Medical Management With Mechanical Ventilation of a Dog With Severe Barium Sulfate Aspiration

To describe the medical management with mechanical ventilation of a dog with severe barium sulfate aspiration and concurrent canine acute eosinophilic dermatitis with edema.

A 26-month-old castrated male Golden Retriever was presented in respiratory distress after the accidental administration of approximately 300 mL of barium sulfate in the lower airways via an improperly placed orogastric tube. Thoracic radiographs revealed marked bilateral aspiration of contrast material. Despite oxygen supplementation via nasal cannulas, there was concern for respiratory muscle fatigue, and mechanical ventilation was provided for approximately 4 days. At the time mechanical ventilation was initiated, PaO₂ was 135.9 mm Hg, FiO₂ was 85%, and the PaO₂:FiO₂ ratio was 159. On Day 3 after admission, focal erythematous macules and wheals were appreciated on both the lateral thorax and abdomen, and in the perianal region. Histopathology of these lesions was consistent with canine acute eosinophilic dermatitis with edema. The dog was weaned from mechanical ventilation on Day 4 when PaO₂ was 86.2 mm Hg, FiO₂ was 45%, and PaO₂:FiO₂ was 216. At discharge (Day 13), the A-a gradient was 25 mm Hg on room air. Four weeks after discharge, the patient was asymptomatic, had an A-a gradient of 6 mm Hg on room air, and had resolved dermatologic lesions.

This is the first case report of the successful medical management of severe barium aspiration in a dog that required mechanical ventilation, with an excellent outcome.