Article

Vasopressor use in 41 critically ill cats (2007–2016)

Nikki Licht, Elizabeth A. Rozanski, John E. Rush

Abstract — This study describes the use of vasopressors in critically ill cats. Records of 41 cats hospitalized in the
ICU were evaluated. Signalment, blood pressure, underlying conditions, evidence of sepsis, type of treatment
(surgical versus non-surgical), vasopressor type and duration, adverse events attributed to vasopressors, and survival
were recorded. Twenty-one cats (51%) had an underlying disease considered amenable to surgical treatment while
20 (49%) cats did not. Evidence of sepsis was present in 24 (59%) cats. Thirty-four cats developed a Doppler
blood pressure (DBP) . 80 mmHg during therapy, and 29 cats became normotensive (DBP . 90 mmHg).
Seven cats did not increase their DBP to . 80 mmHg. All cats received dopamine and/or norepinephrine and
6 cats also received other vasopressors. Sixteen cats survived (39%). Surgical intervention was associated with a
higher survival (P = 0.004). Critically ill hypotensive cats may benefit from administration of vasopressors.

Résumé — Utilisation de vasopressine chez 41 chats en état critique (2007–2016). Cette étude décrit
l’utilisation de vasopresseurs chez les chats en condition critique. Les dossiers médicaux de 41 chats hospitalisés
ont été évalués. Le signalement, pression sanguine, conditions sous-jacentes, évidence de sepsis, type de traitement
(chirurgical contre médical), type de vasopresseurs et durée, effets adverses reliés à l’utilisation des vasopresseurs
et survie ont été comptabilisés. Vingt et un chats (51 %) avaient une condition sous-jacente susceptible au
traitement chirurgical contrairement aux 20 autres chats (49 %). L’évidence de sepsis était présente dans 24 (59 %)
chats. Trente-quatre chats ont développé une pression sanguine au Doppler (DBP) . 80 mmHg durant le traitement
et 29 chats sont devenus normotensifs (DBP . 90 mmHg). Sept chats n’ont pas eu d’augmentation de leur
DBP . 80 mmHg. Tous les chats ont reçu de la dopamine et/ou de la norépinéphrine et 6 chats ont reçus d’autres
vasopresseurs. Seize chats ont survécu (39 %). Une intervention chirurgicale est associée à un plus grand taux de
survie (P = 0,004). Les chats hypotensifs en condition critique peuvent bénéficier de l’utilisation de vasopresseurs.
(Traduit par les auteurs)
Can Vet J 2018;59:1175–1180

Introduction do not exist in cats surrounding the optimal use of vasopressors.

H
ypotension is a common occurrence in animals admitted
to the ICU, and a subset of this population is refractory to
fluid resuscitation (1). Hypotension in critically ill cats has been
associated with a poor prognosis, particularly when coupled with
increases in lactate (1,2). In humans, unresolved hypotension
and inadequate tissue perfusion are recognized as precursors
to multi-organ dysfunction and death, and are important and
tangible targets for intervention (2,3). Evidence-based guidelines
advocate the use of vasopressors in hypotensive humans who are
adequately volume resuscitated and are therefore considered to
have refractory hypotension (4), but evidence-based guidelines
Cummings School of Veterinary Medicine at Tufts University,
55 Willard Street, North Grafton, Massachusetts 01536, USA.
Address all correspondence to Dr. Elizabeth Rozanski; e-mail:
Elizabeth.rozanski@tufts.edu
Use of this article is limited to a single copy for personal study.
Anyone interested in obtaining reprints should contact the
CVMA office (hbroughton@cvma-acmv.org) for additional
copies or permission to use this material elsewhere.
However, based on expert opinion, the use of vasoactive drugs
such as dopamine, dobutamine, norepinephrine, phenylephrine,
vasopressin, or epinephrine has been recommended to improve
blood pressure and subsequently restore organ perfusion (5–9).
