As in most other areas in veterinary medicine, complementary and alternative medicine is acquiring a greater presence in the care of the critically ill.
Veterinarians in charge of these patients may field requests from clients to administer herbs, homeopathics, flower essences or glandulars to their animals during the hospital stay. Or clients may ask that a non-veterinarian CAM practitioner provide treatments on hospital premises.
Determining which therapies pose risks or offer benefits is difficult without evidential support. Delegating care to non-veterinarians with questionable or unfamiliar credentials adds risk and exposure for veterinarians already managing a busy practice.1
Research indicates that human critical care patients suffer from a variety of stressors, including fear, pain, anxiety, lack of sleep, loneliness, lack of control, nightmares and, for those on prolonged mechanical ventilation, inability to speak or communicate.2
Severely ill animals attached to one or more tubes and subjected to incessant talking, lights, beeps and even music would likely find the experience similarly upsetting.
According to one of the leading researchers in the ethics of human critical care, "Alleviating the stresses and symptoms of critically ill patients will enhance the quality of their ICU stay, which itself achieves an important beneficial and ethical outcome, an outcome that should be a priority of every intensivist."3
Many veterinary personnel working with critically ill patients enthusiastically embrace CAM as a means to improve animals' quality of life and survival. In human medicine, a 2005 survey published in the American Journal of Critical Care indicated that more than 90 percent of critical care nurses reported eagerness or openness to using CAM in the CCU setting.4
Pain, sleep deprivation and immobilization can dramatically impair recovery. Pain and stress sensitize the central nervous system, causing wind-up. This further amplifies pain and stress and increases cardiac demand, vasoconstriction, blood viscosity, platelet aggregation and catabolism.5
In fact, "In many patients with severe posttraumatic or postsurgical pain, the ensuing neuroendocrine responses are sufficient to initiate or maintain a state of shock."6
Sometimes pharmacologic analgesics and sedatives used to make patients comfortable can themselves create other problems, such as constipation and disorientation.
A systematic review of CAM treatments for human patients with severe pain indicated that acupuncture may provide relief for those with cancer or who were dying.9 Acupuncture effectively treats motility problems and nauseaÑcommon afflictions of CCU patients.10
Few contraindications preclude acupuncture, but may include bleeding diatheses, aggression or excessive fearfulness.
Comfort Promotes Sleep
Contraindications to massage depend on the patient's medical status and receptivity to touch. Patients with an unstable cardiac status or severe, uncontrolled hypertension may become over-stimulated.18 19
Massage should be avoided near sites of fractures, contusions, thrombi, inflammation and infection.
Aromatherapy may play a supportive role in the CCU, although subjecting all animals and staff to volatile substances may become problematic. For example, inhaled oil of lavender is soporific and antinociceptive.20 Passion flower (passiflora) is also sedating.21
However, oils with high levels of camphor can reportedly promote seizures and as such should be avoided in epileptic patients.22
Simple rehabilitative maneuvers such as passive range of motion and assisted weight-bearing or ambulation can help preserve joint health and reduce lymph accumulation.
On the other hand, aerobic exercise that places excessive demands on deconditioned patients may compromise cardiopulmonary and musculoskeletal function.23
Veterinarians should supervise physical therapists providing rehabilitative care to critically ill patients.
Not all CAM approaches belong in the critical care setting. For example, there is no evidence supporting the inclusion of chiropractic or high-velocity adjustments in the critical care setting. Forceful maneuvers may injure patients with weakened structures.
Herbs pose several hazards due to the vast unknowns regarding species-specific metabolism, alterations in pharmocodynamics and pharmacokinetics in the critically ill patient, and unforeseen drug-herb interactions.24
Botanicals affecting specific neurotransmitters, such as serotonin in the case of St. John's Wort and GABA for valerian root, can produce additive sedation when combined with barbiturates, opiates or other psychoactive medications.
Common herbs such as ginkgo, ginseng, garlic and dong quai may promote bleeding by inhibiting platelet function. Additionally, certain herbs such as dong quai contain coumarins.
Many other herbs cause adverse effects or drug-herb interactions; insufficient research exists to fully delineate all concerns regarding these products.
Other CAM approaches, such as energy work (Reiki, healing touch, therapeutic touch), homeopathy and flower essence therapy, homeopathic dilutions of flower petals soaked in water and sunlight) require further research to determine their effectiveness in veterinary CCU patients.
While these therapies themselves are unlikely to cause harm, non-veterinarians providing these approaches should be instructed in infection control procedures before gaining entry to the veterinary CCU.
Unregulated glandulars, (products made from the bovine or porcine glands or central nervous system components), may contain active hormones, contaminants, or diseased tissue and have no place in the current practice of veterinary medicine.
Dr. Robinson, DVM, DO, Dipl. ABMA, FAAMA, oversees complementary veterinary education at Colorado State University.
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23. Cirio S, Piagi GC, DeMattia E, and Nava S. Muscle retraining in ICU patients. Monaldi Arch Chest Dis. 2003;59(4):300-303.
24. Adapted from Lu Y. Herb use in critical care. What to watch for. Crit Care Nurs Clin N Am. 2003;15:313-319.]