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1.
Objective – To investigate the association between blood lactate concentration, measured at admission and following 12–36 hours of treatment, and age, diagnosis, and survival in neonatal foals. Design – Retrospective, observational study. Setting – Two equine referral hospitals. Animals – One hundred and twelve foals ≤96 hours of age were included. Interventions – Arterial or venous blood samples were obtained from all foals at admission and surviving foals at 12–36 hours. Measurements – The lactate concentration (LAC) was recorded at 2 time points: admission (LAC‐Admission) and 12–36 hours following treatment (LAC‐24 hours). Main Results – LAC decreased by 0.05 mmol/L for each increased hour of age at presentation. Premature/dysmature foals demonstrated increased odds of nonsurvival of 55% for each 1 mmol/L increase in LAC‐Admission while foals with major diagnoses of neonatal encephalopathy (NE), enteritis and ‘Other’ had increased odds of nonsurvival of 52%, 113%, and 247%, respectively, for each 1.0 mmol/L increase in LAC. Blood‐culture positive foals had significantly lower LAC than blood culture negative foals. LAC‐Admission and LAC‐24 hours were significantly larger in nonsurviving foals. LAC‐Admission of >6.9 mmol/L and LAC‐24 hours >3.2 mmol/L, respectively, correctly classified 85.6% and 94.1% of cases as survivors or nonsurvivors. No differences were found when the 24‐hour change in LAC was investigated in terms of outcome, age at admission, or major diagnosis; however, LAC‐24 hours remained significantly associated with survival. Conclusions – Admission or persistent hyperlactatemia is associated with a nonsurvival. Younger foals, premature/dysmature foals, and foals with neonatal encephalopathy had the largest LAC.  相似文献   

2.
Background: Sequential lactate concentration ([LAC]) measurements have prognostic value in that hospitalized humans and neonatal foals that have a delayed return to normolactatemia have greater morbidity and case fatality rate.
Hypothesis: Prognosis for survival is decreased in horses with a delayed return to normal [LAC].
Animals: Two hundred and fifty adult horses presented for emergency evaluation excepting horses evaluated because of only ophthalmologic conditions, superficial wounds, and septic synovitis without systemic involvement.
Methods: Prospective observational study. [LAC] was measured at admission and then at 6, 12, 24, 48, and 72 hours after admission. The change in [LAC] over time ([LAC]Δ T ) was calculated from changes in [LAC] between sampling points.
Results: Median [LAC] was significantly ( P < .001) higher at admission in nonsurvivors (4.10 mmol/L [range, 0.60–18.20 mmol/L]) when compared with survivors (1.30 mmol/L [range, 0.30–13.90 mmol/L]) and this difference remained at all subsequent time points. The odds ratio for nonsurvival increased from 1.29 (95% confidence interval 1.17–1.43) at admission to 49.90 (6.47–384) at 72 hours after admission for every 1 mmol/L increase in [LAC]. [LAC]Δ T was initially positive in all horses but became negative and significantly lower in nonsurvivors for the time periods between 24–72 hours (− 0.47, P = .001) and 48–72 hours (− 0.07, P = .032) when compared with survivors (0.00 at both time periods) consistent with lactate accumulation in nonsurvivors.
Conclusions and Clinical Importance: These results indicate that lactate metabolism is impaired in critically ill horses and [LAC]Δ T can be a useful prognostic indicator in horses.  相似文献   

