Foal with trouble breathing at 8 days old - how we treated it

Abstract

OBJECTIVE: This report describes an 8-day-old foal diagnosed with acute respiratory distress syndrome (ARDS) successfully managed using a novel approach of intratracheal oxygen delivery. CASE SUMMARY: An 8-day-old Standardbred filly presented for an acute onset of respiratory distress. Given the acute onset, known risk factors, bilateral diffuse infiltrate on thoracic radiographs, and low PaO:FiOratio of 170.5, the foal was diagnosed with acute respiratory distress syndrome. Initial treatment consisted of antimicrobial therapy (minocycline and metronidazole), nonsteroidal anti-inflammatories (flunixin meglumine), and intranasal oxygen. The filly responded poorly to intranasal oxygen therapy and clinically worsened in hospital, with poor response confirmed on arterial blood gas. Treatment was transitioned to intratracheal therapy via temporary tracheostomy to improve the FiOdelivered to the foal. After 24 h of therapy, the arterial oxygen saturation improved to 96.8% and PaOimproved to 154.1 mm Hg. The foal was able to avoid constant sedation, intubation, and mechanical ventilation with the use of a temporary tracheostomy. A blood culture was negative, and no transtracheal wash was performed; thus, the underlying etiology is unknown. Oxygen therapy was able to be discontinued on the seventh day of hospitalization, and on the 12th day, the foal was discharged with continued antimicrobial treatment. No complications were associated with placement of the temporary tracheostomy. Five months after discharge, the foal continues to do well at home. NEW OR UNIQUE INFORMATION PROVIDED: This case supports the use of intratracheal oxygen therapy via temporary tracheostomy for the treatment of acute respiratory distress syndrome compared with previous reports of catheterization to improve oxygen delivery. Further investigation is warranted to determine the peak FiOable to be delivered via temporary tracheostomy.