Potential concerns surrounding the use of vasopressors in
humans include hypertension, arrhythmias, acute kidney injury
(AKI), splanchnic and/or peripheral ischemia, and medication
errors (10,11).
The purpose of this study was to describe the use and out-
comes in cats treated with vasopressors in the ICU for hypoten-
sion associated with critical illness.
Materials and methods
The medical record database between January 1, 2007 and
May 31, 2016 was searched, using the keywords “feline,” and
“norepinephrine,” “phenylephrine,” “epinephrine,” “dopamine,”
“dobutamine,” and “vasopressin.” Cats receiving vasopressors
for less than 1 h and cats that received vasopressors only during
anesthesia were excluded.
The following data were collected from the medical record:
signalment, blood pressure measurements, underlying disease

CVJ / VOL 59 / NOVEMBER 2018 1175

 conditions, including presence or suspicion of sepsis, and
whether surgery was performed for the underlying condition,
type, and duration of vasopressor therapy, and documented
adverse events (arrhythmias, acute kidney injury, new onset
of vomiting, or bloody diarrhea) attributed to vasopressor use.
Additionally, blood component transfusions and glucocorticoid
use were recorded. Finally, survival at 24, 48, and 72 h, weaning
A R T I C LE
from vasopressors, duration of hospitalization and whether mor-
tality occurred due to euthanasia or natural death were recorded.
Hypotension was defined as a Doppler blood pressure
, 90 mmHg, while normotension was defined as 90 to
150 mmHg. Doppler blood pressure determinations were made
using a cuff size that was 30% to 40% of the limb circumfer-
ence, the same size cuff was used for repeated measurements,
and usually the same limb, unless catheter location affected
use of a specific limb. Volume status was evaluated by physical
examination, vital signs, and in some cases measurement of
central venous pressure (CVP) or point-of-care ultrasound to
subjectively assess left ventricular size. Acute kidney injury (AKI)
was defined as an increase in creatinine of . 26.6 mmol/L (12).
Critical illness in a cat was defined as having clinical signs of
systemic disease, and inability to maintain homeostasis without
aggressive supportive measures.
Descriptive statistics were used and the Fisher’s exact test was
used to compare groups, with a P-value of , 0.05 considered to
be statistically significant. Correlation was evaluated using the
Pearson correlation coefficient.
Results
Signalment
Forty-one cats fulfilled the inclusion criteria. Breeds identified
included 23 domestic shorthairs, 6 domestic longhairs, 3 Maine
coons, 3 Siamese cats, and 1 each of the following breeds:
Norwegian forest cat, Persian, Himalayan, Bombay, ragdoll,
and Turkish van. There were 24 castrated males, 15 spayed
females, and 2 intact females. The median age was 10 y (range:
1 to 19 y).
Blood pressure
Blood pressure measurements were performed using Doppler
ultrasonography in all cats. Initially all cats had a Doppler blood
pressure (DBP) , 80 mmHg or a non-detectable blood pres-
sure before vasopressor therapy was initiated. Blood pressures
could not be measured in 14 cats. In the cats with detectable
blood pressure the median DBP was 56 mmHg (range: 40 to
70 mmHg). Median temperature on initiation of vasopressor
therapy was 36.9°C (range: 32.5°C to 40.0°C), but any hypo-
thermic cats were actively rewarmed before vasopressor therapy
was intitated. Median heart rate at initiation was 160 beats/min
(bpm) (range: 51 to 250 bpm). The associations between DBP
and temperature, DBP and heart rate, or heart rate and tem-
perature were not significantly correlated.
Underlying disease process, sepsis, and
surgical therapy
By study design, all cats were critically ill, with a wide range of
conditions. Twenty-four cats had evidence of sepsis based on
1176
bacterial (n = 18) or fungal (n = 1) cultures or supportive diag-
nostics and conclusions as noted in the medical record (n = 5).
