Department of Paediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Eur J Pediatr. 2022 Aug;181(8):3031-3038. doi: 10.1007/s00431-022-04487-8. Epub 2022 Jun 2.
The risk for venous thromboembolism (VTE) is considered to be low in the general paediatric intensive care unit (PICU) population, and pharmacological thromboprophylaxis is not routinely used. PICU patients considered at high-risk of VTE could possibly benefit from pharmacological thromboprophylaxis, but the incidence of VTE in this group of patients is unclear. This was an observational, prospective study at a tertiary multi-disciplinary paediatric hospital. We used comprehensive ultrasonography screening for VTE in critically ill children with multiple risk factors for VTE. Patients admitted to PICU ≥ 72 h and with ≥ two risk factors for VTE were included. Patients receiving pharmacological thromboprophylaxis during their entire PICU stay were excluded. The primary outcome of the study was VTEs not related to the use of a CVC. Ultrasonography screening of the great veins was performed at PICU discharge. Seventy patients with median (interquartile range) 3 (2-4) risk factors for VTE were evaluated. Median age was 0.3 years (0.03-4.3) and median PICU length of stay 9 days (5-17). Regarding the primary outcome, no symptomatic VTEs occurred and no asymptomatic VTEs were found on ultrasonography screening, resulting in an incidence of VTEs not related to a vascular catheter of 0% (95% CI: 0-5.1%).
Our results indicate that VTEs not related to a vascular catheter are a rare event even in a selected group of severely ill small children considered to be at high risk of VTE.
• Children in the PICU often have several risk factors for venous thromboembolism (VTE). • The incidence of VTE in PICU patients is highly uncertain, and there are no evidence-based guidelines regarding VTE prophylaxis.
• This study found an incidence of VTEs not related to a vascular catheter of 0% (95% CI: 0-5.1%). • This indicates that such VTE events are rare even in PICU patients with multiple risk factors for VTE.
儿科重症监护病房（PICU）人群发生静脉血栓栓塞（VTE）的风险较低，通常不使用药物预防血栓形成。高危 VTE 的 PICU 患者可能受益于药物预防血栓形成，但该组患者的 VTE 发生率尚不清楚。
这是一项在三级多学科儿科医院进行的观察性前瞻性研究。我们使用综合超声检查对 VTE 高危的危重症儿童进行 VTE 筛查。纳入 PICU 入住时间≥72 h 且有≥2 个 VTE 危险因素的患者。排除整个 PICU 期间接受药物预防血栓形成的患者。本研究的主要结局为与中心静脉导管（CVC）无关的 VTE。在 PICU 出院时对大静脉进行超声筛查。
共评估了 70 例 VTE 中位数（四分位距）为 3（2-4）个危险因素的患者。中位年龄为 0.3 岁（0.03-4.3 岁），PICU 中位住院时间为 9 天（5-17 天）。关于主要结局，无症状 VTE 未发生，超声筛查也未发现无症状 VTE，因此与血管导管无关的 VTE 发生率为 0%（95%CI：0-5.1%）。
即使在高度怀疑存在 VTE 风险的严重疾病儿童中，与血管导管无关的 VTE 也是一种罕见事件。
儿科重症监护病房（PICU）中的儿童常有多种静脉血栓栓塞（VTE）危险因素。PICU 患者 VTE 的发生率极不确定，并且缺乏关于 VTE 预防的循证指南。
这项研究发现，与血管导管无关的 VTE 发生率为 0%（95%CI：0-5.1%）。这表明，即使在有多个 VTE 危险因素的 PICU 患者中，这种 VTE 事件也很少见。
