Deep vein thrombosis during prolonged mechanical ventilation despite prophylaxis

Ibrahim, Emad; Iregui, Manuel; Prentice, Donna; Sherman, Glenda; Kollef, Marin H.; Shannon, William D.

doi:10.1097/00003246-200204000-00008

Cited by 138 publications

(103 citation statements)

References 14 publications

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“…Cook et al [23] and Khouli et al [27], using regular ultrasound screening, estimated the incidence of DVT in ICU medical-surgical patients to approach 10%; in trauma patients the DVT incidence ranged from 8% to 12% when ultrasound was used as a screening tool [4]. Accordingly, the 4.5% DVT incidence found in our prospective phase is consistent with outcome rates reported in other studies involving critically ill patients receiving thromboprophylaxis [4,23,24,27].…”

Section: Discussionsupporting

confidence: 86%

“…In intensive care unit (ICU) patients, stasis plays a major role because of immobility due to trauma, use of sedatives and neuromuscular block that markedly decreases the velocity of limb venous blood flow [2,3]. In addition, mechanical ventilation diminishes venous return of blood to the heart and can further facilitate the stasis of venous blood [4]. Under such pathophysiological conditions, the occurrence of additional DVT risk factors can precipitate thrombosis.…”

Section: Introductionmentioning

confidence: 99%

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Reduction in deep vein thrombosis incidence in intensive care after a clinician education program

Boddi

Barbani

Abbate

et al. 2010

Journal of Thrombosis and Haemostasis

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Summary.Background: Deep vein thrombosis (DVT) is a major complication in intensive care units (ICU) but dedicated guidelines on its management are still lacking. Objectives and Methods: This study investigated the effect of a 1-year educational program for the implementation of DVT prophylaxis on the incidence of inferior limb DVT in a mixed-bed ICU that admits high-risk surgical and trauma patients, investigated during a first retrospective phase [126 patients, SAPS II score 42 (28-54)] and a following prospective phase [264 patients, SAPS II score II 41 (27-55)]. The role of baseline and time-dependent DVT risk factors in DVT occurrence was also investigated during the prospective phase. Results: The educational program on implementation of DVT prophylaxis was associated with a significant decrease in DVT incidence from 11.9% to 4.5% (P < 0.01) and in the mean length of ICU stay (P < 0.01). Combined with pharmacological prophylaxis, the use of elastic compressive stockings significantly also increased in the prospective phase (P < 0.01). The duration of mechanical ventilation, vasopressor administration and neuromuscular block were significantly different between DVT-positive and DVT-negative patients (P < 0.01). Multivariate analysis identified neuromuscular block as the strongest independent predictor for DVT incidence. Conclusion: One-year ICU-based educational programs on implementation of DVT prophylaxis were associated with a significant decrease in the incidence of DVT and also in the length of stay in ICU.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Reduction in deep vein thrombosis incidence in intensive care after a clinician education program

Boddi

Barbani

Abbate

et al. 2010

Journal of Thrombosis and Haemostasis

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“…Os pacientes que não recebem profilaxia constituem um grupo de alto risco, com incidência variando de 25% a 31%. Entretanto, quando a profilaxia é adequada, a taxa de TVP diminui pela metade 5, [13][14][15] . O tromboembolismo pulmonar (TEP) deve ser encarado como complicação de uma trombose venosa, formada, na maioria dos casos, no sistema venoso profundo dos membros inferiores.…”

Section: Avaliação Do Risco Para Ocorrência De Tevunclassified

“…O tromboembolismo pulmonar (TEP) deve ser encarado como complicação de uma trombose venosa, formada, na maioria dos casos, no sistema venoso profundo dos membros inferiores. No ocidente, sua incidência na população geral é estimada em 5/10.000 pacientes; com mortalidade quatro vezes maior, quando o tratamento não é instituído 15 . Entretanto, o diagnóstico é freqüente-mente subestimado, sendo que apenas 40% dos casos de embolia pulmonar diagnosticado em necropsia foram suspeitados clinicamente 7 .…”

