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01.02.2016 | Originalien

Impact of unsuspected subsegmental pulmonary embolism in ICU patients

verfasst von: Dr. C. Koch, MD, R. Schramm, F.C. Roller, A. Hecker, M. Henrich, E. Schneck, G. Krombach, M.A. Weigand, C. Lichtenstern

Erschienen in: Die Anaesthesiologie | Ausgabe 2/2016

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Abstract

Background

Critically ill patients in intensive-care units are at high risk for pulmonary embolism (PE). As a result of modern multi-detector computed tomographic angiography (MDCT) increased visualization of peripheral pulmonary arteries, isolated subsegmental pulmonary embolisms (ISSPE) are increasingly being detected.

Aim

The aim of this study was to investigate the rate, impact on treatment, and outcome of unsuspected ISSPE in critically ill patients receiving MDCT. The secondary aim was to investigate the potential impact of contrast media-induced nephropathy (CIN) in our cohort.

Methods

We conducted a retrospective single-centre analysis on critically ill adult patients treated between January 2009 and December 2012 who underwent a contrast-enhanced chest MDCT. We excluded patients with clinical suspicion of PE/ISSPE prior to CT and patients with MDCT confirmed central PE. Clinical findings, laboratory parameters, and outcome data were recorded.

Results

We identified 240 ICU patients not suspected for PE receiving MDCT. A total of 12 Patients (5 %) showed unexpected ISSPE representing increased 24 h mortality (16.7 vs. 3.5 %; p = 0.026) compared to non-ISPPE/non-PE patients. A 30-days mortality did not differ between the groups (33.3 vs. 33.8 %; p = 0.53). Highest mean creatinine serum level in our cohort (n = 240) was found before MDCT with a significant decrease to day 5 (1.4 ± 1.1 vs. 1.1 ± 0.9 mg/dl: p < 0.0001) after contrast media administration.

Conclusion

Critically ill patients are at relevant risk for ISSPE. ISSPE was associated with a poor 24 h outcome. In addition, in our cohort, contrast media application was not associated with increased serum creatinine.

Adriance SM, Murphy CV (2013) Prophylaxis and treatment of venous thromboembolism in the critically ill. Int J Crit Illn Inj Sci 3:143–151. doi:10.4103/2229-5151.114274 PubMedCentralCrossRefPubMed

Ahvenjärvi LK, Laurila JJ, Jartti A et al (2008) Multi-detector computed tomography in critically ill patients. Acta Anaesthesiol Scand 52:547–552. doi:10.1111/j.1399-6576.2007.01559.x CrossRefPubMed

Anas AA, Wiersinga WJ, de Vos AF, van der Poll T (2010) Recent insights into the pathogenesis of bacterial sepsis. Neth J Med 68:147–152PubMed

Anderson FA (1991) A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. Arch Intern Med 151:933. doi:10.1001/archinte.1991.00400050081016 CrossRefPubMed

Anderson DR, Kahn SR, Rodger MA et al (2007) Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA 298:2743–2753. doi:10.1001/jama.298.23.2743 CrossRefPubMed

Dalhoff K, Abele-Horn M, Andreas S et al (2012) Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbi. Pneumologie 66:707–765. doi:10.1055/s-0032-1325924 CrossRefPubMed

Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228. doi:10.1007/s00134-012-2769-8 CrossRefPubMed

Den Exter PL, van Es J, Klok FA et al (2013) Risk profile and clinical outcome of symptomatic subsegmental acute pulmonary embolism. Blood 122:1144–1149. doi:10.1182/blood-2013-04-497545. (quiz 1329)CrossRefPubMed

Eyer BA, Goodman LR, Washington L (2005) Clinicians’ response to radiologists’ reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT. AJR Am J Roentgenol 184:623–628. doi:10.2214/ajr.184.2.01840623 CrossRefPubMed

10.

Ghaye B, Dondelinger RF (2002) Non-traumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis. Eur Radiol 12:1906–1921. doi:10.1007/s00330-002-1505-0 CrossRefPubMed

11.

Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353:1386–1389. doi:10.1016/S0140-6736(98)07534-5 CrossRefPubMed

12.

Guyatt GH, Akl EA, Crowther M et al (2012) Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: american college of chest physicians evidence-based clinical practice guidelines. Chest 141:7S–47S. doi:10.1378/chest.1412 S3 PubMedCentralCrossRefPubMed

13.

Jochberger S, Mayr V, Luckner G et al (2005) Antifactor Xa activity in critically ill patients receiving antithrombotic prophylaxis with standard dosages of certoparin: a prospective, clinical study. Crit Care 9:R541–R548. doi:10.1186/cc3792 PubMedCentralCrossRefPubMed

14.

Klok FA, Mos ICM, Kroft LJM et al (2011) Computed tomography pulmonary angiography as a single imaging test to rule out pulmonary embolism. Curr Opin Pulm Med 17:380–386. doi:10.1097/MCP.0b013e328348b3de CrossRefPubMed

15.

Lakhal K, Ehrmann S, Chaari A et al (2011) Acute Kidney Injury Network definition of contrast-induced nephropathy in the critically ill: incidence and outcome. J Crit Care 26:593–599. doi:10.1016/j.jcrc.2011.05.010 CrossRefPubMed

16.

Lightfoot CB, Abraham RJ, Mammen T et al (2009) Survey of radiologists’ knowledge regarding the management of severe contrast material-induced allergic reactions. Radiology 251:691–696. doi:10.1148/radiol.2513081651 CrossRefPubMed

17.

Mayr AJ, Dünser M, Jochberger S et al (2002) Antifactor Xa activity in intensive care patients receiving thromboembolic prophylaxis with standard doses of enoxaparin. Thromb Res 105:201–204CrossRefPubMed

18.

Penaloza A, Roy P-M, Kline J et al (2012) Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. J Thromb Haemost 10:1291–1296. doi:10.1111/j.1538-7836.2012.04769.x CrossRefPubMed

19.

Schoepf UJ, Holzknecht N, Helmberger TK et al (2002) Subsegmental pulmonary emboli: improved detection with thin-collimation multi-detector row spiral CT. Radiology 222:483–490. doi:10.1148/radiol.2222001802 CrossRefPubMed

20.

Snow N (1990) Thoracic CT scanning in critically ill patients. Information obtained frequently alters management. Chest 97:1467. doi:10.1378/chest.97.6.1467 CrossRefPubMed

21.

Tsao C-M, Ho S-T, Wu C-C (2015) Coagulation abnormalities in sepsis. Acta Anaesthesiol Taiwan 53:16–22. doi:10.1016/j.aat.2014.11.002 CrossRefPubMed

22.

White RH, Zhou H, Gage BF (2004) Effect of age on the incidence of venous thromboembolism after major surgery. J Thromb Haemost 2:1327–1333. doi:10.1046/j.1538-7836.2004.00848.x CrossRefPubMed

23.

Yoo HHB, Queluz THAT, El Dib R (2014) Anticoagulant treatment for subsegmental pulmonary embolism. Cochrane database Syst Rev 4:CD010222. doi:10.1002/14651858.CD010222.pub2 PubMed

Titel: Impact of unsuspected subsegmental pulmonary embolism in ICU patients
verfasst von: Dr. C. Koch, MD
R. Schramm
F.C. Roller
A. Hecker
M. Henrich
E. Schneck
G. Krombach
M.A. Weigand
C. Lichtenstern
Publikationsdatum: 01.02.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Die Anaesthesiologie / Ausgabe 2/2016
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-015-0118-3

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Impact of unsuspected subsegmental pulmonary embolism in ICU patients