- DO use uncuffed endotracheal tubes in small avian patients.
- DO provide prey species with a 5-10 minute acclimation period whenever possible.
- DO NOT restrain birds for prolonged periods.
- DO provide quiet, calm housing as well as supplemental heat as needed.
- DO place an intraosseous catheter for vascular access in select avian patients.
- DO NOT administer corticosteroids to the avian patient when an alternative medication with fewer adverse effects can be selected.
- DO practice tube feeding so you are prepared to perform this technique efficiently, safely, and gently in the clinical patient.
Although the principles of emergency medicine and critical care are universal for all species, this approach must be balanced with an understanding of the unique aspects of avian medicine. Use this summary page to review the basic approach to the avian patient and select additional links to supplement your knowledge base.
This summary page is a part of the Emergency and Critical Care Teaching Module.
Most birds possess complete tracheal rings. Use of a cuffed endotracheal tube can lead to pressure necrosis if the cuff is inflated because there is no elastic ligament to accommodate tracheal expansion. Always select an uncuffed endotracheal tube in small birds. Traditional cuffed tubes can be used in larger birds, but never inflate the cuff. Intubation is a relatively simple process because there is no epiglottis and the tracheal opening is generally very accessible. Once the bird is intubated, secure the tube to the upper or lower beak with tape.
Careful and vigilant patient monitoring is essential for avian patients as cardiac arrest in birds carries a poor prognosis. Presence of the sternal plate or keel means that direct compression of the heart is impossible in birds, however sternal compressions can push air through the bellows-like air sac system.
Delve deeper into this topic in Cardiopulmonary Resuscitation in Exotic Animals.
Signs of illness
Many companion birds are prey species, which tend to hide signs of illness until disease is advanced. Many conditions can produce a very similar clinical picture. A lethargic, “fluffed and ruffled” appearance is a very common non-specific sign of illness in the avian patient. To increase the likelihood that subtle signs of illness will be recognized during the visual examination, first provide prey species with a 5-10-minute acclimation period. Signs of respiratory difficulty in the bird can include open-mouth breathing, increased sternal motion, and tail bobbing.
Review the slideshow Recognizing Signs of Illness in Birds for additional information.
Careful observation is essential. Is the patient strong enough to handle manual restraint and a complete physical examination? Or is the animal so ill that only a cursory examination can be performed? In the debilitated or dyspneic patient, it may be prudent to first place the patient in an incubator or oxygen cage in a dark, quiet room before evaluation. Even after the bird has had time to gather its strength and calm down, it may only be strong enough to handle diagnostics and treatment in stages.
The avian history must be detailed and includes not only signalment and recent medical history, but also source of the pet, complete dietary history, caging history–including whether or not the pet is always supervised outside of the cage–exposure to other pets, as well as recent illnesses or deaths of other birds in the household.
Refer to the podcast The Exotic Animal History for additional information.
Restraint & handling
Proper restraint of birds, that does not lead to patient or veterinary staff injury, requires training and practice. Prey species or wild birds will undergo a stress response that can cause catecholamine release and even death due to handling and treatment alone. Never restrain the avian patient for a prolonged period. Always plan a procedure that requires restraint and gather all equipment that may possibly be needed beforehand.
House avian patients in a quiet area away from the sight and sound of predator species like cats, dogs, and ferrets. The cage setup should also physically block the view of one animal from another. Many birds will also benefit from some form of visual security. Drape a towel over part of the incubator or tape newspaper or some other opaque material over part of a treatment cage door. Dim light levels as needed to calm the nervous patient.
A rapid metabolic rate means that small birds have a greater susceptibility to hypothermia. Debilitated birds should be kept warm. Target incubator temperatures range between 80-90°F (26-32°C) for most avian patients. Carefully observe the patient for signs of overheating, such as flat, sleek feathers, outstretched wings, and open-mouth breathing. Use particular caution in overweight birds.
All but the weakest perching birds will be much more comfortable if provided with perch material. Place perches on the cage floor or elevate perches only slightly to minimize the risk of falls.
Visit LafeberVet’s Exotic ICU: Nursing Care for the Avian Patient for additional information.