3.
Reasons for Performing Study: Critical illness is associated with hyperglycemia in humans, and a greater degree and duration of hyperglycemia is associated with nonsurvival. Hypoglycemia is also seen in critically ill humans, and is associated with nonsurvival. This might also be true in the critically ill foal.
Objectives: To investigate the association of blood glucose concentrations with survival, sepsis, and the systemic inflammatory response syndrome (SIRS).
Methods: Blood glucose concentrations at admission (515 foals) and 24 hours (159 foals), 36 hours (95), 48 hours (82), and 60 hours (45) after admission were analyzed. Logistic regression analyses were performed to investigate the association of glucose concentrations with survival, sepsis, a positive blood culture, or SIRS.
Results: 29.1% of foals had blood glucose concentrations within the reference range (76–131 mg/dL) at admission, 36.5% were hyperglycemic, and 34.4% were hypoglycaemic. Foals that did not survive to hospital discharge had lower mean blood glucose concentrations at admission, as well as higher maximum and lower minimum blood glucose concentrations in the 1st 24 hours of hospitalization, and higher blood glucose at 24 and 36 hours. Foals with blood glucose concentrations <2.8 mmol/L (50 mg/dL) or >10 mmol/L (180 mg/dL) at admission were less likely to survive. Hypoglycemia at admission was associated with sepsis, a positive blood culture, and SIRS.
Conclusions and Potential Relevance: Derangements of blood glucose concentration are common in critically ill foals. Controlling blood glucose concentrations may therefore be beneficial in the critically ill neonatal foal, and this warrants further investigation.  相似文献   

4.
This prospective study compared survival rates of critically ill and septic foals receiving 1 of 2 different types of commercial equine plasma and analyzed admission variables as possible predictors of survival. Standardized clinical, hematologic, biochemical, and hemostatic admission data were collected and foals received either conventional commercially available hyperimmune equine plasma or equine plasma specifically rich in antiendotoxin antibodies in a double-blinded, coded fashion. Sepsis was defined as true bacteremia or sepsis score >11. Overall survival rate to discharge was 72% (49/68). Foals that were nonbacteremic and demonstrated a sepsis score of < or = 11 at admission had a 95% (18/19) survival rate. The survival rate to discharge for septic foals was 28/49 (57%), with truly bacteremic foals having a survival rate of 58% (14/24), whereas that for nonbacteremic, septic foals was 56% (14/25). Sensitivity and specificity for sepsis score >11 as a predictor of bacteremia were 74 and 52%, respectively. For the entire study population, a higher survival rate to discharge was documented for those foals receiving hyperimmune plasma rich in antiendotoxin antibodies (P = .012, odds ratio [OR] 6.763, 95% confidence interval [CI]: 1.311, 34.903). Administration of plasma rich in antiendotoxin antibodies also was associated with greater survival in septic foals (P = .019, OR 6.267, 95% CI: 1.186, 33.109). Statistical analyses demonstrated that, among 53 clinical and clinicopathologic admission variables, high sepsis score (P < .001), low measured IgG concentration (P = .01), high fibrinogen concentration (P = .018), low segmented neutrophil count (P = .028), and low total red blood cell numbers (P = .048) were the most significant predictors of overall mortality.  相似文献   

5.

Background

A variety of measures of l‐lactate concentration ([LAC]) in the blood of critically ill neonatal foals have shown utility as prognostic indicators. These measures, evaluating either the severity of hyperlactatemia or the duration of exposure to hyperlactatemia, perform fairly well and have correctly classified 75–80% of foals examined in several studies. The area under the l‐lactate concentration versus time curve (LAC Area) encompasses both severity and duration of hyperlactatemia and should improve correct classification of patient survival.

Hypothesis/Objectives

LAC Area is larger in nonsurviving critically ill neonatal foals.

Animals

Forty‐nine foals admitted for critical illness to 1 of 4 referral hospitals.

Methods

Whole blood was obtained at admission and 6, 12, 18, and 24 hours after admission for measurement of l‐lactate using a handheld lactate meter. LAC Area was calculated for: admission–6, 6–12, 12–18, 18–24 hours, and admission–24 hours using the trapezoidal method and summing the 6‐hours interval areas to determine total 24 hours area. Differences between survivors and nonsurvivors were determined using robust regression and Kruskal–Wallis testing, P < .05.

Results

LAC Area was significantly larger in nonsurviving foals (n = 9) than in surviving foals (n = 40) at all time periods examined.

