Occult Pulmonary Embolism in Intensive Care Unit Patients Undergoing Chest Computed Tomography Scan: Incidence and Effect on Outcomes

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 27; no. 3; pp. 474 - 478
• Main Authors: Arnoult, Elodie, MD, Wiramus, Sandrine, MD, Textoris, Julien, MD, PhD, Craighero, Fabien, MD, Ragonnet, Benoit, MD, Hammad, Emmanuelle, MD, Chaumoître, Kathia, MD, PhD, Martin, Claude, MD, Leone, Marc, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2013
• Subjects: Adult; Aged; Anesthesia & Perioperative Care; Case Management; Cohort Studies; computed tomography; Critical Care; Critical Care - methods; embolism; Female; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; occult; pulmonary emboli; Pulmonary Embolism - epidemiology; Pulmonary Embolism - etiology; Pulmonary Embolism - therapy; Respiration, Artificial; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed - adverse effects; Tomography, X-Ray Computed - methods; Treatment Outcome; computed tomography; critical care; embolism; occult; pulmonary emboli
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2012.10.015

Objective To determine the incidence of occult pulmonary embolism (PE) and the associated morbidity in an intensive care unit (ICU). Design Retrospective study. Setting Fifteen-bed ICU of a university hospital. Participants Two hundred patients who underwent chest computed tomography (CT) scans with administration of contrast. Interventions The patients were classified into 3 groups: (1) Occult PE if the chest CT scan was not taken, specifically for elucidating the diagnosis of PE, but it confirmed this diagnosis; (2) non-occult PE if the chest CT scan was taken to elucidate a suspected diagnosis of PE and confirmed this diagnosis; and (3) the chest CT scan did not confirm this diagnosis. The analysis was conducted to identify the effect of a diagnosis of occult PE on the outcomes of patients. Measurements and Main Results Among the 200 patients who underwent chest CT scan, 27 (13%) patients had PE, in whom 18 (9%) were classified as occult PE and 9 (4.5%) as non-occult PE. The duration of ICU stay was increased in patients with PE, as compared with the controls (23 [18-48] days v 17 [10-20] days v 14 [7-29] days; p = 0.02 for occult PE, non-occult PE, and controls, respectively). No difference was observed in mortality rate among the 3 groups. Conclusion Occult PE was found in 9% of the cohort. This emphasized the need for developing diagnostic strategies in high-risk patients. Future studies should aim at assessing interventions for preventing this event.