Respiratory Distress in the Small Animal Patient

RESPIRATORY DISTRESS
Danielle Berube DVM, DACVECC
October 17, 2020

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 Upper Airway Disease
 Brachycephalic airway syndrome
 Laryngeal paralysis
 Tracheal collapse
 Pulmonary Disease
 Pneumonia
 Congestive heart failure
 Noncardiogenic pulmonary
edema
 Pulmonary contusion/hemorrhage
 Pleural space disease
 Pneumothorax
 Pleural effusion
 Chylothorax
 Hemothorax
 Pyothorax
 Neoplastic
 Chest wall disease
 Misc. respiratory disease
 Acute Lung Disease (ALI)
 Acute Respiratory Distress Syndrome (ARDS)
 Transfusion Associated Circulatory Overload (TACO)
 Transfusion Related Acute Lung Injury (TRALI)
 Non respiratory look-a-likes
RESPIRATORY DISTRESS: OUTLINE
10/17/2020RESPIRATORY DISTRESS

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 Upper Airway Disease
 Brachycephalic airway
syndrome
 Pulmonary Disease
 Pneumonia
 Noncardiogenic pulmonary edema
 Pleural space disease
 Pneumothorax
 Chylothorax
 Hemothorax
 Pyothorax
 Neoplastic
 Chest wall disease
 Misc. respiratory disease
 Acute Lung Disease (ALI)
 Non respiratory look-a-likes
RESPIRATORY DISTRESS: OUTLINE

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 Brachycephalic airway
syndrome
RESPIRATORY DISTRESS: UPPER AIRWAY DISEASE
Vectorstock.com/6330788
En.wikibooks.org

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 Loud, noisy breathing with increased inspiratory time
 Hyperthermia
 Nasal passages, nasopharynx
 Nasal discharge, sneezing, reverse sneezing, snoring,
stertorous breathing
 Larynx and trachea
 Coughing (goose honking, nonproductive), gagging, respiratory
stridor
UPPER AIRWAY DISEASE: PATIENT PRESENTATION

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 Bulldogs, French Bulldogs,
Boston terriers etc.
 Narrowed nostrils (58-85%)
 Elongated soft pallet (87-96%)
 Everted laryngeal saccules (55-
58%)
 Hypoplastic trachea (46%)
BRACHYCEPHALIC AIRWAY SYNDROME

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 Can lead to bronchial
collapse
 Can lead to gastrointestinal
changes
 Esophagus: esophagitis,
hiatal hernia,
gastroesophageal reflux
 Stomach: pyloric
hyperplasia, atresia,
gastritis, dudeonogastric
UPPER RESPIRATORY DISEASE: BRACHYCEPHALIC
SYNDROME

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Medical Management
 Weight loss
 Control excitement
 Medical management of GI
signs
 Treatment pulmonary lung
disease
Surgical Management
 Widening Nares
 Soft palate resection
 Resection of everted
laryngeal saccules
 +/- tonsillectomy
UPPER RESPIRATORY DISEASE: BRACHYCEPHALIC
SYNDROME

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 Middle age to older large and giant breed dogs
 Stridor
 Cyanosis
 Hyperthermia
LARYNGEAL PARALYSIS

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 Most often idiopathic
 Other: congenital, injury to nerve due to trauma,
mediastinal or thoracic neoplasia, myasthenia gravis and
hypothyroidism
 Geriatric onset laryngeal paralysis
polyneuropathy (GOLPP)
 Progressive polyneuropathy with laryngeal and
esophageal dysfunction
 Approximately 1/3 dogs display early signs of
generalized neuropathy at time of diagnosis
LARYNGEAL PARALYSIS

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Medical Management
 Environmental/activity,
weight loss
 Sedatives/Antianxiety
(trazodone)
 Clinical trials with Doxepin
(tricyclic antidepressant)
Surgical Management
 Unilateral arytenoid
lateralization
 90% expierence improvement
in respiratory status
 Complications (aspiration
pneumonia) in 8-33%
 Higher complication rate (74%)
in dogs with neurologic
comorbidities
LARYNGEAL PARALYSIS

