Veterinary Emergency and Critical Care Society 2022.)

Objectives: To determine the indications and outcomes of positive-pressure ventilation (PPV) and identify factors associated with successful weaning., Design: Retrospective study from October 2009 to September 2013., Setting: University teaching hospital., Animals: One hundred and eleven dogs and 16 cats., Measurements and Main Results: Medical records were retrospectively reviewed; signalment, indication for PPV, patient characteristics, blood gas, and ventilator variables during PPV, duration of PPV, and outcome were recorded. Dogs were most commonly ventilated for pneumonia (36/111; 32%) and cats for multiple pulmonary diseases (8/16; 50%). The median duration of PPV for all animals was 25.7 h (range, 0.1-957 h). Long-term PPV (≥24 h) was performed in 53% of cases. No differences were noted in successful weaning rates between cases ventilated for pulmonary etiologies (23/99; 23%) versus nonpulmonary etiologies (9/28; 32%). Overall, 32 of 127 (25%; 30 dogs, 2 cats) animals were successfully weaned from PPV and 28 of 127 (22%; 26 dogs, 2 cats) survived to hospital discharge. Long-term ventilation had a higher likelihood of successful weaning (26/67 [39%] vs 6/60 [10%], P = 0.0002) and higher rates of survival to discharge (23/67 [34%] vs 5/60 [8%], P = 0.0005) than short-term ventilation. Animals with higher Pao 2 /Fio 2 and Spo 2 /Fio 2 and lower APPLE and SOFA scores on day 1 of PPV were more likely to be weaned (P < 0.03)., Conclusions: The outcome of PPV appears to be most heavily determined by the underlying disease process and no clear improvement in outcome could be demonstrated in this study, despite advances in veterinary critical care and ventilator management strategies since previous studies. Dogs and cats receiving PPV for more than 24 h in this study had a higher likelihood of a positive outcome. Several indices of oxygenation and illness severity at the onset of PPV were predictive of outcome and maybe useful when considering prognosis of these cases., (© Veterinary Emergency and Critical Care Society 2022.)

Objective: To determine the prognostic significance of plasma lactate concentration, plasma lactate clearance, and delta lactate in dogs and cats presented to an emergency room (ER)., Design: Retrospective study., Setting: University teaching hospital., Animals: A total of 8,321 animals with a plasma lactate concentration measured with 4,863 presenting to the ER and 1,529 dogs and 444 cats having a measurement within 4 hours of admission., Interventions: None., Measurements and Main Results: Plasma lactate concentration of dogs and cats presented to a university teaching hospital was retrospectively evaluated. Of dogs and cats with a plasma lactate concentration measured within 4 hours of admission to the ER, hyperlactatemia was common, and the prevalence of hyperlactatemia for dogs 78% (361/462) and cats 67% (78/116) was highest when evaluated within the first 30 minutes following admission. The distribution of patient's plasma lactate concentration was significantly higher in non-survivors compared to survivors at all time points evaluated (P < $\; < \;$ 0.001). Both lactate clearance (P = 0.010) and delta lactate (P = 0.013) were significantly different between survivors and nonsurvivors. A delta lactate > 4.5 mmol/L was 100% (95% CI: 95 to 100%) specific for nonsurvival in patients with hyperlactatemia measured within 1 hour of admission to the ER. The most common cause of hyperlactatemia was shock in dogs (24%) and urinary tract diseases in cats (22%). Shock was associated with the highest mortality rate in both dogs (61%) and cats (77%). Hyperlactatemia was significantly associated with increased mortality for dogs with shock (P = 0.001), respiratory diseases (P = 0.022), diabetes mellitus (P = 0.018), and liver dysfunction (P = 0.006)., Conclusions: Hyperlactatemia was associated with mortality in both dogs and cats when measured at any time point in the 4 hours following admission to the ER. Serial lactate measurement may also be a valuable tool to guide clinical management decisions., (© Veterinary Emergency and Critical Care Society 2021.)

Objective: To identify characteristics of arterial catheter use, including indwelling times and reasons for removal, and analyze potential risk factors for complications based on patient- and catheter-related variables., Design: Prospective clinical study from July 2012 to September 2016., Setting: University teaching hospital., Animals: One hundred ninety-eight dogs and 29 cats with an arterial catheter monitored in the ICU., Interventions: None., Measurements and Main Results: A questionnaire was used to obtain patient and catheter information for arterial catheters monitored in the ICU during the study period. Two hundred twenty-seven catheters met the inclusion criteria. Most catheters were placed in the dorsal metatarsal artery in dogs (90.4%) and either the dorsal metatarsal artery (51.7%) or coccygeal artery (48.3%) in cats. Weights ranged from 1.5 to 64 kg in dogs and 0.77 to 8.7 kg in cats. The median indwelling time was 24 hours for dogs and 12 hours for cats. Minor complications occurred in 19.2% of catheters in dogs and 17.2% of those in cats with removal of catheter due to complications in 13 of 198 (6.6%) for dogs and 2 of 29 (6.9%) for cats. There was no association between the incidence of complications and patient weight, catheter indwelling time, species, insertion site, catheter size, or level of consciousness during placement. There was also no association between the method of catheter maintenance (intermittent flushing or continuous pressure transducer) and the failure of a catheter to aspirate or flush., Conclusions: Arterial catheter-related complications were relatively frequent, but most complications were minor and did not justify removal of the catheter. This suggests that the use of arterial catheters in both species is relatively safe. However, further research is needed to assess complications related to longer catheter indwelling times, particularly in cats., (© Veterinary Emergency and Critical Care Society 2021.)

Objective: To describe the clinical course and novel biochemical findings in 3 dogs with amitraz toxicosis., Case Series Summary: Three Labrador Retrievers developed acute onset obtundation to stupor after being in a rice field. On admittance to the hospital, they all displayed bradycardia, hyperglycemia, hyperlactatemia, respiratory acidosis, and metabolic alkalosis. All clinical signs resolved in 18-48 hours with supportive care. One dog represented with similar clinical signs and biochemical abnormalities 3 days after discharge following spending time in a different rice field owned by the same owner. Toxicological analysis of serum from all 3 dogs and vomitus from 1 dog returned positive for amitraz and one of its metabolites., New or Unique Information Provided: This is the first case series of dogs with confirmed amitraz toxicosis following an environmental exposure. Novel biochemical findings of hyperlactatemia, respiratory acidosis, and metabolic alkalosis were documented in all 3 dogs. Clinicians should be concerned for amitraz toxicosis when presented with an animal with the constellation of signs including decreased mental status, bradycardia, and hyperglycemia, particularly if relevant acid-base abnormalities are also detected., (© Veterinary Emergency and Critical Care Society 2021.)

Objective: To describe the semiquantitative acid-base status of dogs with untreated naturally occurring typical hypoadrenocorticism and to compare this to the status determined by traditional acid-base analysis., Design: Retrospective study., Setting: University teaching hospital., Animals: Thirty-three dogs with newly diagnosed typical hypoadrenocorticism between 2000 and 2017., Interventions: None., Measurements and Main Results: Dogs were included if they had newly diagnosed hypoadrenocorticism, post-ACTH stimulation serum cortisol concentration <2 μg/dL, and blood collected within 6 hours of presentation for acid-base, electrolyte, and serum biochemical assays. Dogs were excluded if the Na + :K + ratio was ≥28 or the dog had received a mineralocorticoid-containing corticosteroid medication within the preceding month. Traditional acid-base analysis identified normal acid-base status in 1 dog, simple respiratory acid-base abnormalities in 2 of 33 dogs, and simple metabolic acidosis in 14 of 33 dogs. A mixed disorder was most common, noted in 16 of 33 dogs. The semiquantitative approach identified metabolic abnormalities in all cases. All dogs had ≥1 acidifying process, and 29 of 33 had both acidifying and alkalinizing processes. Acidosis attributable to excess free water was present in all dogs, and an acidifying phosphate effect was present in 27 of 33. Hyperlactatemia contributed to the acidosis in 8 of 33 dogs, with a median (range) lactate concentration of 1.5 mmol/L (13.5 mg/dL) (0.3-4.2 mmol/L [2.7-37.8 mg/dL])., Conclusions: Dogs with untreated Addison's disease have complex acid-base derangements. The semiquantitative approach to acid-base analysis provides greater insight into the underlying mechanisms of metabolic acid-base abnormalities in these dogs, particularly because lactic acidosis appears to be a minor influence in most cases., (© Veterinary Emergency and Critical Care Society 2020.)

