Abstract
Respiratory insufficiency and pulmonary health are important considerations in equine neonatal care. As the majority of foals are bred for athletic pursuits, strategies for respiratory support of compromised foals are of particular importance. The administration of supplementary oxygen is readily implemented in equine practice settings, but does not address respiratory insufficiency due to inadequate ventilation and is no longer considered optimal care for hypoxia in critical care settings. Non-invasive ventilatory strategies including continuous or bi-level positive airway pressure are effective in human and veterinary studies, and may offer improved respiratory support in equine clinical practice. The current study was conducted to investigate the use of a commercial bi-level positive airway pressure (BiPAP) ventilator, designed for home care of people with obstructive respiratory conditions, for respiratory support of healthy foals with pharmacologically induced respiratory insufficiency. A two sequence (administration of supplementary oxygen with, or without, BiPAP), two phase, cross-over experimental design was used in a prospective study with six foals. Gas exchange and mechanics of breathing (increased tidal volume, decreased respiratory rate and increased peak inspiratory flow) were improved during BiPAP relative to administration of supplementary oxygen alone or prior studies using continuous positive airway pressure, but modest hypercapnia was observed. Clinical observations, pulse oximetry and monitoring of expired carbon dioxide was of limited benefit in identification of foals responding inappropriately to BiPAP, and improved methods to assess and monitor respiratory function are required in foals.
Highlights
Respiratory disease has long been recognized as of considerable economic importance in newborn foals [1], and as an important cause of morbidity and death in neonates presented for veterinary care [2, 3]
bi-level positive airway pressure (BiPAP) was associated with decreased respiratory rate (RR), increased Vt and increased minute ventilation, suggesting that respiratory mechanics were improved by respiratory support
BiPAP was associated with increased PaO2, more efficient gas exchange and changes in respiratory mechanics including increased tidal volume, decreased respiratory rate, and increased peak inspiratory flow
Summary
Respiratory disease has long been recognized as of considerable economic importance in newborn foals [1], and as an important cause of morbidity and death in neonates presented for veterinary care [2, 3]. The use of non-invasive ventilation (NIV) is widely regarded as the most effective approach for respiratory support of human neonates [4, 5], with continuous positive airway pressure (CPAP) shown to reduce the number of preterm infants requiring admission to neonatal intensive care [6], and to decrease the risk of bronchopulmonary dysplasia or death in neonates requiring. Previous studies have demonstrated that CPAP is associated with improved respiratory function in a number of veterinary species [9,10,11,12]. CPAP has recently been shown to improve gas exchange in healthy foals with pharmacologically induced respiratory suppression [13], hypercapnia was observed in treated foals in this study, and has been observed previously in anesthetized horses during CPAP [10, 11, 14]
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