Deep venous thrombosis and pulmonary embolism. Frequency in a respiratory intensive care unit
K. M. Moser, J. R. LeMoine, F. J. Nachtwey and R. G. Spragg
Radiofibrinogen leg scans were performed in 34 patients admitted to a
respiratory intensive care unit (ICU) for treatment of acute respiratory
failure. In 23 patients, the leg scans were performed during the first ICU
week, and abnormal leg scans developed in three (13%). In 11 patients, leg
scans were done beyond the first week; all were normal. Autopsy incidence
of embolism was 20%. No patient died of embolism. The low frequency of
fatal embolism had led us to discontinue the routine use of low-dose
heparin prophylaxis in these patients in our respiratory ICU. In its place,
we have substituted an ongoing investigation of noninvasive monitoring with
both radioactive fibrinogen leg scanning and impedance plethysmography.
From such investigations should emerge more definitive strategies for
dealing with venous thromboembolism in this complex patient population.