Conclusions and Clinical Importance

Differences in LAC Area between surviving and nonsurviving critically ill neonatal foals are large and support further investigation of this method as an improved biomarker for survival in critically ill neonatal foals is indicated.  相似文献   

6.
Objectives – To (1) determine the occurrence of spurious hypercreatininemia in a population of hospitalized foals <2 days old, (2) assess the resolution of the hypercreatininemia, and (3) determine its association with survival in these foals. Design – Retrospective case series. Setting – 2 Referral hospitals. Animals – Foals <2 days old with an admission creatinine >442 μmol/L (>5.0 mg/dL) from 2 referral hospitals. Interventions – None. Measurements and Main Results – The medical records of 33 foals were reviewed. Twenty‐eight had spurious hypercreatininemia and 5 had acute renal failure. Admission creatinine was not significantly different between the 2 groups (mean [standard deviation]). The creatinine was 1,202 μmol/L (663 μmol/L) (13.6 mg/dL [7.5 mg/dL]) versus 1,185 μmol/L (787 μmol/L) (13.4 mg/dL [8.9 mg/d]) (P=0.96) in each group, respectively, though BUN at the time of hospital admission was significantly higher for acute renal failure foals (P=0.009). In the spurious group, serum creatinine at admission decreased to 504 μmol/L (380 μmol/L) (5.7 mg/dL [4.3 mg/dL]) by 24 hours, and to 159 μmol/L (80 μmol/L) (1.8 mg/dL [0.9 mg/dL]) at 48 hours, and to 115 μmol/L (44 μmol/L) (1.3 mg/dL [0.5 mg/dL]) at 72 hours. Twenty‐three of 28 foals with spurious hypercreatininemia survived to hospital discharge and there was no difference in mean admission creatinine between survivors (1176 μmol/L [628 μmol/L]) (13.3 mg/dL [7.1 mg/dL]) and nonsurvivors (1308 μmol/L [857 μmol/L]) (14.8 mg/dL [9.7 mg/dL]) (P=0.67). Twenty of 28 foals had clinical signs suggestive of neonatal encephalopathy. Conclusion – Creatinine decreased by >50% within the initial 24 hours of standard neonatal therapy and was within the reference interval in all but 1 foal within 72 hours of hospitalization. The diagnosis of neonatal encephalopathy was common in these foals.  相似文献   

7.

Background

Accurate diagnostic markers for sepsis in neonatal foals are needed. Plasma C‐reactive protein concentration (p[CRP]) and haptoglobin concentration (p[Hp]) are well‐established biomarkers of infection in humans, but studies are lacking in foals.

Hypotheses

p[CRP]) and p[Hp] are increased in septic foals compared to sick nonseptic and healthy control foals, and are predictive of survival.

Animals

Eighty critically ill foals (40 septic, 40 sick nonseptic) and 39 healthy control foals <1 week of age.

Methods

Multicenter, prospective observational clinical study. Venous blood was collected at admission from septic and sick nonseptic foals and from clinically healthy foals at 24 h of age. A diagnosis of sepsis was made based on positive blood culture or a sepsis score >11, and p[CRP] and p[Hp] were measured by using ELISA tests. Data were analyzed by using the Mann‐Whitney U‐test and forward stepwise multivariable linear regression. P < .05 was considered significant.

Results

Plasma [CRP] was positively associated with age, serum globulin, adrenomedullin, and bilirubin concentrations, aspartate aminotransferase activity, glutamyl‐transferase activity, band neutrophil count, and rectal temperature, and was increased in foals with toxic neutrophils, enterocolitis, colic, rib fractures and septic arthritis. Surprisingly, p[Hp] was lower in septic foals than in sick nonseptic foals. Neither p[CRP] or p[Hp] was predictive of survival in critically ill foals.

Conclusions and Clinical Importance

Plasma [CRP] increases with inflammation in neonatal foals but is not indicative of sepsis. Single time point, admission sampling of p[CRP] and p[Hp] do not appear to be useful biomarkers for sepsis in foals.  相似文献   