Sources of sepsis included gastrointestinal (n = 6), hepatobiliary
(n = 6), generalized peritonitis (n = 5), pulmonary (n = 4), pleu-
ral space (n = 2), and reproductive tract (n = 1). Seventeen cats
did not have evidence of infection; in these cats, the underlying
disease included traumatic liver rupture and intraabdominal
hemorrhage (n = 1), diabetic ketoacidosis (n = 3), cardiopulmo-
nary disease (n = 3), renal disease (n = 2), liver disease (n = 2),
anaphylaxis (n = 1), and systemic neoplasia (n = 5). Surgical
treatment was performed in 21 cats for source control or to
treat the underlying disease while 20 cats were considered to
have non-surgical conditions. All cats received intensive medical
therapy at the discretion of the attending clinician and all cats
were resuscitated with intravenous fluids prior to the initiation
of vasopressors.
Resuscitation
Five cats suspected of being volume overloaded at the time
of documented hypotension did not receive additional fluid
boluses. Two cats had been transferred from another hospital
and were already receiving vasopressors following an unknown
volume of administered crystalloids. The remaining 34 cats
received a combination of 1 to 4 crystalloid boluses ranging
from 5 mL/kg body weight (BW) to 20 mL/kg BW and contin-
ued to receive crystalloid fluids at rates of 45 to 120 mL/kg BW
per day. Eight cats were administered synthetic colloid boluses
(5 to 20 mL/kg BW, IV), while 9 cats received blood products
(fresh and stored whole blood) immediately before vasopres-
sor initiation. Four cats had CVP measurements taken which
ranged from 4 to 10 mmHg. All cats, except those thought to
be volume overloaded, continued to receive further crystalloids,
colloids, and blood products during vasopressor use as ongo-
ing resuscitative efforts. Seven cats started vasopressor therapy
during surgery after receiving multiple 5 to 10 mL/kg BW
crystalloid and/or synthetic colloid boluses and vasopressors
were continued after surgery. The medical records stated that
the attending clinicians assessed the cats as adequately volume
resuscitated or volume overloaded before starting vasopressors.
Vasopressor used
All vasopressors were given as continuous rate infusions.
Dopamine was used as the first-line vasopressor in 33 cats,
while 7 cats were treated with norepinephrine, and 1 cat was
administered epinephrine. All cats ultimately received either
dopamine, norepinephrine or both. Prior to 2014, norepineph-
rine was the first choice in 1 of the 34 cats treated compared
with being the first choice in 6 of 7 cats treated during or after
2014 (P , 0.001). Fourteen cats did not appear to respond to
the initial vasopressor by an increase in blood pressure and had
another vasopressor added or had the vasopressor changed. Of
the 14 cats that were given 2 vasopressors in the ICU, 13 cats
were on 2 vasopressors concurrently while 1 cat was switched
from one vasopressor to another. Other drugs used in 6 cats
in addition to either dopamine or norepinephrine included
dobutamine (n = 3), epinephrine (n = 1), vasopressin (n = 1),
or phenylephrine (n = 1).
CVJ / VOL 59 / NOVEMBER 2018
 Dopamine was used in 35 cats with a median starting
dose of 10 mg/kg BW per min (range: 3 to 15 mg/kg BW per
min) and a median maximal dose of 10 mg/kg BW per min
(range: 5 to 15 mg/kg BW per min). Seventeen cats treated
with dopamine had their dose increased during treatment.
Norepinephrine was used in 14 cats with a median starting
dose of 0.5 mg/kg BW per min (range: 0.05 to 1 mg/kg BW
per min) and a median maximal dose of 1.5 mg/kg BW per
min (range: 0.05 mg/kg BW per min to 2 mg/kg BW per min).
Ten cats treated with norepinephrine had their dose increased
during therapy. Doses were incrementally adjusted based on
clinician preference and adjustments were generally performed
not more frequently than every 30 min. Dopamine infusion
rates were increased by 2.5 to 5 mg/kg BW per min increments,
while norepinephrine doses were adjusted in increments of
0.1 to 0.2 mg/kg BW per min. When there were multiple
vasopressors in use, only 1 vasopressor dose was changed at
any given time.