Objective: To determine the prevalence of glucose abnormalities in nondiabetic dogs presenting to a veterinary emergency room (ER) and their association with underlying disease processes, previous glucocorticoid administration, and overall mortality., Design: Single-center, retrospective study from January 2013 to December 2014., Setting: University Teaching Hospital., Animals: A total of 660 dogs presenting to an ER with a blood glucose concentration measured within 6 hours of presentation., Interventions: None., Measurements and Main Results: Medical records from dogs with a blood glucose concentration measured within 6 hours of hospital admission were reviewed. Medications administered prior to blood sampling, the presence of shock, final clinical diagnosis, and survival were recorded. Hypoglycemia and hyperglycemia were defined as a blood glucose <4.4 mmol/L (80 mg/dL) and >6.7 mmol/L (120 mg/dL), respectively. Diabetic patients were removed from analysis. Hyperglycemia was found in 40.1% of dogs, whereas hypoglycemia was present in 9.0%. Hyperglycemia was most often associated with gastrointestinal disease, trauma, neoplasia, and respiratory disease. The most common diseases associated with hypoglycemia were sepsis, gastrointestinal disease, and neoplasia. Dogs in shock or with hyperlactatemia had higher blood glucose values than dogs with normal perfusion and plasma lactate concentrations (P = 0.016 and P < 0.0001, respectively). Mortality was higher in dogs with hyperglycemia (33.2%, P = 0.03) or hypoglycemia (44.6%, P = 0.0024) compared to those with normoglycemia (24.9%)., Conclusion: Dysglycemia in nondiabetic dogs evaluated in an ER was associated with a higher mortality rate than dogs in the same population with normoglycemia. Hyperglycemia in this population was common and may represent a stress response., (© Veterinary Emergency and Critical Care Society 2020.)

Objective: To evaluate the ability of arterial hemoglobin oxygen saturation measurement via pulse oximetry (SpO 2 ) to serve as a surrogate for PaO 2 in dogs., Design: Two-part study: prospective observational and retrospective components., Setting: University teaching hospital., Animals: Ninety-two dogs breathing room air prospectively enrolled on a convenience basis. Retrospective evaluation of 1,033 paired SpO 2 and PaO 2 measurements from 62 dogs on mechanical ventilation., Interventions: Dogs with concurrent SpO 2 and PaO 2 measured on room air had a data sheet completed with blood gas analysis. SpO 2 , PaO 2 , and FiO 2 values were collected from medical records of dogs on mechanical ventilation., Measurements and Main Results: Predicted PaO 2 was calculated from SpO 2 using the dog oxyhemoglobin dissociation curve. The correlation coefficient between measured and predicted PaO 2 was 0.49 (P < 0.0001) in room air dogs and 0.74 (P < 0.0001) in ventilated dogs. In room air dogs, Bland-Altman analysis between measured minus predicted PaO 2 versus the average showed a mean bias of -6.0 mm Hg (95% limit of agreement, -35 to 23 mm Hg). The correlation coefficient between PaO 2 /FiO 2 and SpO 2 /FiO 2 ratios was 0.76 (P < 0.0001). After combining data sets, receiver operating characteristic curve analysis showed the optimal cutoff value for detecting hypoxemia (PaO 2  < 80 mm Hg) was an SpO 2 of 95%, with sensitivity and specificity of 77.8% and 89.5%, respectively. Using this cutoff, 6.9% of SpO 2 readings failed to detect hypoxemia, whereas 7.2% predicted hypoxemia that was not present., Conclusions: The SpO 2 was not clinically suitable as a surrogate for PaO 2 , though it performed better in mechanically ventilated dogs. As sensitivity for the detection of hypoxemia was poor, pulse oximetry does not appear to be an acceptable screening test. The SpO 2 /FiO 2 ratio may have value for evaluation of anesthetized dogs on supplemental oxygen. Arterial blood gas analysis remains ideal for assessment of oxygenation., (© Veterinary Emergency and Critical Care Society 2019.)