Section: Avaliação Do Risco Para Ocorrência De Tevunclassified

Desafios na profilaxia do tromboembolismo venoso: abordagem do paciente crítico

Ribeiro¹,

Netto²,

Lage

2006

Rev. bras. ter. intensiva

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RESUMO JUSTIFICATIVA E OBJETIVOS: O tromboembolismo venoso (TEV), que inclui a trombose venosa profunda (TVP) e o tromboembolismo pulmonar (TEP) são complicações comuns em pacientes críticos. A ocorrência de TEV acarreta um substancial aumento da morbimortalidade dos pacientes internados em unidades de terapia intensiva (UTI). CONTEÚDO: A maioria dos pacientes críticos apresenta alto risco para ocorrência de complicações tromboembólicas, entretanto, a prevenção do TEV muitas vezes não é realizada de maneira adequada para este grupo de pacientes. A heparina de baixo peso molecular (HBPM) parece ser o método mais eficiente para a prevenção do TEV em pacientes de UTI. Entretanto, é patente a escassez de estudos voltados para esta população, cujas particularidades levam a recomendações específicas em relação ao diagnóstico e tratamento. Desafios na Profilaxia do Tromboembolismo Venoso:Abordagem do Paciente Crítico* CONCLUSÕES: Esta revisão faz uma análise do risco, discute os principais trabalhos publicados a respeito da profilaxia e sugere estratégias para a diminuição da ocorrência de TEV nos pacientes críticos. Unitermos: paciente crítico, prevenção de TVP, trombose venosa profunda, tromboembolismo pulmonar SUMMARY BACKGROUND AND OBJECTIVES: Venous thromboembolism (VTE), with includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication in critically ill patients, resulting in high morbidity and mortality. CONTENTS: Most patients treated in intensive care units (ICU) face a high risk of thromboembolic complications. Despite these considerations, the prevention of VTE may not be as high a priority in ICU patients as it is in other high-risk patient groups. Low molecular weight heparin (LMWH) may be the optimal prophylaxis in most ICU patients, but there is a lack of sufficient data including the paucity of VTE consensus and guidelines documents pertaining to critically ill patients. CONCLUSIONS: This article reviews background, current options, and recommendations regarding VTE in intensive care population emphasizing special diagnostic and treatment considerations in the ICU setting. Challenges in Prevention Venous

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“…1 Prolonged mechanical ventilation has been associated with high incidence of deep venous thrombosis (DVT) despite thromboprophylaxis. 2,3 In ICU patients, PE has been reported in 7-27% of post-mortem examinations and was thought to have caused or contributed to death in 0-12%, but there was clinical suspicion of PE in only 30% of these patients before death. 4 In sedated and ventilated patients with physiological derangement, PE would produce relatively non-specific signs and minimal or no symptoms, and hence presents a diagnostic challenge.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Embolism in the Mechanically-Ventilated Critically Ill Patient: Is it Different?

Zochios

Keeshan

2013

Journal of the Intensive Care Society

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Acute PE results in increased right ventricular (RV) afterload. If the afterload is severely increased, RV enlargement, hypokinesis, ischaemia and RV failure may ensue. 13,14 The concomitant release of vasoactive and bronchoactive humoral factors such as serotonin from platelets, thrombin from plasma and histamine from tissue, have all been implicated in both pulmonary oedema and the ventilation-perfusion mismatch seen. 15 Experimental data suggest that the main mechanisms involved in hypoxaemia and the increase in the alveolararterial oxygen tension gradient are shunt, low ventilationperfusion ratio (V/Q), decrease in the mixed venous partial Pulmonary embolism in the mechanicallyventilated critically ill patient: is it different? 2C03, 3C00VA Zochios, A Keeshan Pulmonary embolism (PE) confers significant in-hospital morbidity and mortality, and critically ill patients remain at risk for venous thromboembolism despite thromboprophylaxis. Recognition of the clinical manifestations and immediate management of PE are of paramount importance. Despite diagnostic advances, PE is often undiagnosed and untreated in patients receiving mechanical ventilation, as these patients do not exhibit the common clinical features of the condition, making the diagnosis very challenging. Computed tomographic pulmonary angiography is probably the reference standard for the diagnosis of acute PE in the haemodynamically stable, ventilated patient. In the setting of circulatory collapse, bedside echocardiography may be used to risk stratify these patients, based on the presence or absence of right ventricular dysfunction, and guide further management. Treatment options include anticoagulation alone, anticoagulation plus thrombolysis, surgical or catheter embolectomy. Inotropes, vasopressors and pulmonary artery vasodilators may be considered after initial resuscitation of the right ventricle. Few studies have focused on estimating the prevalence of PE among mechanically-ventilated intensive care unit (ICU) patients and there is notable lack of data assessing predictive factors, prevention, diagnostic strategy and management of PE in the ICU setting.

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Deep vein thrombosis during prolonged mechanical ventilation despite prophylaxis

Cited by 138 publications

References 14 publications

Reduction in deep vein thrombosis incidence in intensive care after a clinician education program

Reduction in deep vein thrombosis incidence in intensive care after a clinician education program

Desafios na profilaxia do tromboembolismo venoso: abordagem do paciente crítico

Pulmonary Embolism in the Mechanically-Ventilated Critically Ill Patient: Is it Different?

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