Venous thromboembolism and its prevention in critical care☆,☆☆
Section snippets
Methods
We conducted a computerized, English-language, literature search by using Medline and Embase, from 1966 to January, 2002, using the keywords “venous thromboembolism” or “venous thrombosis” or “pulmonary embolism” and “critical care” or “intensive care units.” In addition, we reviewed the bibliographies of retrieved articles and our personal files. To be included, studies addressing the prevalence of DVT had to (1) be prospective, (2) enroll patients who did not receive thromboprophylaxis, and
VTE prevalence studies in critical care
Six studies have examined the rates of PE and fatal PE shown by autopsy in critically ill patients (Table 1).25, 26, 27, 28, 29, 30
Author (yr) ICU Setting Admissions to ICU Deaths, n (% ICU Admissions) Autopsies n (% Deaths) PE, n (% Autopsies) Fatal PE,* n (% Autopsies) Neuhaus (1978)25 Medical/surgical 617 102 (17%) 66 (65%) 18 (27%) 8 (12%) Moser (1981)26 Respiratory 34 16 (47%) 10 (63%) 2 (20%) 0 Pingleton (1981)27 Medical 197 56 (28%) 40 (71%) 9 (23%)
Discussion
Our main conclusion is that the risk for DVT and PE in critically ill patients is moderate to high, although the available studies are small and have methodologic limitations. The optimal methods of thromboprophylaxis in the intensive care unit are uncertain because of the paucity of randomized trials in critically ill patients. Therefore, current strategies for the prevention of VTE must largely be derived from studies in other patient populations.
For many reasons it is not surprising that
Future directions
It is clear that substantially more ICU-specific data about thromboembolic risks, risk factors, and prevention are required. In Table 9, we outline some of the areas that warrant further research.
Epidemiology Prevalence of VTE on admission to the ICU Incidence of ICU-acquired VTE in heterogeneous ICU patients Analyses of the relative importance of VTE risk factors (genetic, pre-ICU, and ICU-acquired) Accuracy of noninvasive diagnostic
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2018, Journal of Critical CareCitation Excerpt :Risk factors for DVT in trauma include surgical trauma per se, vascular/cardiac catheters, immobility, application of tourniquet, and use of muscular blockade agents [7-9]. Identification of DVT in these cases is paramount because trauma patients frequently have significantly impaired cardio-respiratory reserves [16,17]; therefore, they cannot tolerate even a small pulmonary embolism or other pulmonary disturbances that an otherwise healthy patient can tolerate without difficulty [16-18]. Studies in trauma patients have reported varying rates of overall DVT events ranging from 0.36% to 58%, depending on the patients studied and the methods used to diagnose the DVT [19,20].
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D.C. is a Chair of the Canadian Institutes for Health Research and Chair of the Canadian Critical Care Trials Group. R.S. holds a New Investigator Award from the Canadian Institutes for Health Research.
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