Objective: To determine the severity, concurrent clinical signs, and disease processes associated with potassium abnormalities in dogs and cats presenting to a veterinary emergency department and associated mortality., Design: Retrospective and descriptive study over 20 months., Setting: University teaching hospital., Animals: 1916 dog and 525 cat visits., Interventions: None., Measurements and Main Results: Medical records from patients with a potassium concentration measured within 24 hours of admission were identified. Hypokalemia and hyperkalemia were defined as a potassium concentration <3.5 mmol/L [3.5 mEq/L] and >5 mmol/L [5 mEq/L], respectively. Associated disease processes and pathophysiologic risk factors for potassium abnormalities were reviewed for moderate to severe potassium abnormalities (<3 mmol/L or ≥6 mmol/L) [<3 mEq/L or ≥6 mEq/L]. Mortality associated with normokalemia, mild, and moderate to severe dyskalemia were evaluated. Overall prevalence of abnormal potassium concentration was 27% in dogs and 40% in cats. Moderate to severe hypokalemia and hyperkalemia were present in 3% of dogs and 8% of cats, and 2% of dogs and 7% of cats, respectively. Moderate to severe hypokalemia was most commonly associated with gastrointestinal disease (48% of dogs and 44% of cats) while moderate to severe hyperkalemia was most commonly associated with urinary tract disease (60% of dogs and 97% of cats). Dogs with hypokalemia and dogs and cats with hyperkalemia (P < 0.001) had significantly greater mortality than those with normokalemia. Dogs with mild hypokalemia and mild hyperkalemia (P < 0.0001) had higher mortality than dogs with normokalemia, but this was not found in cats., Conclusions: Dyskalemia was common in this population and was associated with greater mortality. Moderate to severe potassium abnormalities were uncommon in this population and occurred most frequently in animals with gastrointestinal and urinary tract disease., (© Veterinary Emergency and Critical Care Society 2019.)

Objective: To determine the association of plasma lactate concentration, pH, base deficit (BD), and anion gap (AG) in dogs and cats on presentation to an emergency room with outcome, and to compare the prognostic significance of hyperlactatemia with a concurrent metabolic acidosis with that of hyperlactatemia and a normal metabolic acid-base balance., Design: Retrospective study., Setting: University teaching hospital., Animals: Five hundred sixty-six dogs and 185 cats that had venous blood gas analysis performed., Interventions: None., Measurements and Main Results: Medical records were reviewed for plasma lactate concentrations, electrolyte concentrations, and acid-base parameters obtained on emergency room admission, clinical diagnosis, and in-hospital mortality. The primary outcome measure was all-cause mortality for the hospitalized visit. Median plasma lactate concentration and AG were higher, BD was more negative, and pH was lower, in non-survivor dogs and cats. The prevalence of hyperlactatemia was 53% in dogs and 30% in cats. Lactic acidosis was present in 42% and 80% of hyperlactatemic dogs and cats, respectively. Multivariate regression analyses revealed that plasma lactate concentration, BD, and pH, but not AG, were independent predictors of mortality in dogs, and that only plasma lactate concentration was an independent predictor of mortality in cats. Mortality was highest for animals with lactic acidosis, at 59.8% in dogs and 49% in cats. Mortality in dogs with lactic acidosis was significantly higher than dogs with hyperlactatemia and a normal acid-base status (P < 0.0001)., Conclusions: The presence and magnitude of hyperlactatemia on presentation to the emergency room may help identify dogs and cats with high likelihood of in-hospital mortality, and the presence of lactic acidosis specifically may help identify dogs with yet higher risk of in-hospital mortality., (© Veterinary Emergency and Critical Care Society 2017.)

