Abstract
Intravenous fluid therapy is a vital and life-saving therapeutic in veterinary medicine. In the absence of heart or lung disease, trauma or sepsis there is limited evidence that fluid therapy will have a detrimental effect on lung function. In healthy dogs there is a reasonable level of experimental evidence that supraphysiologic rates of fluid are required before signs of fluid overload are made evident. In cats, however, this may not be the case. There are higher rates of asymptomatic myocardial disease, but even in the absence of that it seems that some cats may be susceptible to fluid overload. Where systemic inflammation already exists the careful homeostatic and protective mechanisms within the lung are deranged and increases in hydrostatic pressure are more likely to result in fluid movement into the lung tissues. Strategies including restricting the use of intravenous crystalloid fluid administration and using blood products for management of severe hemorrhage are of increasing importance in human trauma and seem to be associated with fewer pulmonary complications, and lower mortality. Managing dogs and cats with sepsis and acute respiratory distress syndrome is already challenging, but ensuring adequate vascular expansion needs to be balanced with avoiding excessive volume administration which may negatively impact pulmonary function. While fluids remain crucial to management of these conditions, there will be an ongoing requirement to balance need without providing excess. The use of point of care ultrasound may provide clinicians with a non-invasive and accessible way to do this.
Highlights
Fluid therapy is a vital part of the management of the acutely or critically ill veterinary patient
The following writings will explore the experimental, human and veterinary clinical evidence related to conditions where fluid therapy and pulmonary dysfunction are of particular concern; trauma and pulmonary contusions, sepsis, systemic
While the published veterinary literature currently focusses on the use of detection of B-lines in dogs and cats with pulmonary edema secondary to congestive cardiac failure, there is no reason while the same ultrasonographic approach cannot be used for the monitoring of patients at risk of non-cardiogenic pulmonary edema
Summary
Specialty section: This article was submitted to Comparative and Clinical Medicine, a section of the journal Frontiers in Veterinary Science. In the absence of heart or lung disease, trauma or sepsis there is limited evidence that fluid therapy will have a detrimental effect on lung function. In healthy dogs there is a reasonable level of experimental evidence that supraphysiologic rates of fluid are required before signs of fluid overload are made evident. In cats, this may not be the case. Managing dogs and cats with sepsis and acute respiratory distress syndrome is already challenging, but ensuring adequate vascular expansion needs to be balanced with avoiding excessive volume administration which may negatively impact pulmonary function. The use of point of care ultrasound may provide clinicians with a non-invasive and accessible way to do this
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