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 Middle aged, small breed dogs
 Coughing (goose honk)
 Worse with excitement
 Worse with collar
 +/- dyspnea, cyanosis, hyperthermia, collapse
 83% of dogs also had bronchial collapse
 30% of dogs also had laryngeal paralysis
TRACHEAL COLLAPSE
netclipart

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Medical Management
 Cough control
 Hydrocodone, Butorphanol
 Glucocorticoids
 Prednisone
 +/- Bronchodilators
 Use of harness
 Control of environmental factors
 Can control clinical signs for >12
months in 71% dogs
Surgical Management
 Intralumenal tracheal stent
 Placed using fluoroscopy
 Success rate: 75-90%
 Extraluminal tracheal rings
 Success rate: 75-85%
TRACHEAL COLLAPSE

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TRACHEAL COLLAPSE
Deweese, MD, Tobias K. Tracheal Collapse in Dogs. Clinician’s Brief. May 2014.
Weisse, C. Tracheal Collapse: Extraluminal Rings and Tracheal Stents. Clinician’s Brief.
August 2006.

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 Oxygen support: increases bound and unbound oxygen in
arterial blood
 Sedation +/- intubation
 Cooling
 +/- Steroids
UPPER RESPIRATORY DISEASE: STABILIZATION
https://www.braininjury-explanation.com/causes-
disorders/brain-injury-by-lack-of-oxygen

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 Noninvasive
 Flow by oxygen
 Oxygen cage
 E collar
 More Invasive
 Nasal prongs
 Nasal oxygen
 Nasopharyngeal oxygen
 High flow oxygen
 Mechanical Ventilation
Oxygen support: increase both bound and unbound
oxygen in arterial blood

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 Flow by oxygen
 Oxygen source adjacent to or within 2 cm of patient’s nostril
 Flow rate of 2-3L/min provides an FiO2 of 25-40%
 Well tolerated
 Not appropriate or economical for long term use
OXYGEN SUPPORT

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 Face mask
 Tight fitting mask and flow rate of 8-12L/min can provide FiO2 up
to 50-60%
 Careful of rebreathing carbon dioxide
 Often not well tolerated
OXYGEN SUPPORT

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 Oxygen hood
 Commercial oxygen hoods are available
 Make with E collar and plastic wrap (Crowe Collar)
 E collar one size larger than normal
 Plastic wrap over 50-80% of opening
 Oxygen tube through back of e collar
 Flow rate of 0.5-1L/min typically deliver FiO2 of 30-40%
 Carbon dioxide and moisture can build up, hyperthermia can develop
OXYGEN SUPPORT
Dennis T. (Tim) Crowe, Jr
https://www.dvm360.com/view/delivering-supplemental-
oxygen-dogs-and-cats-practical-review

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 Oxygen cage
 Control O2 concentration, humidity,
temperature
 Vented to decrease buildup of
expired CO2
 FiO2 typically maintained at 40-
50% (although up to 60% can be
obtained)
 Well tolerated
 Decreased ability to monitor
patient- O2 drops quickly every
OXYGEN SUPPORT

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 Nasal Prongs
 Medium and large dogs
 Easy to place
 Can be dislodged
 Connect to humidified O2 source
 Unclear FiO2 administered
OXYGEN SUPPORT

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 Nasal oxygen catheter
 Local anesthesia : a few drops of
2% lidocaine or proparacaine
 5-10F red rubber catheter
measured to medial canthus of
eye
 Lubricate tip of catheter and
insert into ventral nasal meatus
OXYGEN SUPPORT

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 Nasal oxygen catheter
 Suture or staple in place
 Humidified oxygen source
 Flow rates of 50-150
ml/kg/min can provide 30-
70% FiO2
OXYGEN SUPPORT
Waddel, L. Oxygen Therapy Clinician’s Brief July 2016. Fig 6