Objective: To prospectively describe cardiopulmonary resuscitation (CPR) and evaluate factors associated with outcome in dogs and cats with cardiopulmonary arrest (CPA)., Design: Prospective observational study., Setting: University teaching hospital., Animals: One hundred twenty-one dogs and 30 cats that underwent CPR., Interventions: None., Measurements and Main Results: Supervising clinicians completed a data form immediately following completion of CPR. Eighty-seven (58%) animals attained return of spontaneous circulation (ROSC), 49 (32%) had ROSC >20 minutes, 15 (10%) were alive at 24 hours, and 8 (5%) were discharged alive. Cardiovascular abnormalities were the most common suspected precipitating cause of CPA (51/151, 34%). Presence of an IV catheter before CPA (P = 0.01) and the presence of palpable pulses during CPR (P = 0.007) were both associated with ROSC. Increased time from CPA to CPR (P = 0.04), longer duration of CPR (P < 0.0001), and neurologic cause of arrest (P = 0.02) were associated with not achieving ROSC. There was no association between ROSC and the initial arrest rhythm identified on ECG, animal weight, number of people present, and ventilation or compression rate. In patients achieving ROSC, those with a "survived event" were more likely to be euthanized and less likely to experience a second CPA than those with ROSC ≤ 20 minutes. Thirty-four percent of patients submitted for necropsy had gross and histological lesions considered secondary to CPR., Conclusions: Early CPR interventions were associated with a greater likelihood of ROSC, emphasizing the importance of prompt recognition, and initiation of CPR efforts. Although ROSC rates in this study were comparable or higher than previous human and veterinary studies, the rate of "survived events" was lower than that reported in human patients. This may suggest that advances in post CPR care could have benefits to the veterinary CPR patient in the future., (© Veterinary Emergency and Critical Care Society 2014.)

Objective: To describe the management and resolution of anuric acute kidney injury (AKI) in a dog with multiple organ dysfunction syndrome (MODS) associated with gallbladder wall necrosis., Case Summary: An 11-year-old neutered female spayed dog was referred for evaluation of anuria following cholecystectomy. Following surgery, the patient became anuric with no response to appropriate medical therapy. During the course of hospitalization, the patient developed MODS as evidenced by alteration in renal function, but also cardiovascular dysfunction, coagulation disorders, and hypoglycemia. Several hemodialysis treatments were performed and, along with intensive care, led to resolution of clinical signs and return of urine production., New or Unique Information: This report describes resolution of anuria in a dog with AKI and MODS. In this clinical setting, despite a poor prognosis, survival and recovery of adequate renal function were possible with medical management that included hemodialysis., (© Veterinary Emergency and Critical Care Society 2014.)

Objective: To compare the diagnostic performance of the traditional approach to acid-base analysis with the Stewart approach and a semiquantitative approach., Design: Prospective cohort study., Setting: University teaching hospital., Animals: A total number of 84 dogs and 14 cats presenting to a university teaching hospital emergency room., Procedures: All dogs and cats in which venous blood samples for acid-base, lactate, and serum biochemical analysis were all collected within 60 minutes of each other, over a 5-month enrollment period. Acid-base analysis was performed using the traditional approach, Stewart approach, and a semiquantitative approach., Results: Traditional acid-base analysis identified respiratory acid-base abnormalities in 14/98 animals and metabolic acid-base abnormalities in 67/98. A mixed disorder of metabolic acidosis and respiratory alkalosis was most common occurring in 29/98 patients. The Stewart approach identified metabolic abnormalities in 82/98 patients; strong ion difference abnormalities were evident in 68/98 cases; an increased strong ion gap acidosis was identified in 49/98 cases; and changes in the quantity of weak acids in 25/98 cases. The semiquantitative approach identified abnormalities in all cases evaluated. Of the 14 patients with a primary respiratory acid-base abnormality, the Stewart approach identified metabolic abnormalities in 9 and the semiquantitative approach found abnormalities in all animals., Conclusions and Clinical Relevance: The physicochemical approaches diagnosed more acid-base abnormalities in this population than the traditional approach although many of the abnormalities identified were small and of unknown clinical relevance. The physicochemical approaches may provide greater insight as to the underlying etiology of abnormalities, which maybe of particular relevance to cases with changes in albumin and/or phosphorus concentration., (© Veterinary Emergency and Critical Care Society 2014.)

