@article{culler_vigani_ripoll_gareau_suter_2022, title={Centrifugal therapeutic plasma exchange in dogs with immune-mediated hemolytic anemia (2016-2018): 7 cases}, ISSN={["1476-4431"]}, DOI={10.1111/vec.13196}, abstractNote={OBJECTIVE
To describe the technique of centrifugal therapeutic plasma exchange (cTPE) in dogs diagnosed with immune-mediated hemolytic anemia (IMHA) and summarize the outcome of the procedure.


DESIGN
Retrospective review of cTPE performed at North Carolina State University from 2016 to 2018, through a search of the institutional database for cTPE and IMHA.


SETTING
University teaching hospital.


ANIMALS
Seven dogs with confirmed IMHA were presented to a university teaching hospital ICU for cTPE. Six dogs were not responsive to standard medical management with immunosuppressive agents, while 1 dog presented before immunosuppressive agents were begun.


INTERVENTIONS
All dogs underwent multiple cTPE procedures using 1 of 2 commercially available apheresis systems.


MEASUREMENTS AND MAIN RESULTS
At presentation, the median HCT was 0.15 L/L (15.7%) (range, 0.10-0.19 L/L [10.3%-19%]) and the median total serum bilirubin was 32.5 mmol/L (1.9 mg/dl) (range, 15.4-597 mmol/L [0.9-34.9 mg/dl]). The median number of transfusions before cTPE was 1 (range, 1-4), with a median total of infused RBCs of 12.9 ml/kg (range, 8.8-37 ml/kg). cTPE with an exchange of ≥4 times total plasma volumes was used to decrease the level of circulating autoreactive antibodies. The median total plasma volumes exchanged was 4.5 times (range, 2.5-6.5 times) over 2-4 procedures. Anticoagulation was performed using a combination of systemic heparinization and regional citrate in all dogs. Six of 7 dogs (85.7%) were discharged from the hospital and were alive 90 days after discharge. One dog (14%) did not respond to cTPE (∼6.5 times total plasma volume exchanged) and was euthanized.