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 Nasopharyngeal oxygen
 Similar technique to nasal oxygen but measure to ramus of the mandible
 Transtracheal oxygen
 High Flow oxygen
 Special delivery system
 Allows for higher flow rate and increased O2 delivery/exchange
 Mechanical ventilation
 Specialized equipment
 1:1 monitoring
 Expensive
OXYGEN SUPPORT: MORE INVASIVE
Fig 10: https://todaysveterinarypractice.com/providing-
supplemental-oxygen-to-patients/
Fig 8.5:
https://veteriankey
.com/techniques-
for-oxygen-
supplementation/
Pouzot-Nevoret C. Prospective pilot
study for evaluation of high-flow
oxygen therapy in dyspnoeic dogs:
the HOT-DOG study JSAP Vol 60
issue 11

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 Sedation
 Butorphanol 0.1-0.5 mg/kg IM or IV
 +/- acepromazine (if cardiolvasculary stable):
 start low 0.005-0.02 mg/kg IV and 0.01-0.05 mg/kg IM
 Other sedatives (midazolam, ketamine, dexmedetomidine) on a
case by case basis
 Remember that it takes 15 minutes for full effect (even IV)

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 If sedation is not enough may need to intubate
 Propofol: 0.05-1 mg/kg IV titrated to effect
 Alfaxalone: 0.5mg-2 mg/kg IV titrated to effect
 Intubate
 Remember to evaluate as much of the upper airway as you can
 If sedation is not enough may need to intubate
 Propofol: 0.05-1 mg/kg IV titrated to effect
 Alfaxalone: 0.5mg-2 mg/kg IV titrated to effect
 Intubate
 Remember to evaluate as much of the upper airway as you can
https://www.boundtree.com/Pharmaceuticals
https://en.wikipedia.org/wiki/Alfaxalone

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 Many of these patients are hyperthermic
 Active cooling
 Cool water bath/towel
 Low temperature in oxygen cage
 Sedation
 Fan
UPPER RESPIRATORY DISEASE STABILIZATION: COOLING
Hyperthermia
Panting

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 +/- glucocorticoids for airway inflammation:
dexamethasone SP 0.05-0.2 mg/kg IM, IV, SQ
 Rule out other causes of respiratory distress with best of ability
 Caution in hypovolemic patients, patients receiving NSAIDS,
known heart disease
RESPIRATORY DISTRESS STABILIZATION: STEROIDS

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 Sedated oral/pharyngeal exam
 Thoracic radiographs
 Fluoroscopy
 CT
UPPER RESPIRATORY DISEASE: ADDITIONAL DIAGNOSTICS

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 Especially if elongated soft palate or laryngeal paralysis
are suspected
ADDITIONAL DIAGNOSTICS: SEDATED ORAL/PHARYNGEAL
EXAM
Photo and video courtesy of Dr Joe Palamara DVM DACVS-SA

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 You might be surprised
ADDITIONAL DIAGNOSTICS: SEDATED ORAL/PHARYNGEAL
EXAM

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ADDITIONAL DIAGNOSTICS: THORACIC RADIOGRAPHS
 Further evaluate portions of upper airway
 Rule out other/contributing causes of respiratory distress
 Ideally 3 view
 Flow by oxygen
 Patient may need a break between views
 Consider DV instead of VD

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ADDITIONAL DIAGNOSTICS: THORACIC RADIOGRAPHS

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 Pneumonia
 Allergic airway disease
RESPIRATORY DISTRESS: PULMONARY DISEASE
En.wikibooks.org

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 Can be asymptomatic or have severe respiratory distress
 Increased/harsh lung sounds
PULMONARY DISEASE: PRESENTATION

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 Can be asymptomatic or extremely dyspneic
 Respiratory signs: cough, increased respiratory effort, purulent
nasal discharge
 78% of puppies with pneumonia are tachypneic
 72% of puppies have increased respiratory effort
 >90% of dogs have abnormally loud breath sounds on auscultation, but
these are nonspecific
 47% dogs cough and 8% of cats cough
 Systemic signs: lethargy, and inappetence
PULMONARY DISEASE: PNEUMONIA

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 Look for predisposing factors
 36-57% of dogs are found to have predisposing factors
 Impaired patient mobility
 Upper airway disorders
 Regurgitation syndromes
 Other: congenital abnormalities, crowded or unclean housing, forceful
intubation, immune compromise, inadequate vaccination, induced
vomiting, seizures etc
PULMONARY DISEASE: PNEUMONIA