Even loss of small volumes of blood can leave a tiny animal critically hypovolemic. For these small patients, use small-volume fluid resuscitation with frequent reassessment rather than large fluid boluses. Vascular access sites are limited in the bird. Peripheral veins can be difficult to access, especially during shock, and the vessels are also prone to hematoma formation. Intraosseous catheter placement is generally faster and easier in birds and should be used as a first choice in an emergency situation.
Subcutaneous fluids are an excellent way to provide maintenance fluids to stable avian patients and to correct mild dehydration. Subcutaneous fluids may also be the safest route initially for extremely debilitated patients as well as those with respiratory distress or coelomic distension.
Antimicrobial choice is more limited when treating birds. Empirical antibiotics selected in the critically ill patient are generally bactericidal and broad-spectrum, such as cefotaxime 75-100 mg/kg IM, IV q8h (Claforan, Sanofi-Aventis) or piperacillin-taxobactam 100 mg/kg IM q6-12 (Zosyn, Wyeth) (Jenkins 2016, Stout 2016, Hawkins et al 2013).
When oral medications are indicated, commercially available or compounded suspensions are preferable. In-house compounding is not recommended, but can be used for individual dosing until a compounded formulation can be obtained. Drugs can also be administered by the intramuscular or subcutaneous routes. Insulin or tuberculin syringes provide more accurate dosing than larger syringes.
Corticosteroid use is controversial in birds, and there are many contraindications for its use. Aspergillosis can develop in avian patients during times of stress or immunosuppression, and corticosteroid use is an important predisposing condition. Therefore, corticosteroid use is not recommended as a standard treatment for most clinical conditions. Select another drug with the potential for fewer adverse effects whenever possible.
Clinical signs of pain are often more subtle in birds when compared to those seen in mammals. Behavioral signs of pain in birds can include reduced vocalization, decreased activity, anorexia, isolation from the group, and increased aggression. Physical signs of pain can include tachycardia, hypertension, arrhythmias, tachypnea, hypoxemia, hypercapnia, acidosis, abnormal posture and/or lameness, and weight loss.
As in all veterinary patients, provide pre-emptive analgesia and multimodal analgesic agents whenever possible. Non-steroidal anti-inflammatory drugs (NSAIDS), such as meloxicam, and opioids are frequently used. Kappa-agonists opioids, like butorphanol, are commonly used in birds however growing evidence suggest mu-agonists, such as hydromorphone and fentanyl, are more effective in some avian species.
The rapid metabolic rate of small avian patients leads to rapid depletion of glucose reserves. Fasting should be avoided and when required, generally should be less than 6 hours.
Nutritional support is essential in these patients. Provide familiar food items ad libitum. After the patient has been warmed and hydrated, tube or gavage feeding is often an essential part of avian supportive care. Tube feeding is a relatively straightforward technique in the bird, however there are serious potential complications, including aspiration, laceration of the oropharynx, cellulitis, and even death. Therefore, this technique should be practiced beforehand so tube feeding can be performed efficiently, safely, and gently in the clinical patient. Closely monitor patient body weight and droppings.
Visit Tube Feeding Birds for additional information.
Test your knowledge
Take the brief quiz Test Your Knowledge: Avian Critical Care
Common emergencies or presenting problems
- Broken blood feather
- Cloacal prolapse
- Dystocia, egg binding
- Fluffed and ruffled, lethargic appearance
- Seizure activity
- Toxic exposure
Although the principles of critical care are universal in all species, their application can be quite challenging in birds. Many companion birds are prey species. Provide these patients with a 5-10-minute acclimation period whenever possible, and minimize the time spent handling the bird. Supportive care relies upon supplemental heat provided in calm, quiet environment. Fluid therapy can be provided by an intraosseous catheter in select avian patients. Once the patient is warm and hydrated, begin nutritional support.
To learn more…
Like all segments of veterinary medicine, the medical care of birds is a complex and fascinating topic. This brief summary merely scratches the surface of what every clinician should know when they touch a bird. To learn more, browse the content featured in LafeberVet’s emergency and critical care teaching module landing page as well as the avian medicine page on LafeberVet, then continue your education with the Association of Avian Veterinarians.
References and further reading