Related Experiment Video
Updated: Jun 12, 2026
07:44
A Porcine Model of Acute Autologous Pulmonary Embolism
Published on: September 6, 2024
Pulmonary embolism in critically ill patients receiving antithrombotic prophylaxis: a clinical-pathologic study
Giorgio Berlot1, Cristina Calderan, Antonella Vergolini
1Department of Anaesthesia and Intensive Care, University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy. berlot@inwind.it
Journal of Critical Care
|June 12, 2010
Summary
Pulmonary embolism (PE) occurs in 14.3% of critically ill patients despite prophylaxis. Recent abdominal surgery and renal failure increase missed diagnosis risk, highlighting PE underestimation in clinical settings.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Pathology
Background:
- Pulmonary embolism (PE) is a significant concern in critically ill patients.
- Antithrombotic prophylaxis is standard, yet PE incidence and outcomes remain unclear.
- Accurate diagnosis of PE in intensive care units (ICUs) is challenging.
Purpose of the Study:
- To determine the true incidence of PE in critically ill adult patients receiving antithrombotic prophylaxis.
- To identify risk factors associated with missed PE diagnoses in ICU patients.
- To evaluate the impact of PE on patient outcomes.
Main Methods:
- Retrospective review of autopsies and clinical data from 1996-2007 in a surgical and medical ICU.
- Analysis of 600 autopsies from patients who received low-molecular-weight heparin prophylaxis.
- Comparison of clinical diagnoses with autopsy findings for PE.
Main Results:
- The overall incidence of PE was 14.3%.
- 73 cases (false negatives) of PE were discovered only at autopsy.
- Recent abdominal surgery, acute renal failure, and septic shock were associated with higher risk of missed PE diagnosis.
Conclusions:
- Critically ill patients are at risk for PE despite thromboprophylaxis.
- Clinical diagnosis of PE is difficult, leading to underestimation on death certificates.
- Improved diagnostic strategies are needed for PE in the ICU setting.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
01:19Pulmonary Embolism I: Introduction
A blood clot, or thrombus, is a semi-solid mass composed of fibrin, platelets, and red blood cells. When it forms within a vessel, it can obstruct blood flow, known as thrombosis. If part of the clot detaches, it becomes an embolus that can travel and block distant vessels. When this occurs in the pulmonary arteries, it causes a condition known as pulmonary embolism (PE).Origin and ImpactMost often, the embolus originates from a thrombus in the deep veins of the lower limbs, a condition called...
01:29Pulmonary Embolism I: Introduction
Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
01:27Pulmonary Embolism III: Nursing Management
A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:30Venous Thrombosis I: Introduction
Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...