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 Three view thoracic radiographs
 Alveolar opacification, air bronchograms, with or without
interstitial patterns
 Aspiration pneumonia: right middle lung lobe and ventral parts of
other lobes
PNEUMONIA: DIAGNOSTICS

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PNEUMONIA: RADIOGRAPHS

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 CBC/Chem/UA +/- coagulation panel
 CBC
 Can be unremarkable
 Leukocytosis characterized by a neutrophilia,
left shift and monocytosis
 Can be leukopenic
PNEUMONIA: DIAGNOSTICS

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 Oxygen support when indicated
 Empiric antibiotics
 Gram positive, gram negative and anerobic bacteria
 Often ampicillin and enrofloxacin
 Continue for 2 weeks after radiographic resolution
 Nebulization of 0.9% NaCl
 Coupage of chest
PNEUMONIA: TREATMENT

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 Response to antimicrobial treatment seen in 69-88%
 Long term: depending on primary cause
 Megaesophagus
 GI motility disorder
 Ciliary dyskinesia
 Laryngeal disease
PNEUMONIA: PROGNOSIS
Fig 2: https://www.vetfolio.com/learn/article/megaesophagus

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 Accumulation of extravascular fluid with pulmonary
parenchyma or alveoli
 Cardiogenic pulmonary edema
 Neurogenic pulmonary edema (NPE)- head trauma, seizures,
electrocution
 Negative pressure pulmonary edema (NPPE)- upper airway obstruction
(i.e. strangulation)
PULMONARY DISEASE: PULMONARY EDEMA

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 Presentation/History
 Canine:
 History: cough, orthopnea, exercise intolerance, heart murmur
 Auscultation: heart murmur, crackles
 Feline:
 Heart murmur, gallop rhythm
 Auscultation
 Note that 20% of cats have no auscultatory abnormalities
LEFT SIDED CONGESTIVE HEART FAILURE: PULMONARY
EDEMA

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 Radiographs for cardiogenic pulmonary edema
 Cardiomegaly, left atrial enlargement
 Canine: intestinal or alveolar infiltrates in perihilar region
 Cats: mixed alveolar pattern that can be patchy
PULMONARY EDEMA: DIAGNOSTIC TESTS

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RADIOGRAPHS CARDIOGENIC PULMONARY EDEMA

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 Oxygen therapy
 +/- sedation
 Diuretics: Furosemide
 Canine: 2-8 mg/kg IV, SQ, IM
 CRI: 0.5-1.0 mg/kg/hr
 Feline: 1-4 mg/kg IV, SQ, IM
 Rapid onset of action
 Pulmonary venodialtor, bronchoidilator, increased colloid oncotic
pressure
CARDIOGENIC PULMONARY EDEMA: STABILIZATION

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 Depends on severity of heart disease
 Survival to discharge
 80% (Goutal et al. JVECC 2010)
 99 dogs and 55 cats
 56% (Brady et al JVECC 2004)
 59 dogs
CARDIOGENIC PULMONARY EDEMA: PROGNOSIS

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 Canine: broad spectrum of
disease that are somewhat
poorly defined
 Feline bronchopulmonary
disease: allergic/asthmatic,
chronic bronchitis
ALLERGIC AIRWAY DISEASE
https://www.vet.cornell.edu
https://www.merckvetmanual.com

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 Presentation
 Increased expiratory effort
 Rapid, shallow breathing
 Forced abdominal push
 Open mouth breathing
 Cough
ALLERGIC AIRWAY DISEASE: FELINE BRONCHOPULMONARY
DISEASE

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 Oxygen
 Sedation
 If highly suspicious of feline bronchopulmonary disease,
consider
 Bronchodilator
 Anti inflammatory steroid
FELINE BRONCHOPULMONARY DISEASE: STABILIZATION