8.
REASONS FOR PERFORMING STUDY: Blood lactate concentration has been shown to be a useful clinical indicator in human patients, but has not been formally investigated in critically ill foals. OBJECTIVE: To investigate the association of blood lactate with hospital survival, markers of cardiovascular status, metabolic acid base status, sepsis and systemic inflammatory response syndrome (SIRS). METHODS: A database containing clinical, haematological, plasma biochemical and hospital outcome data on neonatal foals referred to an intensive care unit in 2000-2001 was analysed. Seventy-two foals for which arterial lactate was measured at admission were included in the study. RESULTS: Sixty-one foals had an admission lactate concentration > 2.5 mmol/l. Admission lactate was statistically associated with hospital survival, mean arterial pressure, blood creatinine concentration, bacteraemia, anion gap, lactate concentration at 18-36 h after admission and evidence of SIRS, but not with packed cell volume or heart rate. Lactate at 18-36 h was also associated with survival and evidence of SIRS. Anion gap, base excess, base excess due to unidentified anions (BEua), simplified strong ion gap or bicarbonate correctly classified foals for presence of hyperlactaemia (> 5 mmol/l) in < or = 80% of animals. CONCLUSIONS: Admission blood lactate gives important prognostic information. Lactate should be measured rather than assumed from the anion gap, base excess, BEua, simplified strong ion gap or bicarbonate. POTENTIAL RELEVANCE: Blood lactate concentrations at admission are clinically relevant in neonatal foals and warrant further investigation. This should include the clinical value of measuring changes in lactate in response to treatment.  相似文献   

9.
Antithrombin (AT) levels are lower in human neonates affected by sepsis and in nonsurvivors compared with survivors. The aims of this study were to evaluate AT profile in healthy newborn foals and its diagnostic and prognostic role in septic foals during the first week of life. Fifteen healthy foals and 35 septic foals were enrolled. Blood samples were collected from each healthy foal at 30 minutes, 3 and 12 hours from birth, daily from days 1–7, and at days 10 and 14. Blood was collected from each septic foal twice a day from admission to discharge or death. The AT analysis was performed by chromogenic method. Healthy foals showed decreasing levels of AT between 3 hours and 2 days, followed by an increasing trend. Septic foals did not show any difference during the period of observation, and no differences were found between healthy and septic age-matched foals. The analysis of AT activity on the day of admission in septic foals showed higher levels compared with healthy foals, in animals hospitalized at 12 and 24 hours of age (P < .01). No differences were found at admission between foals affected by sepsis and that with septic shock. Nonsurviving foals showed significantly lower levels at 3 and 4 days of age compared with surviving foals; when surviving and nonsurviving foals were compared independently by the age, nonsurviving foals showed significant (P < .05) lower levels 12 hours after admission. In conclusion, AT seems to show neither a diagnostic nor a prognostic role in septic neonatal foals.  相似文献   

10.
Background: Bacteremia in sick foals is associated with survival, but the association of bacteremia and diarrhea is not reported.
Hypothesis: Neonatal foals with diarrhea will commonly be bacteremic.
Animals: One hundred and thirty-three neonatal foals.
Methods: Records of all foals <30 days of age presenting with diarrhea between January 1990 and September 2007 were reviewed.
Results: Sixty-six of 133 foals (50%) were bacteremic at admission, with 75 isolates from the 66 samples. The blood culture from a further 18 foals (13.5%) grew coryneform bacteria. Nine foals (6.8%) had 2 or more organisms grown on blood culture. One foal had 5 different organisms, interpreted as contamination. Forty-eight foals (36%) had no growth on admission blood cultures. No cultures isolated fungal organisms. Excluding coryneform bacteria, 43 isolates (57%) were Gram-negative organisms and 32 isolates (43%) were Gram-positive organisms. The most common isolate was Enterococcus spp. (22 isolates, 29%), followed by Pantoea agglomerans (13 isolates, 17%). IgG concentration at admission was not associated with blood culture status. Blood culture status was not associated with survival to hospital discharge.
Conclusions and Clinical Importance: Bacteremia is common in neonatal foals with diarrhea. Decisions regarding antimicrobial selection should be made with these differences in mind.  相似文献   

