ICU Patients May Have Undiagnosed DVT

Patients in intensive care units (ICUs) are especially vulnerable to deep vein thrombosis (DVT) and the potentially fatal pulmonary embolism that can result, yet intensivists often fail to find these conditions, according to new research.

One explanation may lie in the way clinicians think about DVT in the ICU setting. Generally, DVT is diagnosed in mobile patients after they report leg pain or a swelling in one leg, and a radiologic exam shows a blockage in a blood vessel. Since critically ill patients are less able to report symptoms and often have swollen legs as a result of their critical illness, DVT may go unnoticed, note investigators from McMaster University (Hamilton, Canada; www.mcmaster.ca) and the University of Toronto (Canada; www.utoronto.ca). Their findings were reported in Critical Care 2004, Vol.8 (published online at http://ccforum.com/home by BioMed Central).

The researchers asked 71 doctors to rate different factors according to their importance in deciding DVT was likely to lead to short- or long-term illness or death in critically ill patients. The responses showed that doctors were most likely to take DVT seriously if the patient showed leg signs that were suggestive of a blood clot, if the patient already had acute or chronic cardiopulmonary problems, or if they had a suspicion that the patient was suffering from pulmonary embolism. Their concern was likely to be heightened if an ultrasound scan showed the patient to have a large thrombosis in the thigh region that completely blocked a blood vessel.

Deep vein thrombosis in the thigh frequently leads to pulmonary embolism. "In critically ill patients (…), a small pulmonary embolism, which might be of minimal clinical importance in less ill patients, might have severe or fatal consequences,” according to the authors. They wonder if the low tolerance of even small pulmonary embolisms in these patients may indicate a role for routine ultrasound screening for DVT in ICUs. Patients in intensive care are highly susceptible to DVT since they are immobile for long periods of time. Doctors need to maintain a high level of suspicion of blood clots in seriously ill patients and to adopt effective preventive strategies.




Related Links:
MacMaster Univ.
Univ. of Toronto