Side effects attributed to vasopressors
Due to the critically ill nature of the cats, it was difficult to ret-
rospectively attribute side effects specifically to the use of vaso-
pressor therapy. In cats with acute kidney injury, 7/21 (33%)
survived compared with 9/18 (50%) cats that did not have an
increase in creatinine of . 26.6 mmol/L (P = 0.34). However,
there was no documentation in the record attributing AKI to
vasopressor use compared with multi-organ failure associated
with critical illness, and vasopressors rates were not adjusted
based on the development of AKI.
Ventricular arrhythmias were documented in the record
of 2 cats as increasing in frequency during vasopressor use.
Both of these cats were receiving dopamine, 1 at 10 and 1 at
15 mg/kg BW per min. One of these cats had a prior diagnosis
of hypertrophic cardiomyopathy and was being treated for a dia-
betic ketoacidotic crisis, but his cardiac condition worsened, he
developed congestive heart failure, and acute kidney injury, and
was euthanized due to his moribund condition. The other cat
presented in a diabetic ketoacidotic crisis and based on point-
of-care ultrasound in the ICU was noted to have poor cardiac
contractility throughout hospitalization, developed oliguric
renal failure, and was euthanized before having a formal echo-
cardiogram done. No other adverse events, such as evidence of
splanchnic hypoperfusion (new onset vomiting or bloody diar-
rhea), were noted in the medical record to have been suspected
to be a result of vasopressor use.
Twenty-three (56%) cats received type-specific whole blood
or component therapy as part of supportive care, with packed
red blood cells being transfused to 18 cats, whole blood to
12 cats, and plasma to 4 cats. There was no survival difference
in cats receiving or not receiving each component, nor was there
a documented effect of transfusion on blood pressure. No cat
had a documented transfusion reaction; transfusion reactions
may result in hypotension.
Survival
Overall, 16 (39%) cats survived and were discharged from the
hospital. Fourteen (34%) cats were euthanized, and 11 (27%)
CVJ / VOL 59 / NOVEMBER 2018
cats died. All cats that were euthanized were considered mori-
bund. Thirty-two cats (78%) survived to 24 h. Of these 32 cats,
21 (65%) had been weaned off vasopressors while 11 (35%)
were still receiving vasopressor therapy. Eight of these 11 cats
were being administered single agent dopamine while 3 cats
had been started on dopamine and had norepinephrine added.
Twenty-six (63%) cats survived to 48 h. Nineteen (73%) of
A R T I C LE
these cats had been weaned off vasopressors while 7 (27%)
cats continued to receive vasopressors. Twenty-four (58%) cats
survived to 72 h, and in this group, 21 (88%) cats had been
weaned from vasopressor therapy, while 3 (12%) cats remained
on vasopressors. For these 3 remaining cats, 1 cat was weaned
at 75 h and survived, 1 cat was weaned at 112 h and survived,
and 1 cat died at 102 h. Median duration of hospitalization was
6 d, with a range of 1 to 35 d.
Blood pressure effects
Prior to the initiation of vasopressor therapy the DBP was
, 80 mmHg or not detectable in all cats. Thirty-four cats
(83%) had a documented DBP of at least 80 mmHg associated
with vasopressor therapy while 7 cats (17%) did not, and 28 cats
had a documented DBP of . 90 mmHg or were discharged
from hospital.
A single vasopressor was administered to 24 cats that achieved
a DBP of at least 80 mmHg, and 20 of these cats received
dopamine while 4 were administered norepinephrine. Two
vasopressors were given to 10 cats, with 6 of these cats receiving
norepinephrine and dopamine while 1 cat each received a com-
bination of either norepinephrine and epinephrine, dopamine
and dobutamine, dopamine and vasopressin, or norepinephrine
and phenylephrine.
