Acute respiratory distress syndrome

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Chest radiograph of a 5-year-old mixed breed dog presented for penetrating bite wounds to the head, neck and thorax, showing complete transverse fractures of ribs 5 and 6 on the left side (white arrows), a mild increase in pulmonary interstitial markings medial to the fractured ribs, and subcutaneous emphysema (black arrows)[1]

Acute respiratory distress syndrome (acute lung injury, ARDS) is a relatively common disorder of dogs characterized by sudden-onset respiratory inflammatory response that compromises alveolar-capillary membrane integrity[2].

Two genetic forms have been recognized; one in neonatal pups[3] and an adult form in the Dalmatian[4], both of which have differing etiologies and clinical presentations. The adult form in Dalmatians is characterized by interstitial pneumonia.

This condition commonly occurs as a result of pulmonary insults which lead to varying degrees of respiratory compromise and failure that can range along a continuum from dyspnea to acute death[5].

This disease is frequently seen in association with:

Clinical signs in neonatal pups is characterized by non-febrile respiratory distress immediately following birth that is often fatal and is thought to be due to poor pulmonary maturity or multiple organ dysfunction.

The adult form of acute respiratory distress has many presenting symptoms depending on cause but the respiratory component of signs is frequently characterized by fever, dyspnea and cyanosis.

Diagnosis is based on presenting clinical signs, thoracic radiographs and exclusion of other causes of respiratory disease. Radiographs may show pericardial effusion, thoracic effusion, air bronchograms and free air within the lung cavity.

A differential diagnosis would include pulmonary interstitial fibrosis, chronic bronchitis, kennel cough, tracheal collapse, bronchomalacia and bronchial carcinoma.

Most cases are treated as emergencies and dogs are usually anesthetized and placed on positive-pressure ventilation with 100% oxygen. Specific treatment should focus on addressing underlying disease states.

The use of aminophylline or terbutaline may improve symptoms in acute lung injury[19].

References

  1. Kelmer E et al (2012) Successful treatment of acute respiratory distress syndrome in 2 dogs. Can Vet J 53(2):167-173
  2. Ballard-Croft C et al (2012) Large-animal models of acute respiratory distress syndrome. Ann Thorac Surg 93(4):1331-1339
  3. LIDA
  4. Syrjä P et al (2009) Pulmonary histopathology in dalmatians with familial acute respiratory distress syndrome (ARDS). J Comp Pathol 141(4):254-259
  5. Declue AE & Cohn LA (2007) Acute respiratory distress syndrome in dogs and cats: A review of clinical findings and pathophysiology. J Vet Emerg Crit Care 17:340–347
  6. Parent C et al (1996) Respiratory function and treatment in dogs with acute respiratory distress syndrome: 19 cases (1985–1993). J Am Vet Med Assoc 208:1428–1433
  7. Haas SA & Davidow E (2008) Successful management of saltwater submersion injury in a dog using mechanical ventilation. J Vet Emerg Crit Care 18:646–653
  8. Hoggan SR et al (2011) Mojave toxin-type ascending flaccid paralysis after an envenomation by a Southern Pacific Rattlesnake in a dog. J Vet Emerg Crit Care (San Antonio) 21(5):558-564
  9. Kohn B et al (2010) Pulmonary abnormalities in dogs with leptospirosis. J Vet Intern Med 24(6):1277-1282
  10. Ayoob AL et al (2010) Clinical management of canine babesiosis. J Vet Emerg Crit Care (San Antonio) 20(1):77-89
  11. Reagan JK et al (2012) Acute onset of dyspnea associated with Oslerus osleri infection in a dog. J Vet Emerg Crit Care (San Antonio) 22(2):267-272
  12. Walker T et al (2005) Imaging diagnosis: Acute lung injury following massive bee envenomation in a dog. Vet Radiol Ultrasound 46:300–303
  13. Park C et al (2011) Successful therapy of coumatetralyl rodenticide induced pericardial effusion with pericardiocentesis in a dog. Can Vet J 52(2):165-168
  14. Campbell VL (2011) Respiratory complications in critical illness of small animals. Vet Clin North Am Small Anim Pract 41(4):709-716
  15. Lake-Bakaar GA et al (2012) Fossa ovalis tear causing right to left shunting in a Cavalier King Charles Spaniel. J Vet Cardiol 14(4):541-545
  16. Adissu HA et al (2010) yxosarcoma with adrenal adenoma and pituitary hyperplasia resembling Carney complex in a dog. Vet Pathol 47(2):354-357
  17. Simpson SA et al (2009) Severe blunt trauma in dogs: 235 cases (1997-2003). J Vet Emerg Crit Care (San Antonio) 19(6):588-602
  18. Parent C et al (1996) Clinical and clinico-pathologic findings in dogs with acute respiratory distress syndrome: 19 cases (1985–1993). J Am Vet Med Assoc 208:1419–1427
  19. Lee JW (2009) beta2 adrenergic agonists in acute lung injury? The heart of the matter. Crit Care 13(6):1011