Objective: To compare the diagnostic performance of the anion gap (AG) with 2 physicochemical approaches to identify unmeasured anions., Design: Prospective cohort study., Setting: University teaching hospital., Animals: Eighty-four dogs and 14 cats presenting to a university teaching hospital emergency room., Interventions: All dogs and cats in which venous blood samples for acid-base, lactate, and serum biochemical analysis were all collected within 60 minutes of each other, over a 5-month enrollment period. Unmeasured anions were quantified using each of three approaches: the anion gap (AG), strong ion gap (SIG), and a semiquantitative approach (XA)., Measurements and Main Results: An increased AG metabolic acidosis was evident in 34/98 of cases. The Stewart approach identified an increased SIG acidosis in 49/98 of cases. There was a strong correlation between SIG and AG (r = 0.89; P < 0.001). The semiquantitative approach identified increased unmeasured anions in 68/98 of cases. There was a moderate correlation between AG and XA (r = 0.68; P < 0.001) and a slightly stronger correlation between SIG and XA (r = 0.75; P < 0.001). Plasma lactate concentrations and AG were poorly correlated (r = 0.22; P = 0.029) and there was no correlation between lactate concentrations and BE (r = 0.19; P = 0.069)., Conclusions: Unmeasured anions occurred commonly in this sample of small animal emergency room patients and physiochemical approaches identified more animals with unmeasured anions than the traditional AG calculation. Further studies are needed to determine if the results of the physicochemical approach improves clinical management and warrants the associated increases in cost and complexity., (© Veterinary Emergency and Critical Care Society 2014.)

Objective: To evaluate the effects of hetastarch 670/0.75 on canine platelet function and clinical bleeding following its administration as a constant rate infusion (CRI) at 1 mL/kg/h and 2 mL/kg/h for 24 hours., Design: In vivo, prospective, open-label, crossover study., Setting: Research laboratory at a university veterinary facility., Animals: Eight healthy, adult male research dogs., Interventions: Each dog received 1 mL/kg/h hetastarch for 24 hours then 2 mL/kg/h with a washout period of 10 weeks between each experiment. Platelet closure time (CT) was measured using a platelet function analyzer with collagen adenosine diphosphate (ADP) cartridges. CT measurements were performed at baseline and 6, 12, and 24 hours following initiation of hetastarch infusion., Measurements and Main Results: At 1 mL/kg/h, mean CT was significantly increased at the 12- and 24-hour time point relative to the baseline value, although mean CT never rose to a value above the reference interval during the 24-hour infusion. At 2 mL/kg/h, median CT was also significantly increased at the 12- and 24-hour time point relative to the baseline value. Administration of 2 mL/kg/h did progressively prolong the median CT value though only exceeded the reference interval at the 24-hour time point. Despite the prolongation of median CT, there was no clinical evidence of spontaneous bleeding in any dog during the 24-hour infusion at either CRI rate., Conclusions: Hetastarch 670/0.75 when used as a 24-hour CRI at 1 and 2 mL/kg/h prolongs CT in healthy dogs at 6, 12, and 24 hours. Median CT only exceeded the reference interval at 24 hours at 2 mL/kg/h., (© Veterinary Emergency and Critical Care Society 2014.)

