Pulmonary embolism in medical intensive care unit at Sestre Milosrdnice University Hospital

Aim: The aim of the study was to evaluate demographic data and clinical characteristics of patients with pulmonary embolism treated in medical intensive care unit (ICU) at the University Hospital, and to assess the impact of several risk factors on patients' survival. Methods: This is a retrospective analysis of hospital records of 165 patients with suspected pulmonary embolism who were admitted to the ICU during a six-year period. The diagnosis was based on clinical presentation, electrocardiographic and chest X-ray findings, echocardiographic signs of right ventricular dysfunction, D-dimer testing and finally confirmed by high-probability ventilation/perfusion (V/Q) lung scan or multidetector computed tomography (MDCT). Results: The study included 165 patients, mean age 69.3 +/- 13.7 years (median 73, range 21-91 years), predominantly female (70.3%), 114 (69.1%) ICU survivors and 51 (30.9%) non-survivors. Dominant symptom was dyspnea (97.0%), the most common sign tachypnea (69.6%). Duplex scan sonography of the lower extremities revealed deep vein thrombosis as the predominant risk factor for pulmonary embolism in 39.4% of patients. Pulmonary embolism was confirmed by the V/Q lung scan or MDCT in 71.5%. Hypertension and chronic heart failure were found in 96 and 47 patients, respectively. Pulmonary embolism was regarded as massive in 63 (38.2%), submassive in 23 (13.9%) and small in 79 patients (47.9%). Mean length of stay was 5.7 +/- 4.4 days for ICU, and 14.8 +/- 9.1 days overall. ICU mortality was 26.7% and in-hospital mortality 30.9%. There was not statistical difference in mortality between male and female patients (30.6% and 31.0%, respectively; P=0.965), but prolonged immobilization, recent operation or malignancy were shown to influence the outcome. Conclusion: Pulmonary embolism remains an important clinical problem with high mortality rate. Data from this study, however small sample may have been, provide highlights on this problem and may help in raising awareness of the importance of identifying patients at high-risk for unfavorable outcome.