High flow nasal oxygen therapy after mechanical ventilation in dogs with tick paralysis: a case series

Five dogs diagnosed with and treated for Ixodes holocyclus tick paralysis were successfully weaned from mechanical ventilation (MV) to high flow nasal oxygen therapy (HFNOT). All dogs were mechanically ventilated primarily for hypoventilation for a median time of 80 h (36-113 h). Concurrent conditions included aspiration pneumonia (n = 3) and laryngeal paralysis causing upper airway obstruction (n = 3). Median duration of HFNOT was 4 h (0.5-24 h) before either de-escalation to traditional oxygen therapy (TOT) or discontinuation from oxygen support. Reported complications included superficial corneal ulceration (n = 2), thrombophlebitis (n = 2), gastric ileus (n = 3), urinary tract infection (n = 2) and postventilator seizures (n = 1); however, none were associated with HFNOT. One dog developed a pneumothorax during MV, which was managed with continuous suction via bilateral thoracostomy drains but was not noted to progress with HFNOT. Nasal prong placement was well tolerated in all but one dog, requiring transition to TOT after 1 h of HFNOT. All dogs survived to discharge. Although not recommended in the initial management of hypoventilation, in this case series HFNOT was successfully used as a weaning strategy for dogs ventilated with recoverable neuromuscular disease. This is the first reported use of HFNOT after MV in dogs, specifically with tick paralysis.