Year : 2011 | Volume
: 6 | Issue : 4 | Page : 199--206
Post-traumatic pulmonary embolism in the intensive care unit
Mabrouk Bahloul1, Anis Chaari1, Hassen Dammak1, Fatma Medhioub1, Leila Abid2, Hichem Ksibi1, Sondes Haddar3, Hatem Kallel1, Hedi Chelly1, Chokri Ben Hamida1, Mounir Bouaziz1
1 Department of Intensive Care, Hedi Chaker, University Hospital Sfax, Tunisia
2 Department of Cardiology, Hedi Chaker, University Hospital Sfax, Tunisia
3 Department of Radiology, Habib Bourguiba, University Hospital Sfax, Tunisia
Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE) admitted in the intensive care unit (ICU).
Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients admitted to our ICU were classified into two groups. The first group included all patients with confirmed PE; the second group included patients without clinical manifestations of PE. The diagnosis of PE was confirmed either by a high-probability ventilation/perfusion (V/Q) scan or by a spiral computed tomography (CT) scan showing one or more filling defects in the pulmonary artery or its branches.
Results: During the study period, 1067 trauma patients were admitted in our ICU. The diagnosis of PE was confirmed in 34 patients (3.2%). The mean delay of development of PE was 11.3 ± 9.3 days. Eight patients (24%) developed this complication within five days of ICU admission. On the day of PE diagnosis, the clinical examination showed that 13 patients (38.2%) were hypotensive, 23 (67.7%) had systemic inflammatory response syndrome (SIRS), three (8.8%) had clinical manifestations of deep venous thrombosis (DVT), and 32 (94%) had respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 32 cases (94%) and low molecular weight heparin was used in two cases (4%). The mean ICU stay was 31.6 ± 35.7 days and the mean hospital stay was 32.7 ± 35.3 days. The mortality rate in the ICU was 38.2% and the in-hospital mortality rate was 41%. The multivariate analysis showed that factors associated with poor prognosis in the ICU were the presence of circulatory failure (Shock) (Odds ratio (OR) = 9.96) and thrombocytopenia (OR = 32.5).Moreover, comparison between patients with and without PE showed that the predictive factors of PE were: Age > 40 years, a SAPS II score > 25, hypoxemia with PaO2 /FiO 2 < 200 mmHg, the presence of spine fracture, and the presence of meningeal hemorrhage.
Conclusion: Despite the high frequency of DVT in post-traumatic critically ill patients, symptomatic PE remains, although not frequently observed, because systematic screening is not performed. Factors associated with poor prognosis in the ICU are the presence of circulatory failure (shock) and thrombocytopenia. Predictive factors of PE are: Age > 40 years, a SAPS II score > 25, hypoxemia with PaO2 /FiO 2 < 200, the presence of a spine fracture, and the presence of meningeal hemorrhage. Prevention is highly warranted.
Associate Professor, Department of Medical Intensive Care, H˘pital Habib Bourguiba, Route el Ain Km 1 3029, Sfax
|How to cite this article:|
Bahloul M, Chaari A, Dammak H, Medhioub F, Abid L, Ksibi H, Haddar S, Kallel H, Chelly H, Hamida CB, Bouaziz M. Post-traumatic pulmonary embolism in the intensive care unit.Ann Thorac Med 2011;6:199-206
|How to cite this URL:|
Bahloul M, Chaari A, Dammak H, Medhioub F, Abid L, Ksibi H, Haddar S, Kallel H, Chelly H, Hamida CB, Bouaziz M. Post-traumatic pulmonary embolism in the intensive care unit. Ann Thorac Med [serial online] 2011 [cited 2020 May 26 ];6:199-206
Available from: http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2011;volume=6;issue=4;spage=199;epage=206;aulast=Bahloul;type=0