Gebhard Caroline E, Zellweger Núria, Gebhard Catherine, Hollinger Alexa, Chrobok Leon, Stähli David, Schönenberger Christof M, Todorov Atanas, Aschwanden Markus, Siegemund Martin
Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, 4031 Basel, Switzerland.
Department of Clinical Research, University of Basel, 4056 Basel, Switzerland.
J Clin Med. 2021 Dec 25;11(1):103. doi: 10.3390/jcm11010103.
Virchow's triad with stasis, activated coagulation, and endothelial damage is common in SARS-CoV2. Therefore, we sought to retrospectively assess whether the duration of prone position may serve as a risk factor for deep vein thrombosis in critically ill patients.
In this single center retrospective study of a tertiary referral hospital, patients with acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia admitted to critical care underwent venous ultrasound screening for deep vein thrombosis (DVT). Data on DVT diagnosis, duration of prone positioning, demographic, respiratory, and laboratory parameters were retrospectively collected and compared between DVT and non-DVT patients.
21 patients with ARDS from COVID-19 pneumonia were analyzed. DVT was detected in 11 (52%) patients (76.2% male, median age 64 (58; 68.5) years, median body mass index 31 (27; 33.8) kg/m). In patients diagnosed with DVT, median prone ventilation had been maintained twice as long as compared to patients without DVT (57 (19; 72) versus 28 (0; 56.3) h, = 0.227) on ICU day 5 with a trend towards longer prone position time (71 (19; 104) versus 28 (0; 73) h, = 0.06) on ICU day 7.
Prone ventilation and constitutional factors may constitute an additional risk factor for DVT in COVID-19 patients. Since recent studies have shown that therapeutic anticoagulation does not impact the occurrence of thromboembolic events, it may be worthwhile to consider mechanical factors potentially affecting blood flow stasis in this high-risk population. However, due to the limited number of patients, our observations should only be considered as hypothesis-generating. Future studies, sufficiently powered and preferably prospective, will be needed to confirm our hypothesis.
SARS-CoV2患者中常出现伴有血流淤滞、凝血激活和内皮损伤的Virchow三联征。因此，我们试图回顾性评估俯卧位持续时间是否可作为重症患者深静脉血栓形成的危险因素。
在这家三级转诊医院的单中心回顾性研究中，因COVID-19肺炎入住重症监护病房的急性呼吸窘迫综合征（ARDS）患者接受了深静脉血栓形成（DVT）的静脉超声筛查。回顾性收集DVT诊断、俯卧位持续时间、人口统计学、呼吸和实验室参数等数据，并在DVT患者和非DVT患者之间进行比较。
分析了21例因COVID-19肺炎导致ARDS的患者。11例（52%）患者检测到DVT（男性占76.2%，中位年龄64（58；68.5）岁，中位体重指数31（27；33.8）kg/m）。在诊断为DVT的患者中，ICU第5天俯卧通气的中位持续时间是未发生DVT患者的两倍（57（19；72）小时对28（0；56.3）小时，P = 0.227），ICU第7天俯卧位时间有延长趋势（71（19；104）小时对28（0；73）小时，P = 0.06）。
俯卧通气和体质因素可能构成COVID-19患者发生DVT的额外危险因素。由于最近的研究表明治疗性抗凝不会影响血栓栓塞事件的发生，在这个高危人群中考虑可能影响血流淤滞的机械因素可能是值得的。然而，由于患者数量有限，我们的观察结果仅应被视为产生假设。需要未来有足够样本量且最好是前瞻性的研究来证实我们的假设。
