Acute lung injury/acute respiratory distress syndrome in 15 foals.
Authors: Dunkel B, Dolente B, Boston R C
Journal: Equine veterinary journal
Summary
# Acute Lung Injury and Respiratory Distress in Young Foals Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) represent poorly characterised conditions in equine medicine, despite being well-established in human respiratory critical care. This retrospective review examined 15 foals aged 1.5–8 months presenting with acute onset respiratory distress (within 48 hours) and documented clinical findings, imaging characteristics, aetiological agents and outcomes over their hospitalisation and recovery period. Eight foals met diagnostic criteria for ALI and seven for ARDS, characterised by hypoxaemia (arterial oxygen to inspired oxygen ratio ≤300 mmHg) and diffuse bronchointerstitial patterns with alveolar opacities on radiographs; aetiological agents were identified in ten cases, though no single pathogen predominated. Of the 15 foals, nine survived to discharge, with follow-up data available for seven—all performing normally or racing—indicating that aggressive treatment combining intranasal oxygen, systemic corticosteroids and antimicrobial therapy can yield positive long-term outcomes despite severe initial presentation. Practitioners should maintain suspicion for ALI/ARDS in foals exhibiting acute, severe hypoxaemia that fails to respond adequately to supplemental oxygen alone, as early recognition and corticosteroid intervention appear crucial to survival and return to athletic function.
Read the full abstract on PubMed
Practical Takeaways
- •Suspect ALI/ARDS in young foals (1–12 months) presenting with acute severe respiratory distress and hypoxaemia that doesn't respond to intranasal oxygen alone
- •Aggressive multimodal treatment including supplemental oxygen, broad-spectrum antimicrobials, and systemic corticosteroids may improve survival rates in affected foals
- •Foals surviving ALI/ARDS can achieve normal athletic function; long-term prognosis for survivors appears favourable despite initial severity
Key Findings
- •15 foals (1.5–8 months old) met criteria for ALI/ARDS with acute onset respiratory distress within 48 hours of presentation
- •Eight foals met ALI criteria and 7 met ARDS criteria; all presented with tachycardia and tachypnoea, with fever in 8 cases
- •Nine of 15 foals survived (60%); 4 died from respiratory failure and 2 were euthanased; follow-up of 7 survivors showed normal development with one racing successfully
- •Treatment with intranasal oxygen, antimicrobials, and corticosteroids (13 foals) was associated with improved outcomes in this case series