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 Bronchodilators
 Albuterol: 88mcg/dose- 2 puffs with 7-10 breaths q12hr
 Terbutaline: 0.01 mg/kg IV, SQ or IM q4-8hr; 1.25mg PO q12 hr
 Aminophylline: 5-10 mg/kg PO q8-12 hr
 Theophylline: 5 mg/kg PO q8-12 hr
FELINE BRONCHOPULMONARY DISEASE
STABILIZATION/TREATMENT
Fig 3: Nate, L. Update, Diagnosis and Treatment of
Feline Asthma. Clinician’s Brief Sept 2017

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 Steroids
 Dexamethasone SP: 0.2-0.5 mg/kg IV or IM
 Inhaled steroids (long term treatment): fluticasone propionate
 44mcg/dose, 2 puffs with 7-10breaths q12hr
 Less systemic absorption with longer duration
 Administration of systemic glucocorticoids for at least 48 hours prior
improves sensitivity to inhaled steroids
FELINE BRONCHOPULMONARY STABILIZATION/TREATMENT

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 Radiographs
 Doughnuts, tram lines or train tracks
 Can be variable
 Increased interstitial markings
 Hyperinflation of lung fields with flattening of the diaphragm
 Alveolar infiltration/consolidation of right middle lung lobe (11%)
 Severity of radiographic signs severity of
symptoms/prognosis
DIAGNOSTICS: RADIOGRAPHS

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FELINE ASTHMA RADIOGRAPHS
Fig 2: Nate, L. Update, Diagnosis and Treatment of
Feline Asthma. Clinician’s Brief Sept 2017

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 CBC/Chem- almost always normal
 Most do NOT have peripheral eosinophilia
 Fecal exam with baermann
 Feline heartworm antibody and antigen test
 Bronchoscopy with BAL
DIAGNOSTICS: LABORATORY TESTS

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 Pneumothorax
 Chylothorax
 Hemothorax
 Pyothorax
 Neoplastic
RESPIRATORY DISTRESS: PULMONARY SPACE DISEASE
En.wikibooks.org

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 Tachypnea, open mouth breathing, coughing, orthopnea,
cyanosis and short shallow breathing +/- paradoxical breathing
 Muffled lung sounds
RESPIRATORY DISTRESS: PULMONARY SPACE DISEASE

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 TFAST: Thoracic Focused Assessment with Sonography
for Trauma
 Detect free fluid in less than 5 minutes
 5 views
 Bilateral between 7th- 9th intercostal spaces
 Bilateral between 5th-6th intercostal spaces
 Subxiphoid view
PLEURAL SPACE DISEASE: TFAST

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PLEURAL SPACE DISEASE: TFAST
Fig 189-7 Chapter 189 AFAST and TFAST in the Intensive Care Unit by Soren R Boysen In
Small Animal Critical Care Medicine second edition, ed D Silverstein and K Hopper
https://www.scilvet.ca/company/articles/a-general-practitioners-guide-to-
the-daily-use-of-point-of-care-ultrasound-in-small-animals/

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PLEURAL SPACE DISEASE RADIOGRAPHS PNEUMOTHORAX

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PLEURAL SPACE DISEASE RADIOGRAPHS: PLEURAL
EFFUSION

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 Oxygen
 +/- sedation
 Thoracocentesis
PLEURAL SPACE DISEASE: STABILIZATION

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 Flow by oxygen with patient in sternal recumbency
 Clip and aseptically clean/scrub thorax
PLEURAL SPACE DISEASE: THORACOCENTESIS
Wong, C. Thoracocentesis. Clinician’s Brief June 2008

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 Insert
needle/catheter/butterfly
needle perpendicular to
chest wall and just cranial
to the rib
 7-8th intercostal space at
costochondral junction for
fluid
 8th-9th intercostal space half-
way between spine and
costochondral junction-for air
6 7 8 9
Fluid
Air

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 Direct needle dorsally (air)
or ventrally (fluid)
 Aspirate until negative
pressure
 Collect samples

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 Open: due to insult to the thoracic wall (penetrating
trauma)
 Closed: thoracic cavity intact; lesion within lung, trachea,
airways, esophagus, mediastinum or diaphragm
 Tension: site of air leakage creates a one-way valve
during inspiration
PNEUMOTHORAX

