ABSTRACT
Venous thromboembolism (VTE) represents an unrelenting and formidable challenge in
the critical care setting even for the most experienced clinician. The morbidity and
mortality attributed to untreated VTE have been substantiated by increasing series
of epidemiologic and postmortem studies. As a larger group of the general population
grows older, with increasing requirements for critical care services, challenges for
the intensivist in the diagnosis and management of VTE are expected to grow. Moreover,
despite the tremendous development of many critical care technologies, complexities
of medical conditions commonly encountered in the critically ill have detracted from
suspicion of VTE and made prompt recognition difficult. The approach to diagnosis
of VTE should optimize diagnostic yield and outcomes with responsible use of resources.
Key to an appropriate approach of VTE diagnosis in the intensive care unit is an understanding
of the predisposing risk factors-pretest probability and the strengths and weaknesses
of available diagnostic tools. Rational use of ultrasound, impedance plethysmography,
computed tomography (CT), echocardiography, contrast venography, angiography, and
D-dimer assays have provided the clinicians with a more substantial armamentarium,
albeit incomplete, to facilitate diagnosis of VTE. The best use of these diagnostic
tests often are dependent on local availability and expertise as part of a multidisciplinary
team. With application of sound clinical principles in identifying select patients
at risk and disciplined use of diagnostic technologies using simple algorithms, improvements
in the diagnosis and management of VTE in the intensive care unit may be expected.
KEYWORD
Venous thromboembolism - critical care - intensive care unit - pulmonary embolism
- deep venous thrombosis.