CONCLUSIONS
cTPE is a feasible and relatively safe bridging treatment option for the management of canine IMHA.}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Culler, Christine A. and Vigani, Alessio and Ripoll, Alexandra Z. and Gareau, Alexandra and Suter, Steven E.}, year={2022}, month={May} }
 @article{butty_suter_chalifoux_lynch_mauro_moyle_ehrhardt_robertson_culler_londono_et al._2022, title={Outcomes of nonsteroidal anti-inflammatory drug toxicosis treated with therapeutic plasma exchange in 62 dogs}, volume={8}, ISSN={["1939-1676"]}, DOI={10.1111/jvim.16507}, abstractNote={Abstract Background Therapeutic plasma exchange (TPE) is gaining popularity for the management of nonsteroidal anti‐inflammatory drug (NSAID) overdose in dogs. Hypothesis/Objectives Describe a population of dogs treated with TPE for NSAID overdose. Animals Sixty‐two dogs with NSAID overdose treated with TPE. Methods Multicenter retrospective study of dogs treated with TPE for ibuprofen, carprofen, or naproxen overdose. Results The median dose of ibuprofen, carprofen or naproxen ingested was 533 mg/kg (range, 36‐4857 mg/kg), 217 mg/kg (range, 88‐625 mg/kg) and 138 mg/kg (range, 26‐3000 mg/kg), respectively. Based on previously established toxic ranges for each NSAID, 2 (3.2%), 14 (22.6%), and 46 (74.2%) dogs ingested a gastrointestinal, renal, and neurological toxic dose, respectively. The median time between ingestion and presentation was 4 hours (range, 1‐20 hours). The median number of plasma volumes processed was 1.6 (range, 0.4‐2.2). The median TPE session duration was 2 hours (range, 1‐4.5 hours). Circuit clotting developed during 8 (12.9%) sessions. Patient adverse events reported during 21 (33.8%) sessions consisted of urticaria (12.9%), asymptomatic hypocalcemia (9.6%), and hypotension (9.6%). The median duration of hospitalization was 2.25 days (range, 1‐11 days). Sixty‐one (98.4%) dogs survived to discharge, and none were rehospitalized. Thirty‐one (91.1%) of the 34 dogs with at least 1 follow‐up visit were not azotemic at the time of reevaluation. Conclusions and Clinical Importance This population of dogs managed with TPE had excellent outcomes, even in cases of high NSAID dose ingestion. When TPE is available and the time frame is appropriate, this extracorporeal modality should be considered for the management of NSAID overdose.}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Butty, Emmanuelle M. and Suter, Steven E. and Chalifoux, Nolan V and Lynch, Alex M. and Mauro, Katie D. and Moyle, Rachel B. and Ehrhardt, Caryn M. and Robertson, James B. and Culler, Christine A. and Londono, Leonel A. and et al.}, year={2022}, month={Aug} }
 @article{sekiguchi_vigani_ripoll_taylor_culler_suter_2020, title={Clinical Application of Apheresis in Very Small Dogs Weighing < 8 kg to Pediatric Patients}, volume={24}, ISSN={["1744-9987"]}, DOI={10.1111/1744-9987.13432}, abstractNote={Apheresis in low body weight children and adolescents is challenging due to a variety of technical and clinical issues including vascular access, low total blood volume, and hypotension. Although dogs have been a valuable preclinical model for apheresis, the procedure can be challenging since many pure‐bred dogs are extremely small. Therefore, apheresis in these very small breeds presents very similar challenges as seen when performing the procedure in very low body weight people. We describe apheresis of four very small dogs, weighing from 4.6 to 7.6 kg, using either a COBESpectra and Spectra Optia apheresis system (Terumo BCT, Lakewood, CO, USA). Two dogs underwent large volume leukapheresis to collect mononuclear cells in preparation for hematopoietic stem cell transplantation and two dogs underwent therapeutic plasma exchange to treat an immune‐mediated disease. In all cases, a dual‐lumen hemodialysis catheter placed in the jugular vein provided adequate machine inlet and return flow rates. Machine priming was necessary to maintain hemodynamic stability during the beginning of the procedure, and rinseback was avoided for the same reason. Anticoagulant citrate dextrose solution, solution A was used for the large volume leukapheresis procedures and a combination of anticoagulant citrate dextrose solution, solution A and heparin was used for the therapeutic plasma exchange procedures. As such, serum iCa levels were regularly monitored and 10% calcium gluconate constant rate infusions were used to prevent citrate toxicity. All dogs completed the aphereses with no life‐threatening adverse events. We conclude that aphereses in very small dogs is feasible if close attention is paid to hemodynamic stability and citrate toxicity.}, number={3}, journal={THERAPEUTIC APHERESIS AND DIALYSIS}, author={Sekiguchi, Tomoko and Vigani, Alessio and Ripoll, Alexandra Z. and Taylor, Scott and Culler, Christine and Suter, Steven E.}, year={2020}, month={Jun}, pages={333–342} }
 @article{culler_reinhardt_vigani_2020, title={Successful management of clinical signs associated with hepatic encephalopathy with manual therapeutic plasma exchange in a dog}, volume={30}, ISSN={["1476-4431"]}, DOI={10.1111/vec.12940}, abstractNote={OBJECTIVE
To describe the use of manual therapeutic plasma exchange (TPE) to manage hepatic encephalopathy (HE) in a dog.


CASE SUMMARY
A 9-year-old neutered female Dachshund presented for HE secondary to a previously diagnosed portosystemic shunt. The hyperammonemia and severe clinical signs of HE persisted despite extensive medical management. Therapeutic plasma exchange was performed for stabilization prior to surgical shunt ligation. A total of 1 plasma volume was processed during a single manual TPE session. The ammonia immediately prior to TPE was 235 μmol/L (reference interval, 10-30 μmol/L) and decreased to 117 μmol/L by the end of the session. The dog showed significant improvement in clinical signs shortly after the session and remained stable thereafter. Shunt ligation was performed 5 days later with no complications observed with TPE or postoperatively. The dog was discharged 3 days after surgery with no neurological signs and was doing well 100 days after surgery.


