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Pulmonary embolism in mechanically ventilated patients requiring computed tomography: Prevalence, risk factors, and outcome*

Minet, Clémence MD; Lugosi, Maxime MD; Savoye, Pierre Yves MD; Menez, Caroline MD; Ruckly, Stéphane MSc; Bonadona, Agnès MD; Schwebel, Carole MD, PhD; Hamidfar-Roy, Rebecca MD; Dumanoir, Perrine MD; Ara-Somohano, Claire MD; Ferretti, Gilbert R. MD, PhD; Timsit, Jean-François MD, PhD

doi: 10.1097/CCM.0b013e318265e461
Clinical Investigations

Objective: To estimate the rate of pulmonary embolism among mechanically ventilated patients and its association with deep venous thrombosis.

Design: Prospective cohort study.

Setting: Medical intensive care unit of a university-affiliated teaching hospital.

Patients: Inclusion criteria: mechanically ventilated patients requiring a thoracic contrast-enhanced computed tomography scan for any medical reason. Exclusion criteria: a diagnosis of pulmonary embolism before intensive care unit admission, an allergy to contrast agents, and age younger than 18 yrs.

Interventions: All the mechanically ventilated patients requiring a thoracic computed tomography underwent the standard imaging protocol for pulmonary embolism detection. Therapeutic anticoagulation was given immediately after pulmonary embolism diagnosis. All the included patients underwent a compression ultrasound of the four limbs within 48 hrs after the computed tomography scan to detect deep venous thrombosis.

Results: Of 176 included patients, 33 (18.7%) had pulmonary embolism diagnosed by computed tomography, including 20 (61%) with no clinical suspicion of pulmonary embolism. By multiple logistic regression, independent risk factors for pulmonary embolism were male gender, high body mass index, history of cancer, past medical history of deep venous thrombosis, coma, and high platelet count. Previous prophylactic anticoagulant use was not a risk factor for pulmonary embolism. Of the 176 patients, 35 (19.9%) had deep venous thrombosis by compression ultrasonography, including 20 (57.1%) in the lower limbs and 24 (68.6%) related to central venous catheters. Of the 33 pulmonary embolisms, 11 (33.3%) were associated with deep venous thrombosis. The pulmonary embolism risk was increased by lower-limb deep venous thrombosis (odds ratio 4.0; 95% confidence interval 1.6–10) but not upper-limb deep venous thrombosis (odds ratio 0.6; 95% confidence interval 0.1–2.9). Crude comparison of patients with and without pulmonary embolism shows no difference in length of stay or mortality.

Conclusions: In mechanically ventilated patients who needed a computed tomography, pulmonary embolism was more common than expected. Patients diagnosed with pulmonary embolism were all treated with therapeutic anticoagulation, and their intensive care unit or hospital mortality was not impacted by the pulmonary embolism occurrence. These results invite further research into early screening and therapeutic anticoagulation of pulmonary embolism in critically ill patients.

From the Medical Intensive Care Unit (C. Minet, ML, AB, CS, RH-R, PD, CA-S, J-FT), Radiology and Medical Imaging Ward (PYS, GRF), Vascular Medicine Ward (C. Menez), and U823 Institut Albert Bonniot (SR, J-FT), UJF-Grenoble I, University Hospital Albert Michallon, Grenoble, France.

*See also p. 3320.

Currently listed as ClinicalTrials.gov NCT01457963.

Dr. Timsit was the principal investigator. He contributed to the study concept and design, the recruitment of patients, the analysis of the data, the interpretation of the results, and redaction of the article. Dr. Minet contributed to the study design, the recruitment of patients, the acquisition and analysis of the data, the interpretation of the results, and redaction of the article. Mr. Ruckly contributed to the statistical analysis of the data. Dr. Savoye contributed to the acquisition and analysis of the radiological parameters. Dr. Menez contributed to the acquisition and analysis of the vascular parameters. Dr. Ferretti contributed the acquisition and analysis of the radiological parameters and redaction of the article. Drs. Lugosi, Bonadona, Schwebel, Hamidfar-Roy, Dumanoir, and Ara-Somohano contributed to the analysis of the data and the redaction of the article. All the authors approved the final version of the manuscript.

This study was performed at the medical intensive care unit of the Albert Michallon University Hospital, Grenoble, France.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: jftimsit@chu-grenoble.fr

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins