Chest
Pulmonary Embolism in Respiratory Failure
Section snippets
MATERIALS AND METHODS
From January 1972 to November 1975, there were 617 admissions to the Respiratory Intensive Care Unit at University Hospital, Ann Arbor, Mich. The criterion for admission is respiratory failure or insufficiency (eg, arterial oxygen pressure [PaO2] less than 50 mm Hg or arterial carbon dioxide tension [PaCO2] greater than 40 mm Hg), with many patients requiring assisted ventilation at some time in the course of hospitalization. This population of patients is not limited to patients with primary
Group 1
The interpretation of the lung scan and the pulmonary arteriogram in the 12 patients who had both is shown in Table 1. There was an average of two days between procedures, with a range of less than one day to seven days. Pulmonary embolism was demonstrated by arteriograms in only two patients. These two patients had subsequent confirmation of their anteriographic findings on autopsy. The scans did not predict the outcome of the arteriogram. In fact, the lung scan was misleading in one patient
DISCUSSION
The classic presentation of acute pulmonary embolism may be difficult or impossible to recognize in critically ill patients with respiratory failure. The problem is further compounded if the patient requires mechanical ventilation where the history is essentially unobtainable. In his extensive review, Gorham2 states that sudden dyspnea and pain in the chest were major symptoms in acute pulmonary embolism. Israel and Goldstein3 reported chest and abdominal pain, dyspnea, and syncope as frequent
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2018, Clinics in Chest MedicineCitation Excerpt :Diagnosing PE in AE-COPD is challenging, however, because presenting symptoms are often similar. Undiagnosed PE was found in an autopsy study in up to 30% of COPD patients.27 The prevalence of DVT and PE in AE-COPD is 12%28 and 16% to 25%, respectively.28–31
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2011, Critical Care ClinicsCitation Excerpt :Because clinical practice guidelines have recommended the routine use of thromboprophylaxis in critical care patients for more than 20 years, we review historical studies to understand the risk of VTE in patients not receiving pharmacologic or mechanical thromboprophylaxis.4 Autopsies in 436 critically ill patients in six studies detected PE in 7% to 27% of patients (mean 13%), and PE that caused or contributed to death was found in 0% to 12% (mean 3%) of these patients (Table 1).5–10 In the majority of patients with proven or fatal PE, there was no clinical suspicion of PE before death.
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2010, ChestCitation Excerpt :This hypothesis is supported by observational studies that have shown that pulmonary embolism is a frequent occurrence in patients diagnosed with an acute COPD exacerbation, and may be clinically occult because of the similarity in symptoms between the two conditions.11,12 One autopsy study revealed that as many as 30% of patients who died of a COPD exacerbation had evidence of pulmonary embolism,22 whereas a recent systematic review found that the prevalence of pulmonary embolism among hospitalized patients with COPD was as high as 25%.15 The importance of pulmonary embolism in patients with COPD experiencing an acute exacerbation is significant, because it is likely to cause further cardiorespiratory compromise in patients who may already have marked ventilation-perfusion mismatch.
Supported in part by Pulmonary Academic Award 1K07 168-04 from the Division of Lung Diseases, National Heart and Lung Institute.
Read in part before the 42nd Annual Scientific Assembly, American College of Chest Physicians, Atlanta, Oct 26, 1976.
Manuscript received April 5; revision accepted July 14.