Seven cats did not achieve a DBP of at least 80 mmHg, and
3 of these were on single agent therapy while 4 cats received a
vasopressor combination. Three cats were treated with dopamine
alone and 2 cats each received either dopamine and norepineph-
rine or dopamine and dobutamine.
A DBP of at least 80 mmHg was achieved by all 4 cats which
received norepinephrine as a single agent and by 11/23 cats
(48%) on dopamine as the single agent.
The 34 cats that developed a DBP of at least 80 mmHg
required a median time of 6 h (range: 1 to 80 h) to achieve this
target, and the 28 cats that developed a DBP of . 90 mmHg
required a median of 6 h (range: 0 to 96 h) from the time of
initiation of vasopressor therapy. Median heart rate at the time
of documented DBP . 90 mmHg was 180 bpm (range: 51 to
232 bpm). At the time of discontinuation of vasopressor therapy
median body temperature was 37.8°C, range 36.4°C to 39.5°C,
and median heart rate was 186 bpm (range: 102 to 250 bpm).
Twenty-nine cats became normotensive based on a DBP
. 90 mmHg in 27 cats or survival to discharge without docu-
mented normotension (n = 2). Twenty-seven cats survived to
be weaned off vasopressors, although 4 cats did not have docu-
mented normotension. Eleven cats overall were weaned from
vasopressors but did not survive to discharge. In this group of
non-survivors, all were off vasopressors with no evidence of
hypotension for at least 24 h before a clinical decline associated
with progression of their underlying illness.
1177
 Influence of surgery and sepsis
Surgical treatment was performed in 21 cats to control or treat
the underlying disease, while 20 cats were considered to have
non-surgical conditions. Survival to discharge was 62% (13/21)
for cats treated surgically as compared to 15% (3/20) for cats
treated non-surgically (P = 0.004). Twelve of the 24 cats with
sepsis survived (50%), while 4 of the 17 cats without evidence
A R T I C LE
of sepsis survived (24%; P = 0.11). Surgical intervention in cats
with sepsis resulted in 11 cats surviving (61%) compared to
survival of 1 of the 6 cats (17%) with sepsis that did not have
surgery due to a lack of surgical options for source control (e.g.,
cholangiohepatitis) (P = 0.15).
Glucocorticoids and cortisol determination
Glucocorticoids were given to 13 cats. Five of these cats had
been diagnosed with either lymphoma or a mast cell tumor,
while 3 cats were receiving chronic glucocorticoid therapy
for suspected inflammatory bowel disease. Three cats received
glucocorticoids for support of suspected/confirmed sepsis and
possible critical illness associated corticosteroid insufficiency;
1 cat received glucocorticoids for the treatment of anaphylaxis,
and 1 cat was given steroids to decrease airway inflammation
secondary to upper airway obstruction as a result of suspected
laryngeal paralysis. Five (38%) of the 13 cats that received glu-
cocorticoids survived, while 11 (39%) of the 28 cats that did
not receive glucocorticoids survived (P = 1.0).
Cortisol levels were determined for 4 cats, including 3 with
septic conditions. Baseline cortisol values ranged from 129.7 to
460.8 nmol/L. ACTH stimulation tests were performed on
2 cats, 1 with sepsis and 1 with liver disease. One septic cat had
an ACTH stimulation test result consistent with diminished
adrenal reserves (13) (delta cortisol 52.4 nmol/L), received
hydrocortisone therapy and survived to be discharged.
Influence of vasopressor
Twenty-three cats received only dopamine as a vasopressor,
and 8 (47%) survived. Four cats received only norepinephrine
and 2 survived. Fourteen cats received 2 vasopressors and 6 (42%)
survived. There was no statistical benefit of dopamine compared
with norepinephrine or the use of multiple vasopressors. The
median time to normalization of blood pressure (6 h) was similar
whether cats received either dopamine or norepinephrine.