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 Differentials/causes:
 Hit by car (seen in 47% of dogs with pulmonary contusions)
 “High rise syndrome” in cats (63%)
 Iatrogenic: thoracocentesis, barotrauma during mechanical
ventilation, tracheal tears
 Spontaneous pneumothorax due to pulmonary bullous emphysema
(Siberian Husky)
 Neoplasia, feline asthma, pulmonary abscess, heartworm
disease/parasitic infections, foreign body migration, pneumonia,
infectious pneumothorax (gas forming bacteria in thoracic cavity)
PNEUMOTHORAX

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 Overall survival rate 86%
 Closed pneumothorax- typically only require
thoracocentesis once or twice
 Chest tubes with constant negative pressure
 Tension pneumothorax
 Require thoracocentesis more than
twice within 6-12 hours
 Patients requiring mechanical ventilation
PNEUMOTHORAX PROGNOSIS
https://www.theveterinarynurse.com/review/article/management-
of-tubes-lines-and-drains

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 Surgery (thoracostomy or thoracoscopy)
 Closed traumatic pneumothorax that does not resolve after 3-5
days
 Open pneumothorax
 Spontaneous pneumothorax
PNEUMOTHORAX PROGNOSIS

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 Pure transudate:
hypoalbuminemia, portal
hypertension, lymphatic
obstruction
 Modified transudate: heart failure,
vasculitis, lung lobe torsion,
diaphragmatic hernia, neoplasia,
chylothorax
 Exudate:
 Aseptic: inflammation, chylothorax,
neoplasia
 Septic: hematogenous spread,
penetrating wounds, spread from
infected organs
PLEURAL EFFUSION
From Fig 28-1 Chapter 28 pleural space disease by Valerie Sauve in Small Animal Critical
Care Medicine second edition ed D. Silverstein and K Hopper

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 Opaque and white or pink in color
 Small lymphocytes predominate
 Fluid triglycerides > serum triglycerides
 Fluid cholesterol >/= serum cholesterol
 Ddx: heart disease, thoracic duct obstruction, trauma,
mediastinal mass, lung lobe torsion, diaphragmatic hernia or
PPDH, heartworm disease, idiopathic
CHYLOTHORAX
Caruso, K. Effusion in cats. Clinicans Brief June 2006
Vetbook.org

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 Long term survival: 73-100%
 Treatment of underlying disease if identified
 Medical management:
 Intermittent thoracocentesis, low fat diet, rutin
 Surgical management:
 Often required
 Thoracic duct ligation with pericardiectomy +/- cirsterna chyli ablation
 +/- pleural access ports
CHYLOTHORAX

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 Pleural space effusion with Hct >10%, nonclotting blood
 Ddx: severe coagulopathy (rodenticide), neoplasia, trauma
 Thoracocentesis: only enough to relieve dyspnea
(reabsorption RBC over following days)
 PT/PTT, radiographs after thoracocentesis, thoracic
ultrasound or CT
HEMOTHORAX

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 Accumulation of purulent exudate within thoracic cavity
 Bite wounds, extension of pulmonary infections, migrating
inhaled foreign bodies, traumatic thoracic penetration,
esophageal perforation, neoplasia
 Aerobic and anaerobic culture
PYOTHORAX
DVM360.com: Rozanski, E. Pyothorax in cats and dogs (proceedings)
https://www.vetstream.com/treat/felis/diseases/pyothorax

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PYOTHORAX

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 Cats: Pasteurella ssp. most common
 Clindamycin
 Often can be managed with bilateral chest tubes/lavage 4-6 days (95% of
cases)
 Canine: E coli most common
 Can be enrofloxacin resistant; consider amikacin and ceftizoxime
 Surgical treatment has been associated with better outcome
 Overall survival: 63-66.1%
 Patients treated with thoracostomy tubes or thoracotomy (over
intermittent drainage) survival 71-77.6%
PYOTHORAX

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 Transudate or exudate
 Mesothelioma, pulmonary carcinoma, lymphosarcoma,
metastatic disease
NEOPLASTIC

