Surveillance or no surveillance ultrasonography for deep vein thrombosis and outcomes of critically ill patients: a pre-planned sub-study of the PREVENT trial.

Autor: Arabi YM; Intensive Care Department, Ministry of National Guard Health Affairs, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. arabi@ngha.med.sa.; King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. arabi@ngha.med.sa.; King Saud Bin Abdulaziz University for Health Sciences, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. arabi@ngha.med.sa., Burns KEA; Interdepartmental Division of Critical Care Medicine, Unity Health Toronto-St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada., Alsolamy SJ; Intensive Care Department, Ministry of National Guard Health Affairs, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.; King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.; King Saud Bin Abdulaziz University for Health Sciences, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia., Alshahrani MS; Department of Emergency and Critical Care Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia., Al-Hameed FM; Intensive Care Department, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.; King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia., Arshad Z; Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow, India., Almaani M; Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia., Hawa H; Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia., Mandourah Y; Military Medical Services, Ministry of Defense, Riyadh, Kingdom of Saudi Arabia., Almekhlafi GA; Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia., Al Aithan A; Intensive Care Division, Department of Medicine, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia.; King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia.; King Abdullah International Medical Research Center, Al Ahsa, Kingdom of Saudi Arabia., Khalid I; Critical Care Section, Department of Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia., Rifai J; Intensive Care Department, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.; King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia., Rasool G; Intensive Care Department, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.; King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia., Abdukahil SAI; Intensive Care Department, Ministry of National Guard Health Affairs, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.; King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.; King Saud Bin Abdulaziz University for Health Sciences, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia., Jose J; King Saud Bin Abdulaziz University for Health Sciences, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.; Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia., Afesh LY; King Saud Bin Abdulaziz University for Health Sciences, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.; Research Office, Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia., Al-Dawood A; Intensive Care Department, Ministry of National Guard Health Affairs, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.; King Abdullah International Medical Research Center, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.; King Saud Bin Abdulaziz University for Health Sciences, ICU 1425, PO Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2020 Apr; Vol. 46 (4), pp. 737-746. Date of Electronic Publication: 2020 Feb 24.
DOI: 10.1007/s00134-019-05899-1
Abstrakt: Purpose: We examined the association between surveillance for deep vein thrombosis (DVT) among medical-surgical critically ill patients by twice-weekly ultrasonography and 90-day all-cause mortality.
Methods: This was a pre-planned sub-study of the Pneumatic Compression for Preventing Venous Thromboembolism (PREVENT) trial (Clinicaltrials.gov: NCT02040103) that compared addition of intermittent pneumatic compression (IPC) to pharmacologic prophylaxis versus pharmacologic prophylaxis alone. The surveillance group included enrolled patients in the trial, while the non-surveillance group included eligible non-enrolled patients. Using logistic regression and Cox proportional hazards models, we examined the association of surveillance with the primary outcome of 90-day mortality. Secondary outcomes were DVT and pulmonary embolism (PE).
Results: The surveillance group consisted of 1682 patients and the non-surveillance group included 383 patients. Using Cox proportional hazards model with bootstrapping, surveillance was associated with a decrease in 90-day mortality (adjusted HR 0.75; 95% CI 0.57, 0.98). Surveillance was associated with earlier diagnosis of DVT [(median 4 days (IQR 2, 10) vs. 20 days (IQR 16, 22)] and PE [median 4 days (IQR 2.5, 5) vs. 7.5 days (IQR 6.1, 28.9)]. There was an increase in diagnosis of DVT (adjusted HR 5.49; 95% CI 2.92, 13.02) with no change in frequency in diagnosis of PE (adjusted HR 0.56; 95% CI 0.19, 1.91).
Conclusions: Twice-weekly surveillance ultrasonography was associated with an increase in DVT detection, reduction in diagnostic testing for non-lower limb DVT and PE, earlier diagnosis of DVT and PE, and lower 90-day mortality.
Trial Registration: The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103. Registered on 3 November 2013; Current controlled trials, ID: ISRCTN44653506. Registered on 30 October 2013.
Databáze: MEDLINE
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