Discussion
The results of this retrospective study describe the use of vaso-
pressors in a population of critically ill cats with hypotension.
Cats being treated with vasopressors generally had an increase in
their blood pressure, with 29 of 41 cats achieving normotension.
Persistent hypotension in cats has previously been associated
with a poor outcome (1,2). In septic human patients, the sur-
viving sepsis guidelines (4) recommend providing vasopressors
if the mean blood pressure is , 65 mmHg despite adequate
fluid resuscitation. In critically ill animals, most clinicians
also recommend use of vasopressors when administration of
an adequate fluid replacement volume has failed to improve
blood pressure (8). All of the cats that were perceived to be
fluid tolerant in this study received fluid therapy consisting of
1178
crystalloids prior to vasopressor initiation, and further resuscita-
tion with colloids as well as blood products was initiated before
and during vasopressor therapy. Although the exact indication
for initiating vasopressors was poorly recorded in the medical
record, blood pressure measurements were consistently low or
undetectable despite fluid resuscitation. As in humans, it is dif-
ficult to determine at times if an adequate fluid challenge has
been administered before starting vasopressors (14), but there
is growing evidence that a positive fluid balance is linked to an
increase in mortality (15,16).
All the cats in this study were assessed by the clinician as
being adequately volume resuscitated, but considerable chal-
lenges exist in accurate determination of volume status. Physical
examination parameters, response to fluid boluses, and CVP
were all used to determine volume status and perfusion. Central
venous pressure has recently been recognized as a less useful tool
in determining volume status (17). Echocardiography may have
some role in determining volume status, but was not used in this
study for this purpose. Point-of-care ultrasound examination
was performed to assess left ventricular volume as a surrogate
indicator of adequacy of preload. As a retrospective study, it is
impossible to determine if some cats may have responded to
further fluid resuscitation rather than vasopressor therapy.
Vasopressor choice in this retrospective study was based on
clinician preferences, with a recent shift from dopamine to
norepinephrine presumably paralleling guidelines in humans
(4). Dopamine was historically favored as a vasopressor, but
due to apparent improved outcome in septic shock in humans,
norepinephrine is now preferred over dopamine in this subset
of human vasopressor-dependent patients (18). Whether this
recommendation is applicable to critically ill cats with a more
heterogeneous spectrum of disease is unknown. In this study
80% of cats were started on dopamine compared with 17.5%
on norepinephrine, but no conclusions could be drawn as to
their relative effectiveness due to the small number of cats and
the variability of the clinical picture.
Dobutamine provides primarily inotropic support and only
has indirect vasopressor actions. Dobutamine was given to 3 cats
with refractory hypotension, 2 of which had underlying cardiac
disease with reduced contractility documented with an echo-
cardiogram. In cats, use of dobutamine has been infrequently
reported, with documented increases in myocardial performance
in healthy cats (19,20), but limited data applicable to our ICU
patient population exist. Potential side effects of dobutamine
include seizures at doses . 5 mg/kg BW per min (21), which
was not noted in our patient population.
Epinephrine was used in 1 cat as a CRI following a severe
anaphylactic event. In veterinary medicine, epinephrine is
largely reserved for anaphylaxis due to concerns over beta-
agonist effects and increased myocardial oxygen consumption
as well as splanchnic ischemia due to excessive vasoconstriction
(5,22). Vasopressin is a non-adrenergic vasopressor that acts
directly to increase vasoconstriction and potentiate the effects
of adrenergic agonists (5). Prolonged hypotension in humans
and dogs results in a depletion in vasopressin stores (23) and it
has been suggested that vasopressin therapy may be helpful in
cases of prolonged refractory hypotension (24) or hypotension
CVJ / VOL 59 / NOVEMBER 2018
in association with a severely acidemic patient. Vasopressin has
not been explored as a single agent in cats. However, studies in
humans have not indicated a clear benefit (25) and the current
cost of vasopressin limits its use.
