Editor’s Note
There's no theme this month. I went looking for one and decided not to manufacture it.
What these four papers share is only that each addresses something that comes through the door on a regular basis — a dog with pericardial effusion, a bitch in dystocia, a cat that got into lilies, and a patient we're trying to decide whether to call septic. Nothing here is exotic. That was the filter.
Three of the four are more useful for what they permit than for what they prescribe. The pericardiocentesis trial is a null result, and I've said so plainly, but the absence of harm is itself worth having when you're deciding what to do in the ten minutes before you drain a pericardium. The same is true of the hysterotomy paper and the lily paper: each one widens the range of defensible choices rather than narrowing it.
As always, these summaries are a starting point and the papers themselves are worth reading in full. That goes double for the Protocol Note. The sepsis consensus definition is a genuine change to how we are being asked to identify a syndrome most of us diagnose on criteria we learned in school, and it was published alongside a companion Special Article on septic shock. Both are open access and provide a very helpful overview and update on sepsis.
If there's a paper you think belongs in a future issue, send it my way. Also, please tell your friends if you find this newsletter helpful!
Thanks for reading,
Study Spotlight
A Fluid Bolus Before Pericardiocentesis Did Not Improve Shock Index and Did Not Contribute To Negative Changes in Respiratory Status
Jones N, Humm K, Tinson EW. Intravenous bolus fluid therapy versus no fluid therapy prior to pericardiocentesis in dogs: a randomized controlled trial in 30 dogs. J Vet Emergency Crit Care. 2026;36(3):298-307.doi:10.1111/vec.70073
What They Did
Prospective, randomized, nonblinded clinical trial at the Queen Mother Hospital for Animals, Royal Veterinary College, January 2021 through November 2022. Seventy dogs with pericardial effusion presented during the enrollment window; 40 were excluded, leaving 30 enrolled and randomized 15 per group. Dogs received either a 10 ml/kg IV bolus of compound sodium lactate over 10 minutes before pericardiocentesis or no bolus. Heart rate, systolic blood pressure, respiratory rate, lactate and point-of-care ultrasound were recorded at four time points: baseline, 15 minutes later, immediately after pericardiocentesis, and 4 hours after. Shock index was calculated as heart rate divided by systolic blood pressure. Twenty-seven of the 30 dogs had cardiac tamponade; 19 effusions were neoplastic and 11 presumed idiopathic. Analysis was by intention to treat.
What They Found
Shock index was calculable in 28 dogs at baseline, and 23 of those 28 had a shock index about 0.9. No difference in shock index was found between groups at any matched time point. The only between-group difference at any point was heart rate at 4 hours, which was higher in the bolus group (p=0.047). Shock index fell after drainage in both arms, in the no-bolus group between the 15-minute and post-centesis points (p=0.035) and between 15 minutes and 4 hours (p=0.003), and in the bolus group between 15 minutes and 4 hours (p=0.027) with mean shock index at or below 0.9 in both groups by 4 hours. Median lactate moved from 2.6 to 1.9 mmol/L in the bolus group and 2.2 to 2.1 mmol/L without a bolus, neither were significant. Respiratory rate did not differ, and no dog required supplemental oxygen at 4 hours. New B-lines appeared in 9 of 15 no-bolus dogs and 3 of 15 bolus dogs. Twenty-four of 30 dogs survived to discharge, 11 without bolus and 13 with, no difference was noted between groups (p=0.68).
On The Floor
Percardiocentesis should be the priority. Both arms converged on a normal shock index after drainage regardless of what preceded it, The practical value of the bolus question is permissive rather than prescriptive: a 10 ml/kg crystalloid bolus can be run while preparations are underway for pericardiocentesis without producing respiratory compromise. The data does not support delaying drainage to give fluids or expecting the bolus to buy measurable perfusion improvement. Interestingly, the authors note more dogs were hypotensive at the 15 minute mark in the no bolus group than in the bolus group.
The Caveat
This is a null result from a study that could not find a difference. The trial was non-blinded and single center and the sample sizes were underwhelming. Five dogs were excluded because they required immediate pericardiocentesis, which may have removed the most unstable patients most likely to benefit from volume.
At a Glance
01- Single-layer Hysterotomy Closure Carried No Detectable Excess Risk Across 89 Cesarean Sections
Goldblatt BH, Burns JG, Marvel SJ. A single-layer, full-thickness, simple continuous suture pattern is safe for hysterotomy closure in dogs undergoing cesarean section. J Am Vet Med Assoc. 2026. doi:10.2460/javma.26.03.0177
Retrospective medical record review at Colorado State University, May 2014 through February 2025. Seventy-seven dogs underwent 89 cesarean sections: 70 closed with a single-layer, full-thickness, simple continuous appositional pattern and 19 with a two-layer closure adding a partial-thickness inverting layer. Postoperative complications occurred in 6 of 89 procedures; 4 of 70 appositional and 2 of the 19 inverting (OR, 1.94: 95% CI, 0.328 to 11.50; P=.458). The one major complication was iatrogenic bilateral pelvic limb paralysis following epidural, unrelated to uterine closure. All dogs survive the 14-day follow-up period, none required intervention related to the hysterotomy, and no uterine dehiscence or rupture occurred. Twenty-four dogs had a subsequent pregnancy, 19 of them after appositional closure. Anesthesia and surgery times did not differ between groups.
