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Clinical Investigations in Critical CareUtilization of Venous Thromboembolism Prophylaxis in a Medical-Surgical ICU
Section snippets
Materials and Methods
The medical-surgical ICU of St. John's Mercy Medical Center, a large community teaching hospital, was the setting for this study. The medical-surgical ICU is closed (mandatory critical care consult) and staffed by critical care attending physicians and critical care subspecialty residents. The critical care attending staff encompasses five critical care attending physicians who rotate through the ICU to provide 24-h patient coverage and teaching for the house staff. The ICU teams caring for the
Results
There were 308 admissions to the ICU during the study period. Ninety-nine admissions met exclusion criteria, resulting in 209 study patients. The reasons for the 99 exclusions were as follows: 10 admissions that represented patients already enrolled in the study earlier in the same hospitalization; 11 patients admitted to the ICU with the diagnosis of deep venous thrombosis or pulmonary embolism; 3 patients who had been cared for by the investigator; 7 patients who died within 24 h; 3 patients
Discussion
We found that 86% of the study group received VTE prophylaxis within the first 24 h in the ICU. This finding differs dramatically from the previously reported level of utilization in the ICU reported by Keane et al.6 What is the explanation for the dramatic difference in utilization of VTE prophylaxis between this study (86% within 24 h) and the prior study (33% after an average of 2 days)?
First, our study looked at a mixed population of medical and surgical patients, as opposed to a population
Conclusion
This study in a medical-surgical ICU staffed by critical care attending physicians and critical care subspecialty residents documented that 86% of the patients received VTE prophylaxis during their first 24 h in the ICU. The utilization of VTE prophylaxis described in this study is much higher than previously reported. The nature of physician coverage in our medical-surgical ICU (closed unit), consistent practice patterns of a designated ICU staff, and a continuing medical education program
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Cited by (43)
Vena cava filters: Current concepts and controversies for the surgeon
2010, Current Problems in SurgeryCitation Excerpt :In a study of 209 ICU patients (53% surgical), there were an average of 4.4 risk factors for VTE identified per patient. The majority (57%) received mechanical prophylaxis alone, and only 3% underwent prophylactic VCF placement.249 In a recent review article on the management of VTE in the ICU, the only indication discussed for VCF placement was the therapeutic indication in the patient with a PE who cannot be anticoagulated.
Pulmonary Embolism
2008, Critical Care Medicine: Principles of Diagnosis and Management in the AdultVariability in the use of thromboprophylaxis and outcomes in critically ill medical patients
2005, American Journal of MedicineCitation Excerpt :Previous studies showed that utilization of thromboprophylaxis is variable in critical care settings. As few as 33% of critically ill patients receive thromboprophylaxis,11,23 and utilization may vary with institutional education about this aspect of care.12 The mode of prophylaxis also varies across centers.11,12,24
Preventing venous thromboembolism in the intensive care unit: A no-brainer?
2005, Journal of Critical CareThromboprophylaxis in medical-surgical intensive care unit patients
2005, Journal of Critical CareHeparin, low molecular weight heparin, and heparin-induced thrombocytopenia in the ICU
2005, Critical Care Clinics