The use of multiple vasopressors, most commonly dopamine
and norepinephrine, was described in this study, as was chang-
ing from 1 vasopressor to another. Practical considerations in
switching vasopressors include inadvertent bolus associated
with flushing the IV catheter and increased potential for drug
calculation errors. From a clinical perspective, in human medi-
cine, current recommendations for sepsis include starting with
norepinephrine, and adding either epinephrine or vasopressin
if norepinephrine is ineffective or with vasopressin to allow the
down titration of the infusion rate of norepinephrine. Direct
switches from 1 vasopressor to another are rare unless there is
evidence of significant side effects, such as ectopy.
Cats that were treated surgically did significantly better than
cats that did not have a surgical intervention. Cats treated sur-
gically were more likely to have sepsis. A recent human study
clearly documented a survival benefit in patients with sepsis
who underwent source control compared to patients who did
not have source control, supporting the theory that control of
the source of sepsis is useful (26).
Limitations of this study include those of most retrospective
studies, namely a varied approach to vasopressor use by indi-
vidual clinicians, and lack of a standardized approach to fluid
resuscitation prior to beginning vasopressors. Volume status
in cats is particularly difficult to assess, and cats are prone to
fluid overload from occult cardiomyopathy (27). Additionally,
measurement of blood pressure in cats is challenging at times,
particularly in hypotensive and/or vasoconstricted cats (28–30).
The specific rationale behind vasopressor decisions was not
always clear, which might have impacted outcome. There was
no apparent benefit to norepinephrine over dopamine, but due
to the small sample size, the possibility of a type 2 error exists.
It is possible other cats hospitalized during the study period
had hypotension, but did not receive vasopressors and survived,
and it is certainly possible that some cats in this study may have
responded to more aggressive fluid therapy alone.
From a practical standpoint, based upon the results of this
study, vasopressors appear to have a role in support of blood
pressure in critically ill cats. Recommendations for clinical
management of cats with hypotension include an aggressive
search for an underlying cause and aggressive fluid resuscita-
tion with crystalloids (10 to 20 mL/kg BW boluses repeated
as needed). Electrolyte and acid-base disturbances should be
corrected. If hypotension persists, either dopamine starting at
5 mg/kg BW per min or norepinephrine starting at 0.1 mg/kg
BW per min is acceptable and should be initiated and titrated
to effect. Vasopressors may be slowly decreased after a DBP of
90 mmHg is maintained for at least 1 h, but the cat should be
closely monitored for relapse.
In conclusion, this study describes the use of vasopres-
sors in cats with various underlying causes of critical illness.
Vasopressors appear appropriate for use in critically ill cats and
hypotensive cats recovering from surgery in particular may
benefit from the use of vasopressors. CVJ
CVJ / VOL 59 / NOVEMBER 2018
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19. Pascoe PJ, Ilkiw JE, Pypendop BH. Effects of increasing infusion rates
of dopamine, dobutamine, epinephrine, and phenylephrine in healthy
anesthetized cats. Am J Vet Res 2006;67:1491–1499.
20. Hori Y, Uechi M, Indou A, et al. Changes in the myocardial perfor-
mance index during dobutamine administration in anesthetized cats.
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21. Fox PR. Feline myocardial diseases. Proceedings of the 18th Annual
Waltham/OSU Symposium: Cardiology. Vernon, California, USA,
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22. Levy B, Bollaert PE, Charpentier C, et al. Comparison of norepineph-
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24. Silverstein DC, Waddell LS, Drobatz KJ, King LG. Vasopressin therapy
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A R T I C LE
Answers to Quiz Corner
Les réponses du test éclair
1. A) Taurine and arachidonic acid are not found in plant sources
and are required by cats. Cats cannot convert the vitamin A
precursors found in plants to vitamin A; therefore, vitamin A
from meat sources is required by the cat.
