Successful Treatment of Acute Respiratory Distress Syndrome in an 8-Day-Old Standardbred Foal With Intratracheal Oxygen Therapy via Temporary Tracheostomy.

Overview

• This study reports the successful treatment of an 8-day-old foal diagnosed with acute respiratory distress syndrome (ARDS) using a novel method of delivering oxygen directly into the trachea through a temporary tracheostomy.
• The approach improved the foal’s oxygen levels and clinical condition, avoiding the need for invasive intubation and mechanical ventilation.

Background and Case Presentation

• An 8-day-old Standardbred filly was admitted with sudden respiratory distress.
• Clinical evaluation included chest radiographs showing bilateral diffuse infiltrates and an arterial blood gas test revealing a low PaO₂:FiO₂ ratio (170.5), indicative of ARDS.
• Initial therapy involved:
  • Antimicrobials: minocycline and metronidazole
  • Nonsteroidal anti-inflammatory drugs: flunixin meglumine
  • Oxygen given intranasally
• The foal showed poor response to intranasal oxygen and deteriorated clinically, confirmed by follow-up arterial blood gas tests.

Intervention: Intratracheal Oxygen Therapy via Temporary Tracheostomy

• To improve oxygen delivery, treatment was switched to deliver oxygen directly into the trachea through a temporary surgically created opening (tracheostomy).
• This method delivered higher levels of oxygen more effectively to the lungs compared to intranasal delivery.
• Advantages of this approach:
  • Avoided the need for continuous sedation, which is often required for intubation.
  • Prevented mechanical ventilation, reducing risks and complications.
  • Provided a safer, less invasive means to improve oxygenation in the foal.

Outcomes

• After 24 hours of intratracheal oxygen therapy:
  • Arterial oxygen saturation increased to 96.8%.
  • PaO₂ improved to 154.1 mm Hg.
• Oxygen therapy was safely discontinued on day 7 of hospitalization.
• The foal was discharged on day 12 with ongoing antimicrobial treatment.
• No complications related to the temporary tracheostomy were noted.
• Blood cultures were negative and no transtracheal wash was performed, so the exact cause of ARDS was not identified.
• Five months post-discharge, the foal remained healthy, indicating lasting recovery.

Significance and Future Directions

• This case demonstrates that intratracheal oxygen delivery via a temporary tracheostomy may be a viable, less invasive alternative to traditional intubation and mechanical ventilation for foals with ARDS.
• The method potentially allows better oxygenation and clinical improvement without sedation-related complications.
• Further research is recommended to:
  • Determine the maximum fraction of inspired oxygen (FiO₂) that can be delivered through a temporary tracheostomy.
  • Evaluate broader applications and safety of this technique in other young equine patients with respiratory distress.