Inotrope and vasopressor therapy in cardiocirculatory shock in neonatal foals: preliminary study

Regardless of etiology and severity, shock is characterized by an inadequate perfusion to meet metabolic demands at the cellular level. Decreased organ perfusion leads to tissue hypoxia, anaerobic metabolism, activation of the inflammatory cascade, and eventual vital organs dysfunction. Studies about cardiocirculatory shock in neonatal foals are lacking; one report has found that the mortality rate in foals ≤7 days-old with septic shock was 100%. The aim of this prospective study was to evaluate the inotrope and vasopressor therapy in foals ≤7 days-old with fluid refractory shock. To the authors knowledge, there are no other clinical studies about the cardiocirculatory shock in foals. Despite the incidence of shock was low, the mortality rate was higher than in other pathologies, as reported also in human neonates. Noradrenalin is the only catecolamin studied in critically ill foals and it resulted effective to rise the MAP. As dobutamin increases the oxygen myocardial demand, this therapy can lead to tachyarytmia, but in our study we did not find this side effect. Lactatemia did not change after the infusion, probably because lactate needs more time to decrease. Dobutamin has never been studied in sick foals in a clinical setting. More studies with a larger number of foals are necessary to find an effective protocol to increase the survival rate of foals with cardiocirculatory shock.