ABSTRACT
PURPOSE: to evaluate the current rate of pulmonary embolism (PE) in our medico-surgical intensive care unit (ICU), to identify risk factors, and to determine the outcome of PE in ICU. METHODS: We performed a prospective cohort study of consecutive patients requiring intensive care admission during a one-year period. We included, in this prospective study, all the patients with confirmed PE admitted in ICU with more than 18 years of age, and expected to stay in ICU for more than 48 hours. Only the patients who had a clinical suspicion (unexplained hypoxemia and/or shock) for PE underwent diagnostic studies. RESULTS: During the study period, 842 patients were admitted in our ICU. One hundred and two patients were excluded. The diagnosis of PE was confirmed in 75 patients (10.1%). In our study, all patients (100%) had received some forms of pharmaceutical prophylaxis (PP) during ICU stay. The median time from ICU admission to diagnosis of PE was 6 days. The diagnosis of PE was made by spiral CT in 74 patients (98.7%), and by echocardiography in 1 case (1.3%). The mean ICU stay was 26.3 ± 26.5 days (median: 20 days). During their ICU stay, 73 patients (97.3%) developed one, or more, organ failure. Respiratory failure was the most observed (97.3%). Moreover, 38 patients (50.6%) developed nosocomial infections and 29 (38.6%) died. The multivariate analysis showed that the risk factors associated with mortality were the presence of shock the day of PE diagnosis and the presence of right ventricular dilatation on echocardiography. CONCLUSION: Our findings confirm that subjects in the ICU are at high risk of PE, due to a high number of risk-factors. PE was associated with higher ICU mortality and a significantly higher ICU LOS. Our results invite to revise the preventive strategies of deep venous thrombosis and PE in patients requiring ICU admission.
Subject(s)
Cross Infection/etiology , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/mortality , Adult , Aged , Cross Infection/mortality , Echocardiography/methods , Female , Humans , Hypertrophy, Right Ventricular/diagnostic imaging , Intensive Care Units/statistics & numerical data , Length of Stay , Male , Middle Aged , Outcome Assessment, Health Care , Prospective Studies , Pulmonary Embolism/epidemiology , Pulmonary Embolism/prevention & control , Respiratory Insufficiency/etiology , Risk Factors , Tomography, Spiral Computed/methods , Venous Thrombosis/complications , Venous Thrombosis/prevention & controlABSTRACT
AIM: Our aim was to evaluate the indications and contribution of liver biopsy (LB) in intensive care (ICU) and to compare them to those of LB in gastroenterology. METHODS: We included retrospectively 37 successive LB achieved in ICU and 38 successive LB achieved in gastroenterology. All data were reviewed by three intensivists and three gastroenterologists to determine the contribution of the LB. RESULTS: The indications of LB were different in the two units. The most frequent indications were cirrhosis (36.8%), isolated biological hepatic disruptions (26.3%) and histological classification of viral hepatitis (18.4%) in gastroenterology and isolated biological hepatic disruptions (48.6%), hepatopathy during pregnancy (27%) and fever of unknown origin (10.8%) in intensive care unit. According to the six reviewers, LB was enough contributive in the two units, (78.4% in ICU and 71.1% in gastroenterology -p=0.46-). It allowed to eliminate, to confirm, or to change a diagnosis in more than 70% of cases and allowed to modify the course of therapy in 21.6% of cases in ICU and in 26.3% of cases in gastroenterology (p-0.6). CONCLUSION: The LB is a feasible technique in ICU and can be as contributive as it is in gastroenterology.