A) La taurine et l’acide arachidonique ne sont pas rencontrés
dans les plantes et les chats en ont besoin. Les chats ne
peuvent pas convertir les précurseurs de la vitamine A
trouvés dans les plantes en vitamine A. La vitamine A
provenant des viandes est dont nécessaire pour les chats
2. B) A swelling under the tongue could be associated with a ranula
or, potentially, a neoplastic process. While neoplasia may
lead to laryngeal paralysis, the neoplasia is typically found
in the ventral cervical region or the cranial mediastinum, not
under the tongue. The other 4 answers are common present-
ing complaints in dogs afflicted with laryngeal paralysis.
B) L’enflure sublinguale est associée à une ranula ou,
potentiellement, à une néoplasie. Bien que la néoplasie
puisse conduire à une paralysie laryngée, la néoplasie est
rencontrée de façon caractéristique dans la région cervicale
ventrale ou dans le médiastin cranial et non sous la langue.
Les quatre autres réponses sont des troubles fréquents des
chiens atteints de paralysie laryngée.
3. D) Surgery in this region is usually not possible. The ureters
are located there, and it is usually not possible to resect the
entire tumor. Cystectomy with the creation of an external
bag for urine collection is the preferred treatment for humans
but is not a practical therapy for pets. Radiation therapy has
limited benefits to date. Chemotherapy with platinum com-
pounds has limited response over that of piroxicam alone;
nephrotoxicity is a limiting side effect.
1180
29. da Cunha AF, Saile K, Beaufrère H, Wolfson W, Seaton D, Acierno MJ.
Measuring level of agreement between values obtained by directly mea-
sured blood pressure and ultrasonic Doppler flow detector in cats. J Vet
Emerg Crit Care (San Antonio) 2014;24:272–278.
30. Brown S, Atkins C, Bagley R, et al. ACVIM consensus statement:
Guidelines for the identification, evaluation, and management of
systemic hypertension in dogs and cats. J Vet Intern Med 2007;21:
542–558.
D) La chirurgie dans cette région n’est pas habituellement
possible. Les uretères se terminent à cet endroit et il n’est
habituellement pas possible d’enlever la tumeur au complet.
La cystectomie avec la pose d’un sac externe de récupération
de l’urine est le traitement de choix chez les humains, mais
n’est pas pratique chez les animaux. La radiothérapie possède
des effets limités à ce jour. La chimiothérapie à l’aide de
composés de platine possède une réponse limitée sur le
traitement au proxicam seul; la néphrotoxicité représente
un effet secondaire limitant.
4. A) The correct answer is to treat all contact animals. Chorioptic
mange is common in draft breeds, is not associated with poor
nutrition or hygiene, and is not a reportable condition. It is
transmitted via direct and indirect contact and pruritus may
not be present; thus, all contact animals should be treated.
A) La bonne réponse est de traiter tous les animaux qui ont
des contacts. La gale chorioptique est commune chez les
races de chevaux de trait et n’est pas associée à la mauvaise
nutrition ou à la mauvaise hygiène et n’est pas une maladie
à déclaration obligatoire. Elle est transmise par contact
direct ou indirect et le prurit peut être absent; ainsi, tous les
animaux qui ont des contacts doivent être traités.
5. A) Mycoplasma polyarthritis is common in feedlots and rare on
dairy farms. Otitis interna is common in dairy calves but not
beef. Mycoplasma spp. are not implicated in the etiology of
puerperal metritis. Mycoplasma pneumonia is common in all
bovine settings.
A) La polyarthrite à Mycoplasma est commune dans les parcs
d’engraissement mais rare dans les fermes laitières. L’otite
interne est commune chez les veaux de races laitières mais
non chez ceux de races de boucherie. Mycoplasma sp. n’est
pas impliqué dans l’étiologie de la métrite puerpérale. La
pneumonie à Mycoplasma est commune chez tous les bovins.
CVJ / VOL 59 / NOVEMBER 2018