11.
In order to identify variables obtained at admission that could be used to predict survival in septicemic foals, medical records of 65 foals diagnosed with septicemia were reviewed. Initially, variables were analyzed independently (univariate analysis) for association with survival. Of the physical examination and historical data examined using univariate analysis, the ability to stand at admission, respiratory rate ≥ 60 breaths per minute (bpm), and normal-appearing mucous membranes were significantly associated with survival. Foals with history of induced parturition were significantly less likely to survive. The following hematologic and serum biochemical variables determined at admission were significantly associated with survival: white blood cell count a 6,000 cells/μL, neutrophil count <4,000 cells/μL, serum albumin concentration <2.2 g/dL, serum glucose concentration <120 mg/ dL, blood pH ≥ 7.35, and positive base excess. The administration of plasma at admission was significantly associated with survival. Stepwise multiple logistic regression analysis was performed to evaluate the association between survival and variables identified as significantly associated with survival in bivariate analysis. The final multivariate model selected included the variables standing, duration of clinical signs (24-hour intervals) prior to admission, respiratory rate a 60 bpm, neutropenia (> 4,000 cells/μL), and neonatal age category. The probability of survival was significantly increased for foals that were standing, had a respiratory rate a 60 bpm, and that had a neutrophil count <4,000 cells/μL at admission. Probability of survival was significantly decreased for foals that had a longer duration of clinical signs prior to admission. For each 24 hours of duration, the estimated risk of death was increased by 5.8-fold.  相似文献   

12.

Background

Bacterial sepsis remains a leading cause of morbidity and mortality in neonatal foals, but accurate diagnostic and prognostic markers are lacking. Adrenomedullin (AM) is a polypeptide with diverse biologic effects on the cardiovascular system that increases in septic humans and laboratory animals.

Hypotheses

Plasma AM concentration (p[AM]) is increased in septic neonatal foals compared to sick nonseptic and healthy control foals, and p[AM] is predictive of survival in septic neonatal foals.

Animals

Ninety critically ill (42 septic, 48 sick nonseptic) and 61 healthy foals <1 week of age.

Methods

A prospective observational clinical study was performed. Venous blood was collected from critically ill foals at admission and from healthy foals at 24 hours of age. Critically ill foals were categorized as septic or sick nonseptic based on blood culture results and sepsis score. Plasma [AM] was measured by using a commercially available ELISA for horses. Data were analyzed by using the Mann‐Whitney U‐test and P < .05 was considered significant.

Results

Plasma [AM] was not significantly different between septic and sick nonseptic foals (P = .71), but critically ill foals had significantly increased p[AM] compared to healthy controls (P < .0001). In critically ill foals, p[AM] was not predictive of survival (P = .051). A p[AM] cutoff concentration of 0.041 ng/mL provided a test sensitivity of 91% and specificity of 54% to predict illness.

Conclusions and Clinical Relevance

Plasma [AM] shows promise as a marker of health in neonatal foals, but p[AM] increases nonspecifically during perinatal illnesses and is not necessarily associated with sepsis.  相似文献   

13.
BACKGROUND: Septicemia is associated with a systemic inflammatory response, hemostatic activation, and disseminated intravascular coagulopathy (DIC). HYPOTHESIS: Increased plasma d-dimer concentration occurs in septic neonates and can reliably detect sepsis or DIC, and predict death in ill neonatal foals. ANIMALS: 40 septic, 41 nonseptic hospitalized foals, and 22 healthy neonates. METHODS: Prospective observational clinical study. Blood samples were collected on admission, at 24-48 hours after admission, and at the time of discharge or euthanasia. Plasma d-dimer concentration, clotting times, antithrombin activity, and fibrinogen concentration were determined. RESULTS: On admission, d-dimer concentration values were significantly higher in septic foals (median, 25-75th percentiles; 568, 245-2013 ng/mL) compared with the nonseptic and healthy groups (386, 175-559 and 313, 152-495 ng/mL, respectively), and in septic foals at the age of 2-7 days compared with similar-age nonseptic foals. By means of samples taken at 24-48 hours of hospitalization and a cut-off value of > 2000 ng/mL, D dimer concentration was significantly associated with the diagnosis of septicemia (odds ratio [OR] = 19.6, 95% confidence interval [95% CI] 1.9-203) and death (OR = 8.7, 95% CI 1.8-43). Owing to a high false-positive prediction rate (71%), a normal d-dimer concentration is better at eliminating the diagnosis of sepsis than an increased d-dimer concentration at predicting sepsis. Fifty percent of septic foals had a diagnosis of DIC, but d-dimer concentration was not significantly associated with the diagnosis of DIC. CONCLUSIONS AND CLINICAL IMPORTANCE: Septic foals showed a marked activation of coagulation and fibrinolytic systems and a high prevalence of DIC. Increased plasma d-dimer concentration is significantly associated with the diagnosis of sepsis.  相似文献   

14.

