Objective: To examine geriatric classification as a predictor of survival in moderate to severely injured dogs denoted by animal trauma triage (ATT) scores ≥3 or modified Glasgow Coma Scale (mGCS) scores ≤14. Design:Retrospective observational cohort study utilizing data collected between September 2013 and May 2019 with follow-up until death or hospital discharge.Setting: Thirty-one trauma centers including university teaching hospitals and private referral centers.Animals: A total of 6169 dogs entered into the Veterinary Committee on Trauma Registry with complete data entry including age, weight, outcome, mGCS (≤14), and/or ATT (≥3). Interventions: None. Measurements and Main Results:The effect of geriatric classification on survival was estimated using shared-frailty cox proportional hazard models. Model 1 dependent variables: death despite intervention or euthanasia due to grave prognosis. Model 2 dependent variables: death by euthanasia due to financial influence or combined influence of finances and grave prognosis. Model 3 evaluated interactions between geriatric classification and moderate versus severe trauma. The shared-frailty models controlled for contributing site as a random effect and other confounding variables, including trauma severity. Model 1: geriatrics had a significantly increased hazard risk (HR) for death (HR = 1.48, P < 0.0001). Model 2: geriatrics had an insignificant increased HR for death (HR = 1.34, P = 0.08). Model 3: geriatrics demonstrated significantly increased mortality risk with moderate level trauma. Additional Model 1 variables independently associated with mortality include ATT perfusion, neurologic, respiratory subscores, mGCS motor subscore, weight, and spinal trauma. Additional Model 2 variables independently associated with mortality include ATT perfusion

Background: New drugs for veterinary patients with acute respiratory distress syndrome (ARDS) are urgently needed. Early or late postinfection treatment of influenzainfected mice with the liponucleotide cytidine diphosphocholine (CDP-choline) resulted in decreased hypoxemia, pulmonary edema, lung dysfunction, and inflammation without altering viral replication. These findings suggested CDP-choline could have benefit as adjunctive treatment for ARDS in veterinary patients (VetARDS). Objectives: Determine if parenterally administered CDP-choline can attenuate mildVetARDS in dogs with aspiration pneumonia.Animals: Dogs admitted to a veterinary intensive care unit (ICU) for aspiration pneumonia.Methods: Subjects were enrolled in a randomized, double-blinded, placebocontrolled trial of treatment with vehicle (0.1 mL/kg sterile 0.9% saline, IV; n = 8) or CDP-choline (5 mg/kg in 0.1 mL/kg 0.9% saline, IV; n = 9) q12h over the first 48 hours after ICU admission.Results: No significant differences in signalment or clinical findings were found between placebo-and CDP-choline-treated dogs on admission. All dogs exhibited tachycardia, tachypnea, hypertension, hypoxemia, hypocapnia, lymphopenia, and neutrophilia. CDP-choline administration resulted in rapid, progressive, and clinically relevant increases in oxygenation as determined by pulse oximetry and ratios of arterial oxygen partial pressure (P a O 2 mmHg) to fractional inspired oxygen (% F i O 2 ) and decreases in alveolar-arterial (A-a) gradients that did not occur in placebo (saline)treated animals. Treatment with CDP-choline was also associated with less platelet consumption over the first 48 hours, but had no detectable detrimental effects.Conclusions and Clinical Importance: Ctyidine diphosphcholine acts rapidly to promote gas exchange in dogs with naturally occurring aspiration pneumonia and is a potential adjunctive treatment in VetARDS patients.

No abstract

RATIONALE.There is an urgent need for new drugs for both COVID-19 patients and those with other forms of the acute respiratory distress syndrome (ARDS). ARDS in influenza-infected mice is associated with reduced levels of liponucleotides (essential precursors for de novo phospholipid synthesis) in alveolar type II epithelial cells. We found previously that early or late post-infection treatment of influenza A virus-infected mice with the liponucleotide CDP-choline decreased hypoxemia, pulmonary edema, lung dysfunction, and inflammation without altering viral replication. Because it is a truism that mice with ARDS are far easier to cure than people, we wished to show that parenteral liponucleotide administration could likewise attenuate ARDS in a more clinically-relevant real-world situation. METHODS. Client-owned pet dogs admitted to the Small Animal ICU at The Ohio State University Veterinary Medical Center for aspiration pneumonia were enrolled in a randomized, double-blinded, placebo-controlled trial of treatment with vehicle (0.1 ml/kg sterile 0.9% saline, i.v.; n=8 dogs) or CDP-choline (5 mg/kg in 0.1 ml/kg 0.9% saline, i.v.; n=9 dogs) every 12 hours over the first 48 hours after admission. Dogs received standard of care supportive therapy and supplemental O 2 (in an O 2 tent or via nasal cannula) as deemed necessary by the attending clinician. Vital signs, blood pressure, and peripheral O 2 saturations were recorded every 8 hours. Arterial blood gases were measured every 12 hours. Venous blood was collected on admission and at 48 hours for clinical chemistry and CBC/differential counts. Written consent was obtained from all owners, who received a $400 financial incentive (in the form of a contribution to hospital expenses) to participate. RESULTS. Dogs in the treatment arm were significantly younger, but there were no other significant differences between placebo-and CDP-choline-treated dogs on admission. All dogs exhibited tachycardia, tachypnea, hypertension, hypoxemia, hypocapnia, lymphopenia, and neutrophilia. Administration of CDP-choline resulted in rapid, progressive, and clinically significant increases in P a O 2 :F i O 2 values and declines in alveolararterial (A-a) gradients that did not occur in placebo (saline)-treated animals. CDP-choline treatment also prevented platelet consumption over the first 48 hours after admission but had no detectable detrimental effects in sick dogs. CONCLUSIONS. CDP-choline acts rapidly to promote gas exchange in dogs with spontaneous aspiration pneumonia. Because CDP-choline has been shown to be very safe in human subjects, it should be considered as a potential adjunct therapy in ARDS and/or COVID-19 patients.

No abstract