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

Abstract Objective To describe the medical management with mechanical ventilation of a dog with severe barium sulfate aspiration and concurrent canine acute eosinophilic dermatitis with edema. Case summary 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, PaO 2 was 135.9 mm Hg, FiO 2 was 85%, and the PaO 2 :FiO 2 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 PaO 2 was 86.2 mm Hg, FiO 2 was 45%, and PaO 2 :FiO 2 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. New or Unique Information 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.