Background

The hypothalamic‐pituitary‐adrenal (HPA) is influenced by the proinflammatory cytokines IL‐6, IL‐1β, and TNF‐α in critically ill humans. Information about the association of cytokines with the HPA axis in neonatal foals is lacking.

Hypothesis/Objectives

The objectives were to describe for hospitalized septic and nonseptic foals (1) temporal changes in blood concentrations of ACTH, and cortisol, and leukocyte cytokine gene expression, and (2) coassociation of these HPA axis hormones with blood leukocyte cytokine gene expression.

Animals

Hospitalized septic foals (N = 15) and hospitalized nonseptic foals (N = 11).

Methods

Blood samples, obtained from study foals at admission (T = 0), and 24 (T = 1), 48 (T = 2), 72 (T = 3), and 96 (T = 4) hours after admission, were processed to isolate RNA from leukocytes and to harvest plasma and serum for hormone assays. Plasma ACTH and serum cortisol concentrations were determined by radioimmunoassay. Leukocyte mRNA expression of IL‐1β IL‐6, IL‐8, IL‐10, and TNF‐α was determined using RT‐PCR.

Results

Cortisol concentrations were greater (P < .05) in foals at admission than at other time points. The expressions of IL‐8 and IL‐10 mRNA were lower (P < .05) at each time point in septic than in nonseptic foals. Among septic foals, ACTH was positively associated (P = .0026) with IL‐6 mRNA expression.

Conclusions

Sepsis influences secretion of the HPA axis hormones and expression of cytokines in foals. A positive association with the HPA axis and IL‐6 expression was detected. The clinical importance of these findings requires additional study.  相似文献   

15.
Objectives: To describe and compare admission colloid osmotic pressure (COP) measurement using both direct and indirect methods in neonatal foals under intensive care, and to evaluate for associations between COP and clinical/clinicopathologic parameters. Design: Prospective study. Setting: Intensive care unit at a veterinary medical teaching hospital. Animals: Twenty‐six critically ill neonatal foals were studied. A control group consisted of 9 clinically healthy neonatal foals. Interventions: Clinicopathologic data were collected at the time of admission. COP was measured directly using a colloid osmometer. Indirect COP was calculated using equations by both Landis–Pappenheimer (L–P) and Thomas and Brown. Measurements and main results: Measured admission COP values were 17.1±4.3 and 17.7±2.4 mmHg in critically ill and control foals, respectively, and these values were not significantly different. Critically ill foals with blood lactate concentrations >3 mmol/L had lower COP values than those with lactate ≤3 mmol/L. There was close agreement between indirect COP values calculated using the L–P equation and direct COP values measured in control foals (mean error=0.0±1.3 mmHg; R2=0.87). However, indirect values were not as predictive of direct COP in critically ill foals (mean error=0.8±3.8 mmHg; R2=0.64). As COP values increased, the indirect method tended to overestimate COP, whereas at lower values it slightly underestimated COP. Conclusion: While the L–P equation was a close approximation of direct COP in healthy foals, direct measurements of oncotic pressure cannot be replaced for monitoring of critically ill foals. Critically ill foals with higher lactate concentrations had lower COP values, suggesting a possible relationship between COP and lactate.  相似文献   

