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.
Intensive Care Med. 2020 Apr;46(4):737-746. doi: 10.1007/s00134-019-05899-1. Epub 2020 Feb 24.
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.
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).
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).
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.
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.
我们研究了每周两次通过超声检查对重症监护病房（ICU）的外科患者进行深静脉血栓（DVT）监测与 90 天全因死亡率之间的关联。
这是一项预先计划的气动压迫预防静脉血栓栓塞症（PREVENT）试验的亚研究（ClinicalTrials.gov：NCT02040103），比较了间歇性气动压缩（IPC）联合药物预防与单独药物预防的效果。监测组包括试验中纳入的患者，而非监测组包括符合条件但未纳入的患者。我们使用逻辑回归和 Cox 比例风险模型，研究了监测与主要结局 90 天死亡率之间的关联。次要结局是 DVT 和肺栓塞（PE）。
监测组包括 1682 名患者，非监测组包括 383 名患者。使用带有自举法的 Cox 比例风险模型，监测与 90 天死亡率降低相关（校正 HR 0.75；95%CI 0.57，0.98）。监测与 DVT[中位数 4 天（IQR 2，10）比 20 天（IQR 16，22）]和 PE[中位数 4 天（IQR 2.5，5）比 7.5 天（IQR 6.1，28.9）]的更早诊断相关。DVT 的诊断率增加（校正 HR 5.49；95%CI 2.92，13.02），但 PE 的诊断频率无变化（校正 HR 0.56；95%CI 0.19，1.91）。
每周两次的监测超声检查与 DVT 检出率增加、非下肢 DVT 和 PE 诊断检测减少、DVT 和 PE 的更早诊断以及 90 天死亡率降低相关。
PREVENT 试验在 ClinicalTrials.gov 注册，ID：NCT02040103。于 2013 年 11 月 3 日注册；当前对照试验，ID：ISRCTN44653506。于 2013 年 10 月 30 日注册。
