HLA and Foster Hospital Clinicians Pool Expertise and Resources to Save Cria with Acute Respiratory Distress Syndrome
When Griffin arrived into the world a few weeks too early, a novel treatment for a cria and the combined care from doctors at both Hospital for Large Animals (HLA) and Henry and Lois Foster Hospital for Small Animals (FHSA) at Cummings School of Veterinary Medicine at Tufts University brought the newborn alpaca, struggling to breathe and fighting for his life, back to health.
Crimson Skye Farm in Pennsylvania is home to Griffin and, more than 40 other alpacas and several chickens. Karen and Gary Nace breed and show alpacas and offer agritourism and summer camps at the farm. They bought Griffin’s mother, Best Lady, when she was pregnant.
Best Lady delivered in the middle of the night, and though she was kept in a heated barn, by morning, the premature cria had no measurable temperature. The veterinarian recommended they take him to Cummings School. He spent the first three weeks of his life at HLA with Best Lady, overcoming a series of life-threatening conditions.
“I am shocked that he survived,” says Karen Nace. “There were a host of things wrong with him. He was very small and premature, had a raging infection throughout his body, and was not breathing well. He was just one sick little fella.”
Griffin had not been able to ingest colostrum and therefore experienced failure of transfer of passive immunity (FTP). Crias need to ingest antibodies from the dam’s milk within the first 24 hours of life to stave off infection.
“This was one of the top five sickest crias I’ve ever seen,” says Dr. Claire Dixon, assistant clinical professor in the Department of Clinical Sciences, on the internal medicine team at HLA. Dixon and Dr. Fionna Lehmann, a large animal internal medicine resident at HLA, took over the alpaca’s initial care. “When they’re born and not ready for life outside of the uterus, it’s easy for them to become sick. Their immune defense is not fully developed yet, which is why good quality colostrum is particularly important.”
A chest x-ray revealed aspiration pneumonia. The doctors initially stabilized Griffin with intensive supportive care, including intravenous fluids for dehydration, dextrose (glucose), antibiotics to fight infection, and a plasma infusion for antibodies.
By the following morning, Griffin had increased lung inflammation and dangerously low oxygen levels. His pneumonia rapidly progressed into acute respiratory distress syndrome (ARDS), a rare but severe inflammatory response to lung injury (such as aspiration) that involves severe hypoxemia, a lack of oxygen transfer to the blood, and leads to respiratory failure.
“ARDS is fairly uncommon but very serious because it can carry a mortality rate above 70 percent,” says Dr. Daniela Bedenice, professor in the Department of Clinical Sciences and specialist in Emergency and Critical Care (ECC) and Internal Medicine at HLA. “This cria had a plethora of different medical problems, but the most serious were related to the respiratory tract.”
The doctors administered conventional oxygen to Griffin through a nasal tube, but his blood oxygen levels remained low, and radiographic imaging showed severe abnormalities in his lungs. He also showed evidence of sepsis, which refers to a form of body-wide infection, in addition to acute kidney injury.
“This cria was so unwell that every decision had to be carefully thought through so that we would not lose him,” says Dixon. “Dr. Lehmann was woken up every night with techs calling to ask questions. “Those first few days, we didn’t know if the cria would make it.”
In patients who do not respond to conventional oxygen therapy, the next step typically would be to anesthetize the alpaca for machine ventilation to deliver oxygen. However, machine ventilation is invasive, not without risk for animals, and often cost-prohibitive for owners. Since Griffin was about the size of a cat, the clinicians reached out to the ECC team at FHSA to improve his ventilation non-invasively.
A newer method for treating respiratory failure, high-flow nasal oxygen therapy, is often used for dogs in the intensive care unit at FHSA before reaching for mechanical ventilation. To date, it’s only rarely been applied to large animals. In this system, oxygen flows through nasal tubes, called “prongs,” at a high rate to open the airways.
“High-flow oxygen can help the animal breathe better and deeper and get more oxygen on board,” says Dixon. “The nasal prongs fit perfectly for the cria, and it was the first time we successfully used prolonged high-flow oxygen therapy in a cria in this situation.”
Dr. Alexia Berg, on the ECC team at FHSA and assistant clinical professor in the Department of Clinical Sciences, explains that patients receiving this therapy can be awake and even walk around during treatment. “For the right patient and the right problem, it can make the difference between making it out of the hospital or not,” she says.
Berg provided her expertise in using the equipment and lent it to HLA so that the alpaca could be with his mother. After five days of high-flow oxygen therapy, Griffin finally turned the corner.
“Having this therapy as an option was the reason this cria lived,” says Dixon. “It’s great to have so much expertise in the same building. All the teamwork, brainstorming, and experience certainly paid off and made a difference for this little guy.”
“We’re thrilled it worked for them,” says Berg. “We’re glad we could offer the technology, that they were open to trying it, and it worked great for him.”
Karen Nace appreciated the large and small animal teams working so closely to help save the cria.
“I don’t think he would have survived if it weren’t for the collaboration between all the vets at the hospitals,” she says. “They really did an amazing job with him. They were absolutely wonderful and very communicative.”
Griffin underwent intensive care, and as his condition improved and he was able to stand, the team turned their attention to nursing.
“For him to learn what a healthy cria would normally achieve in the first two hours after birth took a week,” says Dixon. “It’s exciting when they finally latch on, independently suckle, and no longer want the bottle. The dam was amazing, fantastic to handle, and good with him. She made it a lot easier.”
Bedenice spreads the credit around for the cria’s remarkable recovery. “The owner and attending vet referred the animal early, which was a key factor for survival. This was a unique scenario where we had the opportunity to identify the disease early and initiate a newer way of treatment immediately after normal oxygen support failed. Another reason this animal did well is that alpacas are genetically adapted to tolerate low oxygen environments since they are a high-altitude-adapted species. The strong collaboration between many clinicians and staff involved in the cria’s care was absolutely essential for his recovery. It’s professionally rewarding to put our minds together and optimize care of patients large and small, and it’s fun too.”
Griffin is back home with Best Lady at Crimson Skye Farm, now fully recovered, aside from some scarring in his lung tissues that should not impact his breathing, and he’s up over 20 pounds. In finding a name for the cria, Karen Nace looked up “warrior” and “survivor” and found a fit with “Griffin.”
Source: https://vet.tufts.edu/
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