16.
Objective – To determine if changes in viscoelastic variables are associated with abnormalities observed in the standard coagulation profile and patient outcome in foals with suspected septicemia. Design – Prospective clinical trial during 2003 and 2004 foal season. Setting – Neonatal intensive care unit at a veterinary teaching hospital. Animals – Thirty critically ill foals <72‐hour‐old admitted sequentially meeting criteria for systemic inflammatory response associated with infection. Interventions – Hemostatic evaluation, using standard coagulation testing and viscoelastic analysis, was performed at admission, 24 hours following admission, and 48 hours following admission in critically ill foals. Standard coagulation tests included platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin(ogen) degradation products, and antithrombin. Data collected from viscoelastic analysis included time to initial clot formation (ACT), clot rate, and platelet function. Signalment, blood culture results, clinicopathologic data, and outcome were collected from medical records. Equality of populations test was used to determine associations between coagulation tests and blood culture status/outcome, as well as between viscoelastic parameters and coagulopathy, blood culture status, and outcome. Logistic regression was used to quantify associations. A significance level of P<0.05 was used. Measurements and Main Results – Foals with decreasing clot rate (CR) over the sample period were more likely to be euthanized or die (P=0.02). Foals with prolonged ACT (P=0.03), and decreased CR at admission (P=0.047), were more commonly coagulopathic. Identification of coagulopathy on admission (P=0.02), or persistence of hemostatic dysfunction 48 hours later (P=0.04), was associated with death. Conclusions – Viscoelastic coagulation evaluation could be used in a neonatal intensive care unit setting to further characterize coagulopathy, and identify foals at higher risk for poor outcome.  相似文献   

17.
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18.
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19.
The equine industry has a need for a convenient, rapid, and reliable method of measuring blood lactate concentrations ([LA]). We hypothesized that the handheld Lactate Plus lactate meter (LPlus), developed and tested for use in humans, would provide dependable results when used in horses undergoing an exercise conditioning program and that horse's fitness would improve following individualized conditioning based on each horse's velocity at which [LA] = 4 mmol/L (VLA4) was reached. Five adult horses underwent a 4-week training program that consisted of 3 exercise bouts/wk. Horses were subjected to an incremental step standardized exercise test (SET) before starting (SET-1) and after the completion of the program (SET-2). Blood samples were collected before each increase in speed until [LA] reached ≥4 mmol/L, and then the SET was terminated. The [LA] sample range in our study was 0–8 mmol/L. Blood was analyzed at the time of collection using a calibrated LPlus, and plasma was collected for [LA] determination using the lactate dehydrogenase–based enzymatic colorimetric method. Although the LPlus tended to significantly underestimate [LA] by 0.39 mmol/L (P < .001), the LPlus proved to be a dependable device for use in horses based on good correlation with the biochemical analysis (r = 0.978) and Bland–Altman limits of agreement and 95% confidence intervals. All horses showed an increase in VLA4 from SET-1 to SET-2, consistent with improved fitness following our 3 exercise bout/wk training protocol. The LPlus can reliably be used in horses to determine [LA] ranging from 0–8 mmol/L. When determining serial [LA], analytical techniques should not be used interchangeably.  相似文献   

20.
BACKGROUND: Little information exists on the hypothalamic-pituitary-adrenal axis in septic foals. HYPOTHESIS: The plasma concentrations of adrenocorticotropin (ACTH) and cortisol are expected to be higher in septic foals as compared to normal foals. The concentrations of hormones in septic foals also are expected to differ further depending upon survival. ANIMALS: Twenty-eight control foals and 46 septic foals <14 days of age were included in this study. METHODS: Blood was collected in EDTA once from 28 normal foals born in the University of Georgia or Cornell University equine research herds and from 46 septic foals within 12 hours after admission to 1 of the 3 tertiary care referral centers involved in the study. Septic foal selection was based on a sepsis score of >11 or a positive blood culture. The control foals were age matched to the septic foals in the study. ACTH and cortisol concentrations were measured by a chemiluminescent immunoassay system. RESULTS: Cortisol concentrations in control foals did not vary with age. Septic foals had significantly higher mean ACTH, cortisol, and ACTH/cortisol ratios than did normal foals. Within the septic foal group, 28 foals survived to discharge, and 18 were euthanized or died. The mean age was not significantly different between the septic surviving and nonsurviving foals. The mean ACTH/cortisol ratio was significantly higher in the septic nonsurviving foals as compared to the septic surviving foals. CONCLUSIONS AND CLINICAL IMPORTANCE: Septic foals had higher hormone concentrations as compared to normal foals, which is an expected endocrine response to critical illness. The increased ACTH/cortisol ratio in nonsurviving septic foals in comparison to surviving septic foals could indicate hypothalamic-pituitary-adrenal axis dysfunction at the level of the adrenal gland in critically ill septic foals.  相似文献   

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