Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
Intensive Care Med. 2017 Mar;43(3):419-428. doi: 10.1007/s00134-016-4655-2. Epub 2016 Dec 27.
To estimate the prevalence, risk factors, prophylactic treatment and impact on mortality for venous thromboembolism (VTE) in patients with moderate to severe traumatic brain injury (TBI) treated in the intensive care unit.
A post hoc analysis of the erythropoietin in traumatic brain injury (EPO-TBI) trial that included twice-weekly lower limb ultrasound screening. Venous thrombotic events were defined as ultrasound-proven proximal deep venous thrombosis (DVT) or clinically detected pulmonary embolism (PE). Results are reported as events, percentages or medians and interquartile range (IQR). Cox regression analysis was used to calculate adjusted hazard ratios (HR) with 95% confidence intervals (CI) for time to VTE and death.
Of 603 patients, 119 (19.7%) developed VTE, mostly comprising DVT (102 patients, 16.9%) with a smaller number of PE events (24 patients, 4.0%). Median time to DVT diagnosis was 6 days (IQR 2-11) and to PE diagnosis 6.5 days (IQR 2-16.5). Mechanical prophylaxis (MP) was used in 91% of patients on day 1, 97% of patients on day 3 and 98% of patients on day 7. Pharmacological prophylaxis was given in 5% of patients on day 1, 30% of patients on day 3 and 57% of patients on day 7. Factors associated with time to VTE were age (HR per year 1.02, 95% CI 1.01-1.03), patient weight (HR per kg 1.01, 95% CI 1-1.02) and TBI severity according to the International Mission for Prognosis and Analysis of Clinical Trials risk of poor outcome (HR per 10% increase 1.12, 95% CI 1.01-1.25). The development of VTE was not associated with mortality (HR 0.92, 95% CI 0.51-1.65).
Despite mechanical and pharmacological prophylaxis, VTE occurs in one out of every five patients with TBI treated in the ICU. Higher age, greater weight and greater severity of TBI increase the risk. The development of VTE was not associated with excess mortality.
评估重症监护病房中中重度创伤性脑损伤（TBI）患者静脉血栓栓塞症（VTE）的发生率、危险因素、预防性治疗及对死亡率的影响。
对红细胞生成素治疗创伤性脑损伤（EPO-TBI）试验进行了事后分析，该试验包括每周两次的下肢超声筛查。静脉血栓栓塞事件定义为超声证实的近端深静脉血栓形成（DVT）或临床发现的肺栓塞（PE）。结果以事件、百分比或中位数和四分位间距（IQR）表示。使用 Cox 回归分析计算 VTE 和死亡的时间调整后的风险比（HR）和 95%置信区间（CI）。
在 603 名患者中，119 名（19.7%）发生了 VTE，主要为 DVT（102 名患者，16.9%），PE 事件较少（24 名患者，4.0%）。DVT 诊断的中位时间为 6 天（IQR 2-11），PE 诊断的中位时间为 6.5 天（IQR 2-16.5）。机械预防（MP）在第 1 天有 91%的患者使用，第 3 天有 97%的患者使用，第 7 天有 98%的患者使用。第 1 天有 5%的患者使用药物预防，第 3 天有 30%的患者使用，第 7 天有 57%的患者使用。与 VTE 发生时间相关的因素包括年龄（每年 HR 为 1.02，95%CI 为 1.01-1.03）、体重（每公斤 HR 为 1.01，95%CI 为 1-1.02）和根据国际预后和临床试验分析风险评估的 TBI 严重程度不良结局（每增加 10%HR 为 1.12，95%CI 为 1.01-1.25）。VTE 的发生与死亡率无关（HR 0.92，95%CI 0.51-1.65）。
尽管采用了机械和药物预防措施，重症监护病房中仍有五分之一的 TBI 患者发生 VTE。较高的年龄、更大的体重和更严重的 TBI 会增加风险。VTE 的发生与超额死亡率无关。
