Monitoring of Pulmonary Emboli Patients in Intensive Care Unit

Öz

Objective: Pulmonary embolism is a fatal disease that requires close follow-up and urgent intervention. Our aim is to examine the processes of these patients in our intensive care.

Material and Methods: This study examines the follow-up of 37 patients hospitalized with the diagnosis of pulmonary embolism in Anesthesiology and Reanimation Intensive Care between 26.12.2013 and 01.01.2019. In this study, parameters such as intensive care stay, age, diagnosis, blood transfusion requirement, invasive procedures, echocardiographic findings, location of the trombus in the pulmonary arteries were examined.

Results: Of the patients 27% were male and 73% were female. The average age of the patients was determined as 74. Of the 37 patients who were diagnosed with pulmonary embolism and treated in intensive care, 46% were transferred to the service and later discharged. In the computerized thoracic angiography of the patients, it was seen that thrombus location (38%) was mostly in the right main pulmonary artery.

Conclusion: Pulmonary embolism is a disease that may require early diagnosis and rapid treatment. Patients may need respiratory and cardiac support. The high mortality rates of these patients who are followed up in the tertiary intensive care unit despite the treatment they received during the treatment process can be explained by the high mortality of this disease, advanced age and the presence of accompanying diseases.

Anahtar Kelimeler

• Intensive care
• pulmonary embolism
• mortality

PULMONER EMBOLİ HASTALARININ YOĞUN BAKIM TAKİBİ

Öz

Amaç: Pulmoner emboli yakın takip ve acil müdahale gerektiren ölümcül bir hastalıktır. Amacımız bu hastaların yoğun bakımımızdaki süreçlerini incelemektir.

Gereç ve Yöntemler: Bu çalışmada 26.12.2013 ile 01.01.2019 tarihleri arasında Anesteziyoloji ve Reanimasyon Yoğun Bakımda yatarak tedavi gören 37 pulmoner emboli hastası incelenmiştir. Hastaların yoğun bakım yatış süreleri, yaşı, tanıları, kan ihtiyacı, girişimler işlemleri, ekokardiyografik bulguları, pulmoner arterlerdeki trombüsün yerleşim yeri gibi parametreler incelenmiştir.

Bulgular: Hastaların %27’si erkek, %73’ü kadınlardan oluşmaktaydı. Hastaların yaş ortalaması 74 olarak tespit edildi. Yoğun bakımda tedavi gören ve pulmoner emboli tespit edilen 37 hastamızdan %46’sı servise devredilerek daha sonra taburculuğu sağlanmıştır. Hastalara çekilen bilgisayarlı toraks anjiyografisinde trombüs yerleşiminin en sık olarak sağ ana pulmoner arterde (%38) olduğu görüldü.

Sonuç: Pulmoner emboli; erken tanı, hızlı tedavi gerektirebilen bir hastalıktır. Hastalar solunumsal ve kardiyak destek ihtiyacı duyabilir. 3. basamak yoğun bakımda takip edilen bu hastaların tedavi sürecinde aldıkları tedaviye rağmen ölüm oranlarının yüksek olması bu hastalığın mortalitesinin yüksekliği, ileri yaş ve eşlik eden hastalıkların varlığı ile açıklanabilir.

Anahtar Kelimeler

• Yoğun bakım
• pulmoner emboli
• mortalite

Kaynakça

1. 1. Alikhan R, Peters F, Wilmott R, Cohen AT. Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol. 2004;57(12):1254-7.
2. 2. Heit JA, O’Fallon WM, Petterson TM, Lohse CM, Silverstein MD, Mohr DN et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med. 2002;162(11):1245-8.
3. 3. Palevsky HL, Kelly MA, Fishman AP. Pulmonary thromboembolic disease. In: Fishman AP, ed. Fishman’s Pulmonary Diseases and Disorders. 3rd ed. New York. Mc Graw-Hill, 1998;1297-329.
4. 4. Wagenvoort CA. Pathology of pulmonary thromboembolism. Chest. 1995;107(1):10-7.
5. 5. Saygıner A. Akciğer embolizmi. In: İliçin G, Ünal S, Biberoğlu K, Akalın S, Süleymanlar G, eds. Temel İç Hastalıkları. Ankara. Güneş Tıp Kitabevi, 1996;538-43.
6. 6. Morgenthaler TI, Ryu JH. Clinical characteristics of fatal pulmonary embolism in a referral hospital. Mayo Clin Proc. 1995;70(5):417-24.
7. 7. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res. 2016;118(9):1340-47.
8. 8. Harold I, Mark A. Pulmonary thromboembolic disease. In: Fishman AP, ed. Pulmonary Disease and Disorders. Newyork. Mc Graw-Hill Book Company, 1998;1297-329.

