Clinical and epidemiological features of a series of 73 cases of pulmonary embolism admitted to an ICU

Introduction

Pulmonary embolism (PE) is a clinical syndrome resulting from occlusion of the pulmonary arterial circulation from one or more emboli. In the United States, its incidence is estimated at 1/1,000 hospital admissions per year [1].

Objective

To describe the clinical and epidemiological data of patients admitted to an ICU due to PE.

Materials and methods

From January 2006 to February 2009, 73 patients diagnosed with PE were admitted to the ICU of Hospital Santa Lúcia, Brasília, Brazil. The study is an observational research in which the data were prospectively collected through interviews with patients and their families and by consultation of medical charts and laboratorial tests.

Results

Seventy-three patients were analyzed, 42 female (57.53%) and 31 male (42.27%). The mean age was 59.53 ± 18.90 years (17 to 91). The mean body mass index was 29.77 ± 8.04 kg/m² (18.97 to 63.26). A total of 76.71% of patients were older than 40 years of age. The risk factors with higher prevalence for PE were recent surgery – up to 6 months before admission (31.50%), previous PE or deep venous thrombosis (DVT) (30.13%), immobility (30.13%), venous insufficiency (30.13%) and obesity (27.39%). Thirty-three patients (45.20%) had a sedentary lifestyle and 26 patients (35.61%) presented systemic arterial hypertension. Dyspnea was the most prevalent (84.93% of patients) clinical manifestation, followed by chest pain (52.05%), cough (38.35%) and sweating (26.02%). The D-dimer was determined in 19 patients (26.02%), which was positive in 17 (89.47%). Computerized tomography was performed in 69 patients (94.52%), lower limb compression venous ultrasonography in 21 patients (28.76%), echocardiography in 20 patients (27.39%) and scintigraphy in 10 patients (13.69%). The rate of complications of thromboembolic event was about 19.17% (n = 14), and the most prevalent was respiratory failure with 10 cases (13.69%), followed by pneumonia (5.47%), hemorrhage (4.1%), pulmonary edema and sepsis, each one with two patients (2.73%). Low-molecular-weight heparin was used in 35 patients (47.94%), unfractionated heparin in 28 patients (38.35%), thrombolytics in eight patients (10.95%) and inferior vena cava filter in two patients (2.73%). The hospital mortality was 8.21%. The mean length of stay in the ICU was 5.45 ± 11.61 days (0 to 83). Patients who had dyspnea (84.93%) on admission and those who needed orotracheal intubation had a higher mortality rate, with statistical significance (P = 0.0405 and P = 0.0305, respectively).

Conclusion

The most prevalent risk factors for PE were recent surgery, previous PE or DVT, restriction of mobility, venous insufficiency and obesity [1, 2]. Dyspnea and chest pain were the most prevalent clinical manifestations [1, 2]. The D-dimer was performed in a small percentage of patients. Computerized tomography was performed in 94.52% of patients, as it is an important diagnostic test for its high sensitivity and specificity [1]. The presence of dyspnea and orotracheal intubation were risk factors for mortality.