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 Acute Lung Injury (ALI)
 Non-Respiratory Look-a-Likes
MISCELLANEOUS RESPIRATORY DISEASE

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1. Compensation for metabolic acidosis
2. Decreased oxygen content/delivery
3. Sympathetic stimulation “fight or flight”
4. Hyperthermia/mu opioids
5. Electrolyte imbalance
6. Hyperadrenocorticism/hyperthyroidism
7. Peripheral nervous system disease
8. Central nervous system disease
NON-RESPIRATORY LOOK A-LIKES

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 Brief evaluation/”hands off”
 Use presentation, signalment and respiratory pattern to
localize respiratory disease
 Oxygen support +/- sedation
 Diagnostics: TFAST, thoracic radiographs +/- CBC/Chem,
other
 Further treatment for stabilization
 Address long term treatment plan/transfer and prognosis
RESPIRATORY DISTRESS: SUMMARY

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RESPIRATORY DISTRESS SUMMARY
Respiratory Distress
Oxygen +/- Sedation
Upper airway
(Breed, presentation, stridor/stertor)
+/- Additional sedation
+/- Intubation
+/- Steroids
+/- Active cooling
Sedated oral exam
Radiographs
BAS Laryngeal paralysis Tracheal collapse
Lower Airway
(History, presentation, auscultation)
TFAST: Fluid or no fluid
Fluid No Fluid
Thoracocentesis
Post tap radiographs
Chylothorax
Hemothorax
Pyothorax
Neoplasia
Feline
Asthma
Radiographs
Pneumothorax
Pneumonia
CHF
NCPE
Contusions/hemorrhage

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Adamantos, S. Chapter 21 ‘Pulmonary Edema’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 116-120.
Bookbinder, L. et al. Idiopathic Canine Laryngeal Paralysis as One Sign of a Diffuse Polyneuropathy: An Observational Study of 90 cases (2007-2013) Vet Surg 2016: 45 (2) 254-260.
Boysen, S. Chapter 189 ‘AFAST and TFAST in the Intensive Care Unit’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 988-994.
Clark, D. Chapter 17 ‘Upper Airway Disease.’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 92-104.
Cote, E. Chapter 22 ‘Pneumonia’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 1120-126.
Jagodich, T. et al. Comparison of high flow nasal cannula oxygen administration to traditional nasal cannula oxygen therapy in healthy dogs. JVECC 2019 vol 29 issue 3.
Lee, J. Chapter 29 ‘Nonrespiratory look-alikes’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 157-160.
Mazzaferro, E. Chapter 14 ‘Oxygen Therapy.’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages77-80.
Mellema, M. Chapter 18 ‘Brachycephalic Syndrome’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 104-110.
Miller, C. Chapter 172 ‘Inhaled Medications’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 903-906.
Miller, C. Chapter 20 ‘Allergic Airway Disease in Dogs and Cats and Feline Bronchopulmonary Disease’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 111-115.
Nafe, L. Update, Diagnosis and Treatment of Feline Asthma, Veterinary Team Brief September 2017. Pages 35-38.
Pouzot-Nevoret C. Prospective Pilot Study for Evaluation of High Flow Oxygen Therapy in Dyspneoic dogs: the HOT-DOG study. JSAP 2019. Vol. Issue 11.
Rozanski, E. Pythorax in cats and dogs (proceedings) DVM360.com.
Rozanski, E., Oura, T. and Chan, D. Chapter 24 ‘Acute Lung Injury and Acute Respiratory Distress Syndrome’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages. 133-138
Sauve, V. Chapter 28 ‘Pleural Space Disease’(2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 151-156.
Sigrist, N. Chapter 198 ‘Thoracocentesis’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 1029-1031.
Stanley B. Dysphonia and Respiratory Noise in a Labrador Retriever. Clinician’s Brief November 2019 pages 57-61.
Wey, A. Chapter 43 ‘ Valvular Heart Disease’ (2015) in Silverstein, D, Hopper K. Small Animal Critical Care Medicine Second Edition. Saunders. Pages 230-235.
Wong, C. Thoracocentesis. Clinician’s Brief June 2008 pages 75-78.
REFERENCES

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