**Background:** Tick paralysis (TP) is a common cause of morbidity and mortality in dogs and cats in Australia, with over 10,000 pets estimated to present annually. The disease is caused primarily by the toxin holocyclotoxin1 from the salivary glands of adult female *Ixodes holocyclus* ticks, which prevents presynaptic release of acetylcholine at the neuromuscular junction, leading to ascending flaccid paralysis. Respiratory failure is the main cause of death, with mortality rates of 2–5% in treated animals. Mechanical ventilation (MV) is a critical intervention for severely affected animals, but evidence-based guidelines are limited. This review aims to summarize current recommendations for indications, management, and prognosis of MV in TP patients and identify areas for future research.
**Methods:** This is a narrative review of the literature on MV in dogs and cats with TP. The authors synthesized data from retrospective studies, case reports, and expert consensus guidelines, focusing on pathophysiology, indications for MV, airway management, anesthesia, ventilator settings, patient monitoring, nursing care, fluid therapy, nutrition, weaning, and prognosis. Key studies cited include a retrospective multi-center study of 54 dogs and 7 cats (Webster et al.), a retrospective analysis of 26 dogs and 2 cats with positive airway cultures, and histopathological studies of fatal TP cases.
**Key Results:** MV is indicated when severe hypoxemia (PaO2 <60 mmHg or SpO2 <90% despite supplemental oxygen), severe hypercapnia (PaCO2 >60 mmHg), or unsustainable respiratory effort persists. In a retrospective study, 38.9% of dogs were ventilated for hypoxemia, 33.3% for hypercapnia, 18.5% for unsustainable effort, and 7.4% for respiratory arrest; cats were most frequently ventilated for hypoventilation (71.4%). Median duration of MV ranges from 23 hours to 4 days (range 1–10 days). Survival to discharge (STD) is 75% overall when financial euthanasia is excluded, with 90.5% STD for ventilatory failure and 52.6% for hypoxemia. A more recent study reported 77% STD in animals with positive airway cultures. Bronchopneumonia is present in 48–60% of dogs and 18% of cats with fatal TP. Ventilator-associated pneumonia incidence is 3.8%. Corneal ulceration occurs in 5–36% of ventilated patients, and oral lesions in 37–90.5% of dogs. Recommended initial ventilator settings include tidal volume 6–8 ml/kg, PEEP 5 cmH2O, and FiO2 1.0, with lung-protective strategies to avoid plateau pressures >30 cmH2O. Total intravenous anesthesia (TIVA) with propofol, butorphanol, and midazolam is commonly used. Weaning is guided by clinical judgment, with pressure support ventilation preferred at the authors' institution.
**Clinical Implications:** MV is a life-saving intervention for dogs and cats with severe TP, with favorable outcomes compared to other causes of respiratory failure. Clinicians should initiate MV early based on clinical signs and blood gas parameters, using lung-protective strategies to minimize ventilator-induced lung injury. Meticulous nursing care—including airway management, ocular care, oral hygiene, and fluid balance—is essential to reduce complications. Nutritional support should be considered after 72 hours, but enteral feeding is often contraindicated due to megaesophagus and aspiration risk. Weaning should be attempted when the patient is cardiovascularly stable and can maintain adequate gas exchange on minimal support. Future research is needed to optimize sedation protocols, ventilator modes, and ancillary care for this unique patient population.