NEW OR UNIQUE INFORMATION PROVIDED
To the authors' knowledge, this is the first published report of manual TPE to manage HE in veterinary medicine. Therapeutic plasma exchange should be further investigated as a possible strategy to manage clinical signs of HE in patients that are refractory to medical management. Achieving this with manual TPE may be considered in patients that are too small for conventional TPE due to extracorporeal volume or in situations where conventional TPE is not available.}, number={3}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Culler, Christine A. and Reinhardt, Alyx and Vigani, Alessio}, year={2020}, month={May}, pages={312–317} }
 @article{culler_balakrishnan_yaxley_guillaumin_2019, title={Clinical use of cryopoor plasma continuous rate infusion in critically ill, hypoalbuminemic dogs}, volume={29}, ISSN={["1476-4431"]}, DOI={10.1111/vec.12834}, abstractNote={OBJECTIVE
To investigate the impact of cryopoor plasma (CPP) continuous rate infusion (CRI) on albumin concentration and colloid osmotic pressure (COP) in critically ill dogs with hypoalbuminemia.


DESIGN
Retrospective study between 2013 and 2015 with a 90-day follow-up on survivors.


SETTING
University teaching hospital.


ANIMALS
Ten hypoalbuminemic dogs receiving a CPP CRI for albumin replacement or oncotic support. All patients with documented hypoalbuminemia or low COP receiving CPP administration for albumin or oncotic support during the study period were included.


INTERVENTIONS
CRI of CPP.


MEASUREMENTS AND MAIN RESULTS
Mean age was 7.4 ± 4.5 years. Mean survival prediction index score was 0.66 ± 0.13. Seven dogs were septic, with 2 of 7 in septic shock and 5 of 7 having septic peritonitis. The mean pre- and postinfusion albumin was 15 ± 4 g/L and 21 ± 2 g/L, respectively. The median pre- and postinfusion COP was 8.6 mm Hg (4.9-9.7 mm Hg) and 10.2 mm Hg (8.1-13.3 mm Hg), respectively. The median duration of CRI was 16 hours (11-121 h). The mean CPP rate was 1.8 ± 0.6 mL/kg/h, the mean crystalloid rate administered concurrently was 0.8 ± 0.9 mL/kg/h, and the mean hydroxyethyl starch rate administered concurrently was 1.2 ± 0.9 mL/kg/h. The difference in pre- and postinfusion albumin was significantly correlated with CPP rate (P = 0.0004), whereas the difference in pre- and postinfusion COP was correlated with hydroxyethyl starch rate (P = 0.0128). Mean duration of hospitalization was 8.6 ± 3.9 days. Mann-Whitney U and Fisher's exact tests were used to compare survivors and nonsurvivors. Survivors were significantly younger than nonsurvivors (3.5 vs 11.5 y, P = 0.033). No side effects were reported. Survival to discharge was 40% with identical 90-day survival. Of the nonsurvivors, 50% died naturally.


CONCLUSIONS
There was an association between the rate of CPP and the change in albumin after CPP CRI in critically ill dogs, suggesting that CPP may be a viable option for treatment of hypoalbuminemia.}, number={3}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Culler, Christine A. and Balakrishnan, Anusha and Yaxley, Page E. and Guillaumin, Julien}, year={2019}, pages={314–320} }
 @article{culler_vigani_2019, title={Successful treatment of a severe cannabinoid toxicity using extracorporeal therapy in a dog}, volume={29}, ISSN={["1476-4431"]}, DOI={10.1111/vec.12899}, abstractNote={OBJECTIVE
To describe the use of extracorporeal therapy (ECT) to treat severe cannabinoid intoxication in a dog with severe hyperlipidemia.


