ABSTRACT
BACKGROUND: Pulmonary embolism (PE) is morbid perioperative complication and deep vein thrombosis (DVT) is the most common cause of PE. Echo-color-Doppler examination for DVT is a specific test. But it would not be cost-effective to perform in all preoperative patients. The aim of this study was to determine the cut-off value of age body mass index (BMI) and D-dimer (DD) for further examination (echo) of DVT. METHODS: The age, BMI and DD of patients who had undergone echo-color-Doppler test were retrospectively examined. There were 94 patients scheduled for elective operation under general anesthesia from May 2004 to March 2005 in Himeji Red Cross Hospital. RESULTS: Forty five patients were with DVT and 49 patients were without DVT. There was no significant difference between the two groups in BMI. The cut-off value of age was 39 years and that of D-dimer was 0.8 µg x ml(-1). Discriminant function of DVT and D-dimer age were obtained in the formulae, Z = 0.0047 x (Age)(2) - 0.0565 x (D-D)(2) - 0.0046 (Age) x (DD) - 0.7085 x (Age) +0.546 x (DD) + 26.5674. CONCLUSIONS: We recommend that the patients above the discriminant function curve of DVT should undergo further examination for DVT.
Subject(s)
Body Mass Index , Fibrin Fibrinogen Degradation Products/metabolism , Preoperative Period , Ultrasonography, Doppler, Color , Venous Thrombosis/diagnosis , Adult , Age Factors , Aged , Aged, 80 and over , Biomarkers/blood , Female , Humans , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Pulmonary Embolism/etiology , Pulmonary Embolism/prevention & control , Retrospective Studies , Venous Thrombosis/complications , Venous Thrombosis/diagnostic imagingABSTRACT
A 73-year-old man hit his fore-chest accidentally when he rode his motorcycle. A huge flail chest was observed on his central fore-chest, and multiple fractures of costal cartilage were suspected. He developed pneumonia on the 4th hospital day, and he was intubated and mechanical ventilation was initiated. Because frequent sputum aspiration was necessary and aggressive physiotherapy was desirable, a tracheotomy was performed on the same day of intubation. He recovered from respiratory failure with conservative therapy and the mechanical ventilation was disconnected 13 days later. Tracheotomy in the early phase of respiratory failure with flail chest was very effective and the surgical fixation of flail segment would not be necessary even in the case of 'stove-in chest' like the present case.