Objective: To report acid base, electrolyte, glucose, and lactate values collected during or immediately after cardiopulmonary resuscitation (CPR) in dogs and cats., Design: Retrospective study., Setting: University Teaching Hospital., Animals: Thirty-two dogs and 10 cats., Interventions: None., Measurements and Main Results: Blood gas, electrolyte, glucose, and lactate values measured during CPR or within 5 minutes of return of spontaneous circulation (ROSC) were retrospectively evaluated. The time of blood collection with respect to the occurrence of cardiopulmonary arrest (CPA), the initiation of CPR or ROSC was noted. Forty-two venous blood samples were analyzed, 24 collected during CPR and 18 samples were collected within 5 minutes of ROSC. Metabolic acidosis and hyperlactatemia were evident in all samples in the study while an increased PvCO2 occurred in 88% of samples collected during CPR and in 61% of samples collected following ROSC. Hyperkalemia occurred in 65% of all cases, decreased ionized calcium was evident in 18%, hypoglycemia was evident in 21% while hyperglycemia was evident in 62%. There was no significant difference in any parameter evaluated between dogs and cats during CPR. There was no significant difference of any variable measured during the first 15 minutes of CPA versus those measured more than 15 minutes following CPA. When the values measured during the first 5 minutes of ROSC were compared to those measured during CPR, the pH and PvO2 were significantly lower in the CPR group., Conclusions: Biochemical abnormalities including metabolic acidosis, hyperkalemia, ionized hypocalcemia, hypoglycemia, and hyperglycemia can be identified during CPR and immediately following ROSC. The therapeutic and prognostic relevance of these changes are yet to be defined and may prove to be useful to guide patient management in the future., (© Veterinary Emergency and Critical Care Society 2014.)

Objective: To determine the normal osmole gap for 18 previously published formulae used to estimate serum osmolality in dogs., Design: Prospective study., Setting: University veterinary medical teaching hospital., Animals: Two hundred and fifty client-owned dogs., Interventions: None., Measurements and Main Results: Serum samples were saved and frozen at -80°C after routine biochemical analysis as ordered by attending clinicians. An Advanced Micro Osmometer 3300 was used to measure serum osmolality. Eighteen distinct formulae previously reported in the medical literature were used to calculate the osmolality from the biochemical analysis results. The calculated osmolality was then subtracted from the measured osmolality to determine the osmole gap. Osmole gaps for azotemic and hyperglycemic dogs were compared to those of dogs without azotemia or hyperglycemia using each formula. The median measured osmolality for all dogs in the study was 302 mOsm/kg (interquartile range 297-307). The osmole gaps varied widely depending on the formula used to calculate osmolality and the presence or absence of hyperglycemia or azotemia. Eleven formulae led to calculated osmolality and osmole gaps that were not statistically different when hyperglycemia or azotemia was present. Four out of these 11 formulae resulted in osmole gaps near zero., Conclusions and Clinical Relevance: Multiple formulae reported to calculate serum osmolality can be used in the clinical setting, but they result in significantly different normal osmole gaps. Clinicians should be aware of the specific reference interval for the formula being used. The authors recommend the formula 2(Na(+) ) + [glucose/18] + [BUN/2.8] because it is easy to use and is reliable even when hyperglycemia or azotemia are present., (© Veterinary Emergency and Critical Care Society 2014.)

Objective: To describe false increases in plasma lactate concentration measured on point-of-care analyzers in 2 dogs with ethylene glycol (EG) intoxication., Case Summary: Two dogs presenting with EG intoxication had extreme increases of plasma lactate concentrations recorded on a point-of-care machine. Laboratory analysis by spectrophotometry of lactate concentration determined these lactate measurements to be erroneous. False increases in plasma lactate concentration were demonstrated in 2 out of 3 point-of-care machines tested., New or Unique Information Provided: Glycolate, a toxic metabolite of EG, can interfere with the measurement of plasma lactate by some analyzers and this may delay the correct diagnosis of EG toxicity if not recognized., (© Veterinary Emergency and Critical Care Society 2012.)

