Journal of veterinary emergency and critical care
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J Vet Emerg Crit Care (San Antonio) · Jan 2015
ReviewControversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care.
To (1) review the development and medical applications of hydroxyethyl starch (HES) solutions with particular emphasis on its physiochemical properties; (2) critically appraise the available evidence in human and veterinary medicine, and (3) evaluate the potential risks and benefits associated with their use in critically ill small animals. ⋯ Currently, there are no consensus recommendations regarding the use of HES in veterinary medicine. Veterinarians and institutions affected by the HES restrictions have had to critically reassess the risks and benefits related to HES usage based on the available information and sometimes adapt their procedures and policies based on their reassessment. Meanwhile, large, prospective, randomized veterinary studies evaluating HES use are needed to achieve relevant levels of evidence to enable formulation of specific veterinary guidelines.
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J Vet Emerg Crit Care (San Antonio) · Jan 2015
ReviewThe role of antimicrobials in the treatment of sepsis and critical illness-related bacterial infections: examination of the evidence.
To appraise the evidence behind the Surviving Sepsis Campaign Guidelines on antimicrobial therapy in sepsis and evaluate relevant literature in small animal veterinary critical care. ⋯ Clinicians should aim to administer early and appropriate antimicrobials; however, the impact this will have on patient outcome remains uncertain. The ability to administer early and appropriate antimicrobials may be considered a measure of the quality of medical practice rather than a prognostic indicator.
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J Vet Emerg Crit Care (San Antonio) · Jan 2015
ReviewControversies surrounding critical illness-related corticosteroid insufficiency in animals.
To describe the controversies surrounding critical illness-related corticosteroid insufficiency (CIRCI) and the use of hydrocortisone in critically ill patients, and to present published diagnostic and therapeutic strategies in companion veterinary species. ⋯ If the patient survives the critical illness, prognosis for resolution of CIRCI and hydrocortisone dependence is very good.
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J Vet Emerg Crit Care (San Antonio) · Jan 2015
ReviewControversies in the use of fresh frozen plasma in critically ill small animal patients.
To review the literature supporting or discouraging the use of fresh frozen plasma (FFP) transfusion in critically ill patients. ⋯ The use of FFP in critically ill patients remains controversial. In the absence of clinical bleeding or a risk for clinical bleeding associated with a planned procedure, treatment use of FFP is not recommended in human patients. There are insufficient data in critically ill animals to enable formulation of recommendations. Further research is warranted in dogs and cats to establish evidence-based guidelines.
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J Vet Emerg Crit Care (San Antonio) · Jan 2015
ReviewThe crystalloid-colloid debate: Consequences of resuscitation fluid selection in veterinary critical care.
To provide a comprehensive review of the current literature in human and veterinary medicine evaluating the impact of resuscitation fluid choice on patient outcome and adverse effects. ⋯ Clinical data from critically ill human patients have failed to demonstrate an outcome advantage associated with colloidal fluid resuscitation and indicate that hydroxyethyl starch solutions may be associated with significant adverse effects, including acute kidney injury, need for renal replacement therapy, coagulopathies, and pathologic tissue uptake. The ability to apply these findings to veterinary patients is unknown; however, similar pathophysiology may apply, and critical re-evaluation of resuscitation strategies is justified.