Objectives
To review the literature in regards to the pathophysiology of acute spinal cord injury, and to describe current concepts in regards to patient assessment, diagnostic, and therapeutic measures with a special emphasis on emergency and critical care considerations.

Etiology
Acute spinal cord injury occurs in 2 phases. The primary injury occurs at the time of initial injury and may include intervertebral disk herniation, vertebral fracture or luxation, penetrating injury, and vascular anomalies such as fibrocartilaginous embolic myelopathy. Secondary injury occurs following primary injury and is multifactorial encompassing numerous biochemical and vascular events that result in progression of injury.

Diagnosis
The diagnosis is based on history and physical examination findings. A neurologic examination should be performed following initial patient assessment and stabilization. Further diagnostics to characterize acute spinal injury include radiographs and advanced imaging modalities such as myelography, computed tomography, or magnetic resonance imaging.

Therapy
Initial treatment should focus on addressing the patient's cardiovascular and respiratory system. Supportive measures to support systemic perfusion are vital to minimizing secondary injury. Specific therapy toward minimizing secondary injury in veterinary medicine remains controversial, especially in regards to the utilization of methylprednisolone. Other therapies are either in need of additional research or have failed to document clinical difference.

Prognosis
The prognosis for acute spinal injury is varied and is dependent upon the presence of concurrent trauma, location, and type of primary injury sustained, and extent of neurologic impairment at the time of initial presentation. The etiology of the underlying trauma is of great importance in determining prognosis and outcome. Loss of deep pain is generally accepted as a poor prognostic indicator; however, even these patients can recover depending on their response to treatment.

Mechanisms of injury and emergency care of acute spinal cord injury in dogs and cats.

Background: Malnutrition is a common problem in critically ill dogs and is associated with increased morbidity and mortality in human medicine. Enteral nutrition (EN) delivery methods have been evaluated in humans to determine which is most effective in achieving caloric goals.



Objectives: To compare continuous infusion and intermittent bolus feeding of EN in dogs admitted to a critical care unit.



Animals: Fifty-four dogs admitted to the critical care unit and requiring nutritional support with a nasoenteric feeding tube.



Methods: Prospective randomized clinical trial. Dogs were randomized to receive either continuous infusion (Group C) or intermittent bolus feeding (Group I) of liquid EN. The percentage of prescribed nutrition delivered (PPND) was calculated every 24 hours. Frequencies of gastrointestinal (GI), mechanical, and technical complications were recorded and gastric residual volumes (GRVs) were measured.



Results: PPND was significantly lower in Group C (98.4%) than Group I (100%). There was no significant difference in GI or mechanical complications, although Group C had a significantly higher rate of technical complications. GRVs did not differ significantly between Group C (3.1 mL/kg) and Group I (6.3 mL/kg) and were not correlated with the incidence of vomiting or regurgitation.



Conclusions and Clinical Importance: There was a statistically significant difference in the PPND between continuously and intermittently fed dogs, but this difference is unlikely to be clinically relevant. Critically ill dogs can be successfully supported with either continuous infusion or intermittent bolus feeding of EN with few complications. Increased GRVs may not warrant termination of enteral feeding.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1939-1676.2010.0487.x

Intermittent and continuous enteral nutrition in critically ill dogs: a prospective randomized trial.

Objective

To compare complication rates between nasoesophageal (NE) and nasogastric (NG) feeding tubes in dogs.



Design

Retrospective study.



Setting

University referral veterinary hospital.



Animals

A total of 46 dogs that were fed through a NE (n = 28) or NG (n = 18) tube between January 2007 and December 2011 and that also had either thoracic radiography or computed tomography performed so that location of the distal tip of the tube in either the esophagus or stomach could be confirmed.



Interventions

None.



Measurements and Main Results

The medical record of each eligible case was reviewed and data recorded included signalment, underlying disease, body weight, body condition score, medications, duration of feeding, diet used, and complications observed (ie, vomiting, regurgitation, diarrhea, early tube removal, clogged tube, epistaxis, pulmonary aspiration, hyperglycemia, and refeeding syndrome). Dogs with NE tubes were significantly younger than dogs with NG tubes (P = 0.03) but there were no other significant differences in signalment, underlying disease, medications, duration of anorexia, percent of resting energy requirement achieved, or change in weight during tube feeding. There also was no significant difference between the NE and NG groups for any of the recorded complications. Significantly fewer dogs in the NE group died or were euthanized (3/28) compared to the NG group (7/18; P = 0.02) but outcome was not associated with age, underlying disease, or any of the recorded tube complications.



Conclusions

This study did not identify a difference in complication rate between NE and NG feeding tubes in dogs. Additional studies are required to determine the optimal terminal location of feeding tubes in dogs.

Comparison of complication rates in dogs with nasoesophageal versus nasogastric feeding tubes.

Bacterial translocation involves the passage of intestinal bacteria to extraintestinal sites and has been shown to increase morbidity and mortality in critical illness. This review outlines the pathophysiology of bacterial translocation, host defence mechanisms, and reviews the evidence for the clinical management of critically ill patients in order to minimise the negative outcomes associated with bacterial translocation.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jsap.12626

Bacterial translocation in critical illness.

Vomiting is a common presenting complaint in feline practice. This article differs from previous reviews in that it is an evidence-based review of the mechanisms, causes, investigation and management of vomiting in the domestic cat. Published evidence was reviewed, and then used to make recommendations for clinical assessment, diagnosis, antiemetic drug treatment, dietary management and monitoring of cats presenting with vomiting. The strength of the evidence on which recommendations are made (and areas where evidence is lacking for cats) has been highlighted throughout.

https://journals.sagepub.com/doi/pdf/10.1177/1098612X12473466

Mechanisms, causes, investigation and management of vomiting disorders in cats: a literature review:

Objective – To compare continuous to intermittent feeding at delivering prescribed nutrition in hospitalized canine and feline patients.

Design – Retrospective clinical study.

Setting – University teaching hospital.

Animals – Fifty-four cats and 37 dogs.

Measurements and Main Results – Twenty-four-hour periods of prescribed and delivered nutrition (kcal) were recorded, and the percentage of prescribed nutrition delivered (PPND) was calculated. If the patient received nasoenteric feeding for >1 day, then the average PPND per day was calculated. Frequency of gastrointestinal complications (vomiting, diarrhea, and regurgitation) was calculated per patient for each group. The PPND was not significantly different between patients fed continuously (99.0%) and patients fed intermittently (92.9%). Vomiting affected 29% of patients (26/91), diarrhea affected 26% of patients (24/91), and regurgitation affected 5% of patients (5/91). There was no significant difference in incidence of gastrointestinal complications between the patients fed continuously and the patients fed intermittently. There was a significantly higher incidence of diarrhea and regurgitation in dogs than in cats.

Conclusions – PPND was not significantly different for continuous versus intermittent feeding via nasoenteric tubes. Frequencies of gastrointestinal complications were not significantly different between patients fed continuously and patients fed intermittently. Enterally fed dogs had a significantly higher frequency of regurgitation and diarrhea than enterally fed cats. Prospective studies are warranted to investigate causes for these potential inter-species differences.

Continuous versus intermittent delivery of nutrition via nasoenteric feeding tubes in hospitalized canine and feline patients: 91 patients (2002-2007).

Jennifer A. Campbell

Papers

Continuous versus intermittent delivery of nutrition via nasoenteric feeding tubes in hospitalized canine and feline patients: 91 patients (2002-2007).