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

Abstract: 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. Methods: 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:FiO ratio 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 FiO delivered to the foal. After 24 h of therapy, the arterial oxygen saturation improved to 96.8% and PaO improved 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. Conclusions: 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 FiO able to be delivered via temporary tracheostomy.