Objective: To report a case of blindness due to the ingestion of ivermectin and subsequent successful treatment with intravenous lipid (IVL) therapy., Case Summary: A female neutered Jack Russell Terrier was examined for acute onset of apparent blindness after being exposed to ivermectin the previous day. The dog appeared to be blind during initial examination. Pupillary light reflex, menace response, and dazzle reflex were not present in either eye. Fundic examination revealed small areas of linear retinal edema. Electroretinography (ERG) showed diminished activity in both eyes. Ivermectin was present in the serum on toxicological assay. Approximately 20 hours after exposure, IVL was infused. Within 30 minutes of initiating the infusion, the pupillary light reflexes returned in both eyes, and by the end of the infusion the patient behaved as if sighted. Fundic examination and ERG were unchanged at this time. The dog was tested for the multidrug resistance gene mutation and was unaffected., New or Unique Information Provided: Ivermectin toxicity occurs in dogs with apparent blindness being a common clinical sign. This is the first case report of ivermectin-induced blindness evaluated with ERG before and after treatment with IVL in a dog unaffected by the multidrug resistance gene mutation. Treatment with an infusion of IVL therapy appeared to shorten the clinical course of disease in this patient without affecting ERG results., (© Veterinary Emergency and Critical Care Society 2013.)

Objective: To systematically examine the evidence on basic life support (BLS) in veterinary CPR and to determine knowledge gaps., Design: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Relevant questions were answered on a worksheet template and reviewed by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) BLS domain members, by the RECOVER committee and opened for comments by veterinary professionals for 30 days., Setting: Academia, referral practice, and general practice., Results: Sixteen worksheets were prepared to evaluate techniques for chest compression and ventilation strategies as well as identification of cardiopulmonary arrest (CPA). Major recommendations arising from this evidence review include performing chest compressions at a rate of at least 100/min at a compression depth of one-third to half the width of the chest with minimal pauses, and early instigation of ventilation at a rate of 8-10 breaths/min in intubated patients, or using a 30:2 compression/ventilation ratio in nonintubated patients., Conclusions: Although veterinary clinical trials are lacking, much of the experimental literature on BLS utilized canine models. The major conclusions from this analysis of the literature are the importance of early identification of CPA, and immediate initiation of BLS in these patients. Many knowledge gaps exist, most importantly in our understanding of the optimal hand placement and technique for chest compressions, warranting coordinated future studies targeted at questions of relevance to differences between veterinary species and humans., (© Veterinary Emergency and Critical Care Society 2012.)

Objective: To compare airway microbiological culture and susceptibility results in 2 groups of dogs and cats: 1 with respiratory failure requiring positive pressure ventilation (PPV) and 1 with respiratory disease., Design: Retrospective study., Setting: University teaching hospital., Animals: Fifty-two dogs and cats requiring PPV that had an airway microbiologic culture submitted from October 1, 2003 to October 31, 2008 were included. One hundred and four airway microbiologic cultures from dogs and cats with respiratory disease not requiring PPV were randomly sampled for comparison., Interventions: None., Measurements and Main Results: Patients with respiratory failure were more likely to have a gram-negative enteric isolate identified (P<0.001), while patients with respiratory disease were more likely to have a gram-negative nonenteric isolate (P<0.001) or anaerobic isolate (P<0.001) identified. Aerobic bacterial isolates from patients with respiratory failure were less likely to be susceptible to ampicillin (P=0.006), amoxicillin/clavulonate (P<0.001), chloramphenicol (P=0.004), enrofloxacin (P<0.001), ticarcillin/clavulonate (P=0.004), and the combination of ampicillin with enrofloxacin (P<0.001) than were aerobic bacterial isolates from patients with respiratory disease., Conclusions: Canine and feline patients with respiratory failure severe enough to require PPV exhibit a different pattern of bacterial isolates cultured from their airways when compared with isolates from patients with respiratory disease that has not resulted in ventilator dependence. These isolates are more likely to be resistant to commonly used antimicrobials/antimicrobial combinations than patients in the respiratory disease group. These findings suggest that in canine and feline patients with infectious lower respiratory tract disease, consideration of the severity of the pulmonary insult may allow for better prediction of likely isolates and their antimicrobial susceptibilities. Further prospective studies with a standardized collection technique are warranted., (© Veterinary Emergency and Critical Care Society 2010.)