On the floor: The single-layer full-thickness closure deliberately penetrates the uterine lumen, which runs against standard surgical texts, and it produced no detectable excess complication risk here. For an emergency cesarean at 3 a.m, faster closure with no apparent penalty is a nice option. Reading the finding narrowly, it is worth noting that the inverting group only included 19 procedures and the confidence interval runs from 0.328 to 11.50, so this is an absence of detected difference rather than demonstrated equivalence. Over half the initially identified cases were excluded, largely for incomplete 14-day follow-up, and the authors note their population skews toward planned breedings managed by a theriogenology service rather than compromised emergency dystocias.
02- No Outpatient Cat Progressed Past Grade II Kidney Injury After Lily Exposure
Lam J, Hess RS, Reineke EL. Prevalence of acute kidney injury and outcome in cats treated as inpatients versus outpatient following lily exposure. J Am Vet Med Assoc. 2025;263(1):41-46.doi:10.2460/javma.24.05.0355
This was a single-center retrospective review of 112 cats presenting to the University of Pennsylvania within 48 hours of known or suspected nephrotoxic lily exposure, January 2011 through January 2024. Ninety-six were hospitalized on IV fluids; 16 were managed as outpatients, most receiving SQ fluids with serial creatinine monitoring. AKI developed at some point in 45 of 96 inpatients and 7 of 16 outpatients, a difference that did not reach significance (P=0.6). Maximum AKI grade in the outpatient group was II, reached by 4 cats; a single inpatient grade reached III. Survival favored hospitalization: all 96 inpatients survived, compared with 14 of 16 outpatients (P=.02). Both outpatient non-survivors were euthanized, one with financial constraints recorded as the reason.
On the floor: Intravenous fluid therapy remains the standard of care, and the survival difference between groups warrants weight in that conversation. The data in this paper does support presenting outpatient management as an alternative, rather than declining treatment altogether. Two limitations temper the comparison: 7 of 16 outpatients had only suspected exposure compared with 17 of 96 inpatients (P=.02), so the outpatient cohort likely included cats that were never exposed, and the authors state the study was underpowered to detect a treatment effect. Overall, not the strongest study ever performed, however in keeping with the theme of offering a spectrum of care, this paper provides some helpful information.
Protocol Note
Sepsis in Dogs and Cats Now Has a Consensus Definition, and SIRS is Not Required for it
Veterinary medicine has never had a formally derived consensus definition of sepsis. What we have used instead was adapted from the 1991 and 2001 human criteria— SIRS in the presence of document or suspected infection— with multiple competing SIRS criteria sets in circulation and no agreement on which to apply. A 14-member international committee has now set that framework aside.
Sepsis is now defined as the life-threatening syndrome associated with a dysregulated host response to infection, resulting in organ dysfunction, The committee recommends that in dogs and cats with infection, identification of organ dysfunction is required for the diagnosis of sepsis, and that the use of the SIRS criteria is not. The definition was reached by a committee drawn from six countries, supported by a systematic review that screened 16,599 articles and evaluated 352 in full. On SIRS specifically, 10 studies supports its use and 18 did not, with the nonsupportive studies covering more patients in aggregate.
To make the new requirement more usable, the paper includes a table of candidate organ dysfunction markers organized by system (highly recommend pulling if you have a suspected septic patient) — CNS, cardiovascular, respiratory, renal, hepatic, coagulation, metabolic or hormonal, and gastrointestinal. Each qualified by the caveat that a derangement counts only when it is not attributable to the primary disease, known comorbidities, untreated shock, or predicable drug effects. The committee also recommends using a validated, structured illness severity score such as APPLE (Acute Patient Physiologic and Laboratory Evaluation) to support the diagnosis and gauge severity.
This is one of two Special Articles published together in JVECCS. The companion paper addresses septic shock and prognosis. Both contain a thorough review and history of how sepsis has been defined in veterinary medicine, and both are open access. I would encourage reading them in full rather than relying on this summary.
Goggs R, Cortellini S, DeClue AE, et al. Sepsis in dogs and cats— consensus definition and clinical criteria. J Vet Emerg Crit Care. 2026;36(4):445-469.doi:10.1111/vec.70129
Goggs R, Cortellini S, DeClue AE, et al. Septic shock and prognosis in dogs and cats with sepsis— consensus definition and clinical criteria. J Vet Emerg Crit Care. 2026;36(4):470-488.doi:10.111/vec.70130