Incidence of pulmonary embolism in patients with non-invasive respiratory support during COVID-19 outbreak.

Autor: González-García JG; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain., Pascual-Guardia S; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain., Aguilar Colindres RJ; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Ausín Herrero P; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain., Alvarado Miranda M; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Arita Guevara M; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Badenes Bonet D; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain., Bellido Calduch S; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Caguana Vélez OA; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain., Cumpli Gargallo C; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Dominguez-Alvarez M; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain., Gea J; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain., Grau N; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain., Khilzi K; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Martínez-Llorens J; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain., Sánchez Ortiz M; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Sánchez-Font A; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain., Sancho-Muñoz A; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain., Parrilla-Gómez FJ; Intensive Care Unit, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Marín Corral J; Intensive Care Unit, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Pérez Terán P; Intensive Care Unit, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Rodríguez-Sevilla JJ; Hematology Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain., Chalela R; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain. Electronic address: rchalela@parcdesalutmar.cat., Rodríguez-Chiaradia D; Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Respiratory medicine [Respir Med] 2021 Mar; Vol. 178, pp. 106325. Date of Electronic Publication: 2021 Feb 04.
DOI: 10.1016/j.rmed.2021.106325
Abstrakt: While the incidence of thrombotic complications in critically ill patients is very high, in patients under non-invasive respiratory support (NIS) is still unknown. The specific incidence of thrombotic events in each of the clinical scenarios within the broad spectrum of severity of COVID-19, is not clearly established, and this has not allowed the implementation of thromboprophylaxis or anticoagulation for routine care in COVID-19. Patients admitted in a semi-critical unit treated initially with NIS, especially Continuous-Positive Airway Pressure (CPAP), were included in the study. The cumulative incidence of pulmonary embolism was analyzed and compared between patients with good response to NIS and patients with clinical deterioration that required orotracheal intubation. 93 patients were included and 16% required mechanical ventilation (MV) after the NIS. The crude cumulative incidence of the PE was 14% (95%, CI 8-22) for all group. In patients that required orotracheal intubation and MV, the cumulative incidence was significantly higher [33% (95%, CI 16-58)] compared to patients that continued with non-invasive support [11% (CI 5-18)] (Log-Rank, p = 0.013). Patients that required mechanical ventilation were at higher risk of PE for a HR of 4.3 (95%CI 1.2-16). In conclusion, cumulative incidence of PE is remarkably higher in critically patients with a potential impact in COVID-19 evolution. In this context, patients under NIS are a very high-risk group for developing PE without a clear strategy regarding thromboprophylaxis.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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