Continuous digital hypothermia in the prevention and treatment of acute equine laminitis

Published:

2020-12-09

Share
Open Access Logo

DOI

https://doi.org/10.18849/ve.v5i4.307

Abstract

PICO question

Does continuous digital hypothermia improve clinical outcome in equids with acute laminitis compared to supportive treatment alone?

 

Clinical bottom line

Category of research question

Treatment

The number and type of study designs reviewed

Six experimental randomised controlled trials and one multicentre retrospective case series were reviewed

Strength of evidence

Moderate

Outcomes reported

The outcomes reported were reduced severity of histopathological lamellar lesions in limbs treated with continuous digital hypothermia (CDH; initiated prior to or soon after the onset of experimentally induced acute laminitis) compared to limbs remaining at an ambient temperature in all five experimental studies where histology was performed. A significant reduction was observed in the prevalence or severity of clinical signs of laminitis in limbs treated with CDH compared to limbs remaining at an ambient temperature. In a single retrospective case series, significantly reduced prevalence of clinical laminitis was reported amongst animals receiving CDH compared to those that did not in a referral hospital population of animals treated for colitis

Conclusion

There is moderate evidence to support that CDH when used prior to or in the early stages of clinical signs, may reduce the severity and progression of lamellar lesions in acute laminitis and no evidence demonstrating that it improves clinical outcome compared to supportive treatment alone. Further research into the clinical outcome of equids treated for acute laminitis using CDH is warranted

 

How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

 

Open Access Peer Reviewed

References

de Laat, M.A., McGowan, C.M., Sillence, M.N. and Pollitt, C.C. (2010). Equine laminitis: Induced by 48 hr hyperinsulinaemia in Standardbred horses. Equine Veterinary Journal. 42(2), 129–135. DOI: http://dx.doi.org/10.2746/042516409X475779

Dern, K., van Eps, A., Wittum, T., Watts, M., Pollitt, C. and Belknap, J. (2018). Effect of continuous digital hypothermia on lamellar inflammatory signaling when applied at a clinically-relevant time point in the oligofructose laminitis model. Journal of Veterinary Internal Medicine. 32(1), 450–458. DOI: https://dx.doi.org/10.1111/jvim.15027

Kullmann, A., Holcombe, S.J., Hurcome, S.D., Roessner, H.A., Hauptman, J.G., Geor, R.J. and Belknap, J. (2014). Prophylactic digital cryotherapy is associated with decreased incidence of laminitis in horses diagnosed with colitis. Equine Veterinary Journal. 46(5), 554–559. DOI: https://doi.org/10.1111/evj.12156

Obel, N. (1948). Studies of the Histopathology of Acute Laminitis. Almgvist and Wilcsells Bottrykeri Ab Uppsala (Thesis).

Patterson-Kane, J.C., Karikoski, N.P. and McGowan, C.M. (2018). Paradigm shifts in understanding equine laminitis. The Veterinary Journal. 231, 33–40. DOI: http://dx.doi.org/10.1016/j.tvjl.2017.11.011

Pollitt, C.C. (1996). Basement membrane pathology: A feature of acute equine laminitis. Equine Veterinary Journal. 28(1), 38–46. DOI: https://dx.doi.org/10.1111/j.2042-3306.1996.tb01588.x

Stokes, S.M., Belknap, J.K., Engiles, J.B., Stefanovski, D., Bertin, F.R., Medina-Torres, C.E., Horn, R. and van Eps, A.W. (2019). Continuous digital hypothermia prevents lamellar failure in the euglycaemic hyperinsulinaemic clamp model of equine laminitis. Equine Veterinary Journal. 51(5), 658–664. DOI: https://doi.org/10.1111/evj.13072

van Eps, A.W. and Pollitt, C.C. (2004). Equine laminitis: cryotherapy reduces the severity of the acute lesion. Equine Veterinary Journal. 36(3), 255–260. DOI: https://doi.org/10.2746/0425164044877107

van Eps, A.W. and Pollitt, C.C. (2009). Equine laminitis model: Cryotherapy reduces the severity of lesions evaluated seven days after induction with oligofructose. Equine Veterinary Journal. 41(8), 741–746. DOI: https://doi.org/10.2746/042516409X434116

van Eps AW. (2010). Therapeutic hypothermia (cryotherapy) to prevent and treat acute laminitis. Veterinary Clinics of North American Equine Practice. 26(1), 125–33. DOI: https://doi.org/10.1016/j.cveq.2010.01.002

van Eps, A.W., Leise, B.S., Watts, M., Pollitt, C.C. and Belknap, J.K. (2012). Digital hypothermia inhibits early lamellar inflammatory signalling in the oligofructose laminitis model. Equine Veterinary Journal. 44(1), 120–124. DOI: https://doi.org/10.1111/j.2042-3306.2011.00416.x

van Eps, A.W., Pollitt, C.C., Underwood, C., Medina-Torres, C.E., Goodwin, W.A. and Belknap, J.K. (2014). Continuous digital hypothermia initiated after the onset of lameness prevents lamellar failure in the oligofructose laminitis model. Equine Veterinary Journal. 46(5), 625–630. DOI: https://doi.org/10.1111/evj.12180

Wylie, C.E., Collins, S.N., Verheyen, K.L., and Newton, J.R. (2011). Frequency of equine laminitis: a systematic review with quality appraisal of published evidence. The Veterinary Journal. 189(3), 248–256. DOI: https://doi.org/10.1016/j.tvjl.2011.04.014

Wylie, C.E., Newton, J.R., Bathe, A.P., and Payne, R.J. (2015). Prevalence of supporting limb laminitis in a UK equine practice and referral hospital setting between 2005 and 2013: implications for future epidemiological studies. Veterinary Record. 176(3), 72. DOI: https://doi.org/10.1136/vr.102426

Most read articles by the same author(s)

1,877

Save

1,183

View

Vol. 5 No. 4 (2020): The fourth issue of 2020

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  /  Exotics  /