CASE SUMMARY
A 7-month-old female intact Labrador Retriever presented with seizures and severe hyperesthesia that were refractory to multiple anticonvulsant medications and required induction of general anesthesia with propofol and mechanical ventilation. The dog's urine yielded a strong positive signal for delta-9-tetrahydrocannabinol (THC) on urine drug test and exposure to THC oil was confirmed by the owner. Bloodwork revealed severe hyperlipidemia such that IV lipid emulsion was considered contraindicated. The dog was treated with a 3-hour ECT session, using charcoal hemoperfusion and hemodialysis in series. Neurologic signs improved during the session and mechanical ventilation was discontinued. Immediately after the session, the dog's mentation was significantly improved and seizures and hyperesthesia had ceased, although the dog remained moderately ataxic. The dog was hospitalized for 36 hours following the ECT session for continued monitoring. The dog fully recovered and was successfully discharged.


NEW OR UNIQUE INFORMATION PROVIDED
To the authors' knowledge, this is the first published report to document ECT to treat THC intoxication in veterinary medicine. ECT may be considered as a treatment option for severe THC intoxication that is refractory to standard therapy or where severe hyperlipidemia precludes use of IV lipid emulsions.}, number={6}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Culler, Christine A. and Vigani, Alessio}, year={2019}, month={Nov}, pages={674–679} }
 @article{culler_fick_vigani_2019, title={Ultrasound-guided placement of pigtail cystostomy tubes in dogs with urethral obstruction}, volume={29}, ISSN={["1476-4431"]}, DOI={10.1111/vec.12832}, abstractNote={BACKGROUND
Circumstances such as the inability to pass a retrograde urinary catheter or a lack of surgeon availability may prevent immediate relief of urethral obstruction in dogs. In such situations, a cystostomy tube may be placed with ultrasound guidance to allow urinary diversion until further treatment is possible.


KEY FINDINGS
A case of a 5-year-old male neutered Swiss Mountain dog with an obstructive urolith at the level of the os penis is used to describe the technique. Multiple attempts to pass a urinary catheter under sedation were unsuccessful. A pigtail cystostomy tube was placed with ultrasound guidance to allow urinary diversion. The dog was discharged from the hospital within 2 days after scrotal urethrostomy and the dog made a full recovery. Ultrasound-guided placement of a pigtail cystostomy tube was straightforward and without complications.


SIGNIFICANCE
Ultrasound-guided placement of a pigtail cystostomy tube may be beneficial as it is not technically challenging, can be performed rapidly, and may avoid the need for general anesthesia. Additionally, ultrasound is readily available and an inexperienced ultrasonographer can easily locate the urinary bladder. This report serves to provide a detailed technique of ultrasound-guided placement of a pigtail cystostomy tube in dogs for emergency urinary diversion.}, number={3}, journal={JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE}, author={Culler, Christine A. and Fick, Meghan and Vigani, Alessio}, year={2019}, pages={331–336} }
 @article{vigani_culler_2017, title={Systemic and local management of burn wounds}, volume={47}, DOI={10.1016/j.cvsm.2017.06.003}, abstractNote={Management of severe burn injury (SBI) requires prompt, complex, and aggressive care. Despite major advances in the management of SBI—including patient-targeted resuscitation, management of inhalation injuries, specific nutritional support, enhanced wound therapy, and infection control—the consequences of SBI often result in complex, multiorgan metabolic changes. Consensus guidelines and clinical evidence regarding specific management of small animal burn patients are lacking. This article aims to review updated therapeutic consideration for the systemic and local management of SBI that are proven effective to optimize outcomes in human burn patients and may translate to small animal patients.}, number={6}, journal={Veterinary Clinics of North America. Small Animal Practice}, author={Vigani, A. and Culler, C. A.}, year={2017}, pages={1149-} }