9. 9. Guintini C, Di Rocco G, Marini C, Melillo E, Palla A. Pulmonary embolism: Epidemiology. Chest. 1995;107:3-9.
10. 10. Manganelli D, Polla A, Donnamaria V. Clinical features of pulmonary embolism. Chest. 1995;107(1):25-32.
11. 11. Sakuma M, Nakamura M, Nakanishi N, Miyahara Y, Tanabe N, Yamada N et al. Inferior vena cava filter is a new additional therapeutic option to reduce mortality from acute pulmonary embolism. Circ J. 2004;68(9):816-18.
12. 12. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Accessed date: 17.08.2021: www.ncbi.nlm.nih.gov/books/NBK44178/.
13. 13. Silverstein MD, Heit JA, Moher DN, Petterson TM, O'Fallon WM, Melton LJ et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: A 25-year population based study. Arch Intern Med. 1998;158(6):585-93.
14. 14. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galie N, Pruszczyk P et al. Guidelines on the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008;29(18):2276-315.
15. 15. Golbaşı Z. Chronic thromboembolic pulmonary hypertension: diagnosis, medical therapy and monitoring. Anadolu Kardiyol Derg. 2010;10(2):56-60.
16. 16. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N et al. ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35(43):3033-69.
17. 17. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353(9162):1386-89.
18. 18. Kabrhel C, Mark Courtney D, Camargo CA, Moore CL, Richman PB, Plewa MC et al. Potential impact of adjusting the threshold of the quantitative D-dimer based on pretest probability of acute pulmonary embolism. Acad Emerg Med. 2009;16(4):325-32.
19. 19. Becattini C, Lignani A, Masotti L, Forte MB, Agnelli G. D-dimer for risk stratification in patients with acute pulmonary embolism. J Thromb Thrombolysis. 2012;33(1):48-57.
20. 20. Kollef MH, Zahid M, Eisenberg PR. Predictive value of rapid semiquantative D-dimer assay in critically ill patients with suspected venous thromboembolic disease. Crit Care Med. 2000;28(2):414-20.
21. 21. Kostrubiec M, Labyk A, Pedowska-Wloszek J, S Pacho, A Wojciechowski, K Jankowski et al. Assessment of renal dysfunction improves troponin-based shortterm prognosis in patients with acute symptomatic pulmonary embolism. J Thromb Haemost. 2010;8(4):654-58.
22. 22. Ozbudak O, Erogullari I, Oğuz C, Cilli A, Turkay M, Ozdemir T. Doppler ultrasonography versus venography in the detection of deep vein thormbosis in patients with pulmonary embolism. J Thromb Trombolysis. 2006;21(2):159-62.
23. 23. Van Belle A, Buller HR, Huisman MV, Huisman PM, Kaasjager K, Kamphuisen PW et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295(2):172-79.
24. 24. Naidich DP, Zerhouni EA, Müller NL, Webb WR, Krinsky GA, Siegelman SS. Computed tomography and magnetic resonance of the thorax. 3rd ed. New York. Lippincott-Raven, 1999.
25. 25. De Monye W, van Strijen MJ, Huisman MV, Kieft GJ, Pattynama PM. Suspected pulmonary embolism: Prevalence and anatomic distribution in 487 consecutive patients. Advances in new technologies evaluating the localisation of pulmonary embolism (ANTELOPE) group. Radiology. 2000;215(1):184-88.
26. 26. Şen E, Arslan F, Eladağ Yurt S, Tarakcı N, Kaya A, Atasoy C ve ark. Pulmoner bilgisayarlı tomografi anjiyografi ile pulmoner tromboemboli tanısı konulan hastalarda klinik ve radyolojik bulgular. Tuberkuloz ve Toraks Dergisi. 2009;57(1):5-13.
27. 27. Duru S, Ergün R, Dilli A, Kaplan T, Kaplan B, Ardıç S. Pulmoner embolide klinik, laboratuvar ve bilgisayarlı tomografi pulmoner anjiyografi sonuçları: 205 hastanın retrospektif değerlendirmesi. Anadolu Kardiyol Derg. 2012;12(1):142-9.
28. 28. Messika J, Goutorbe P, Hajage D, Ricard JD. Severe pulmonary embolism managed with high-flow nasal cannula oxygen therapy. Eur J Emerg Med. 2017;24(3):230-32.
29. 29. THESEE study group. A comparison of low-molecular weight heparin with unfractioned heparin for acute pulmonary embolism. N Engl J Med. 1997;337(10):663-69.
30. 30. Uçar EY. Thrombolitic treatment. Türkiye Klinikleri J Pulm Med-Special Topics. 2016;9:39-43.
31. 31. Hasanoglu HC, Hezer H, Karalezli A, Arguder E, Kilic H, Sentürk A et al. Half dose recombinant tissue plasminogen activatortreatment in venous thromboembolism. J Investig Med. 2014;62(1):71-77.
32. 32. Sharifi M, Berger J, Beeston P, Bay C, Vajo Z, Javadpoor S. Pulseless electrical activity in pulmonary embolism treated with thrombolysis (From the “PEAPETT” Study). Am J Emerg Med. 2016;34(10):1963-67.
33. 33. Truhlář A, Deakin CD, Soar J, Khalifa GE, Alfonzo A, Bierens JJ et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015;95:148-201.
34. 34. Alizoroğlu D, Erbaycu A E, Çimen P, Ediboğlu Ö, Kıraklı C. Kardiyopulmoner arrest gelişen masif pulmoner embolide trombolitik kullanımı: hayata dönen iki hasta. Turk J Intensive Care. 2019;17:102-6.
35. 35. Vishal S, Mehta N, Rawat N, Lehrman SG, Aronow WS. Management of massive and nonmassive pulmonary embolism. Arch Med Sci. 2012;6:957-69.