Pulmonary embolism in medical-surgical ICU patients

Research coordinators documented all clinical, laboratory, radiologic and autopsy criteria relevant to PE, which was a secondary outcome for this multicenter trial. Patients with a possible PE were adjudicated in quadruplicate; those considered possible, probable or definite PE were considered in this analysis. PEs were considered clinically suspected if the ICU team conducted tests seeking a diagnosis; otherwise, they were incidental.In 3,659 patients, PE was clinically suspected in most patients who were diagnosed with a prevalent PE at ICU admission (12/14, 85.7%) or incident over the course of the ICU stay (57/64, 89.1%). Among 64 patients who developed a PE, only three (4.7%) had prehospital DVT or PE. Within the index hospitalization, before or after the PE diagnosis, additional acute deep venous thromboses occurred at any site in 27 (42.2%) patients with PE. Patients without PE compared with those with PE appear to have a shorter duration of ventilation (median, interquartile range) (5 (2, 11) days vs. 12 days (5.5, 20.5), P < 0.001), duration of ICU stay (9 (6, 16) days vs. 20.5 (13, 35), P < 0.001), and hospital stay (21 (13, 40) days vs. 35 (21.5, 58.5), P < 0.001), and a lower ICU mortality (15.2% vs. 31.8%, P = 0.005) and hospital mortality (22.8% vs. 31.3%, P = 0.13).The majority of PEs in these medical-surgical ICU patients were clinically suspected rather than incidental findings. More than one-half of the PEs developed in the absence of leg or other venous thromboses; in some cases, additional venous thromboses post-dated rather than pre-dated the PE. PE was associated with significantly increased morbidity and mortality in this ICU population.For the PROTECT Investigators, CCCTG and ANZICS-CTG.