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Aspiration Pneumonia
Sent to Pet Experts July 14 01:55 PM

What is the expected treatment for a cat with severe aspiration pneumonia? Our recent experience was that antibiotics and force-feeding was used, but oxygen was not used nor was there any treatment to encourage the cat to expell the fluid in his lungs. After close to two weeks with fluid in his lungs, our beloved Duffy passed away while being kept at the vet's. I can't help thinking that treatment was insufficient and poorly managed.

 

Optional Information:
Age: 10; Male; Breed: Domestic Short Hair Cat

Already Tried:
Antibiotics & forced feeding

Customer (name blocked for privacy)
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July 14 4:27 PM (18 minutes and 41 seconds later)
         
Reply to RGK's Post: Duffy had a cancerous tumor removed from his hear. The surgery went well and all of the tumor was removed. He spent 10 days at home and seemed perfectly fine. When we returned to have the stitches removed he was anesthetized again. Two days later he stopped eating and seemed to have trouble breathing so we took him back to the vet. They told us they believed he had aspiration pneumonia from the last procedure. His temp was 104. They took him in and began administering antibiotics. I don't know if there were any IV meds - I visited him twice and was able to hold him and there was no line set. One vet told me that he was making slow but positive progress, but she stressed that they did not want to send him home until his breathing was stable. It was my understanding that it would be several more days at least before that happened. We were suprised when the office called us the next day and released him to us - with two antibiotics, one steriod and one appetite stimulant (sorry, I don't remember the names.) He ate the first day he was home and then got worse again, so we took him back. This vet (there are four in the practice) was very concerned and took him in right away. The day he passed they began nebulizer treatments and I left a msg for the vet to call me as I was concerned nothing was being done to encourage him to get rid of the fluid. THe call we got was that Duffy was not going to make it through the night. 20 minutes later they called to say he was gone.

All of Duffy's bloodwork was good. His systems were quite healthy and we were told this several times.
Answer
July 14 5:02 PM (35 minutes and 10 seconds later)
         
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I am at a disadvantage not knowing the exact type and location of the tumor that was removed. So unfortunately, I can't say whether that contributed at all to his passing and will have to limit my answer to the treatment Duffy received for the aspiration pneumonia.
In severe cases when the patient is exhibiting significant respiratory distress, oxygen therapy is often necessary. The use of an oxygen cage is generally the least stressful method of delivering oxygen therapy, but as these are quite expensive, not all private practices are equipped with them. Nasal insufflation (placing a tube into the nostrils) is the next best thing. If the cat is not in significant respiratory distress, then oxygen therapy is usually not needed.
Cats with pneumonia will very commonly go off food because they are more concerned with breathing, than eating or drinking. As a result, intravenous fluids are usually recommended to guard against dehydration. Subcutaneous fluids(fluids given just beneath the skin) may be substituted if dehydration is minimal. Force feeding is often needed but this needs to be done several times a day to keep up with the cat's metabolic requirements. Placement of a feeding tube would be ideal and less stressful for the cat, but was not practical in Duffy's situation because he simply could not have withstood another anesthetic procedure given the state of his lungs.
The use of antibiotics is essential in cases of aspiration pneumonia. Ideally, material is collected from the airway for submission for culture and sensitivity to determine what organisms are present and what is the best medication to use. Barring this, a combination of broad spectrum antibiotics such as amoxicillin with gentamicin, amikacin or Baytril, is usually what is required. The use of steroids is controversial- there is inflammation within the airways and the steroids will help alleviate that. In fact, steroids are commonly used in human patients with pneumonia. However, they also suppress the immune system and could potentially make the pneumonia worse. Unfortunately, there is not a good consensus in veterinary medicine as to whether steroids should or should not be used in these cases.
In cats with aspiration pneumonia, bronchodilators such as theophylline or terbutaline often help to open up the airways and aid breathing. Nebulization to loosen up consolidated areas of lung tissue is an important part of therapy in cases that are slow to resolve. Following nebulization, coupage (cupped hands "pounded" against the chest wall), is used to further loosen up secretions and encourage coughing to expel the material. Diuretics are not recommended for cases of pneumonia.
Again, I don't know that I can say that what was done was inappropriate or that the care Duffy received was a contributing factor in his death. The tumor may have played a part in weakening him and making him less responsive to the therapy that was offered, or it could be that sending him home too early proved too much of a stress on his system. As uncomfortable as it may be for you, I recommend that you request a sit down meeting with the veterinarians that were involved in Duffy's care. Approaching them in a non-confrontational manner and asking them to guide you step by step through the disease process and treatment. You may find that they were doing things that you weren't aware of (sometimes things go unmentioned or are assumed). It may be that they were not as upfront with you about how guarded his condition was, or that they felt that they had conveyed that to you but there was a miscommunication somewhere along the line. If they offered him the best quality of care they were capable of, they should have no reservations about discussing things with you and helping you to understand where things went wrong. I'm under no illusions that if they had slipped up somewhere down the line that they would necessarily admit to that- though it certainly would be refreshing. But perhaps learning more about what went on during Duffy's stay will enable you to get a clearer picture of illness and what was done to help him. It may be a good idea to allow yourself more time to grieve before you approach them about a meeting. This may allow you to focus your questions and objectives more clearly so that you are able to gather the information you're seeking.
Unfortunately in a situation like this, sometimes there are more questions than answers. I truly hope that you are able to bring some resolution to this and allow yourself to celebrate the 10 wonderful years you shared with your boy.
Please let me know if I can help you further.
1 Other Expert Agrees with this!
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July 14 5:15 PM (13 minutes and 16 seconds later)
         
Reply to RGK's Post: Thank you. I will take your advice about waiting and then asking for a meeting. The vet has already refunded us all services and meds back to the date of the stitches removal. They are also not charging us for Duffy's cremation.

Since we do have other cats, I'm mostly interested in knowing how to deal with this should it happen again. (And we pray that it does not.)

Thank you again.
Answer
July 14 5:27 PM (11 minutes and 13 seconds later)
         
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