Embolia pulmonar: registro multicêntrico da prática clínica em hospitais terciários
Embolia pulmonar: registro multicêntrico da prática clínica em hospitais terciários
Data
2009
Autores
Volschan, André
Albuquerque, Denilson Campos de
Tura, Bernardo Rangel
Knibel, Marcos de Freitas
Souza, Paulo César Pereira da Silva e
Toscano, Maria Luiza
Journal Title
Journal ISSN
Volume Title
Publisher
Revista Brasileira de Terapia Intensiva
Resumo
INTRODUÇÃO: O perfil clínico e as estratégias diagnósticas e terapêuticas nos pacientes com embolia pulmonar demonstram a prática clínica na abordagem da doença. Essas informações, escassas nos estudos nacionais, possibilitam melhor conhecimento da embolia pulmonar. MÉTODOS: Estudo multicêntrico de 727 pacientes admitidos em unidades de emergência ou terapia intensiva, com o diagnóstico de embolia pulmonar confirmado por um ou mais dos seguintes exames: arteriografia pulmonar angiotomografia computadorizada helicoidal angioressonância magnética, ecodopplercardiograma, cintilografia pulmonar ou duplex-scan venoso. Dados demográficos, comorbidades, manifestações clínicas e métodos complementares foram analisados. RESULTADOS: A média de idade foi 68 anos, sendo 42% homens. Os fatores de risco mais prevalentes foram: idade > 40 anos, repouso no leito e neoplasia. A dispnéia, taquipnéia, taquicardia, dor torácica, foram as manifestações clínicas mais frequentes. O eletrocardiograma apresentou alterações em 30%, a radiografia de tórax em 45%, o duplex-scan venoso em 69% e o ecodopplercardiograma em 37%. O D-dímero a troponina e a CKMB foram positivos em respectivamente 93, 9 e 8%. Os métodos mais utilizados para o diagnóstico foram: tomografia computadorizada: 47%, duplex-scan venoso: 14% e cintilografia pulmonar: 14%. As formas mais freqüentes de tratamento foram: heparina não fracionada 50%, heparina de baixo peso molecular 30% e trombolítico 12%. A mortalidade intra-hospitalar foi de 19,5%. CONCLUSÕES: Observou-se que a idade > 40 anos, imobilização prolongada e neoplasia foram os fatores de risco de maior prevalência e a dispnéia a apresentação clínica mais freqüente. A angiotomografia computadorizada helicoidal foi o método mais utilizado para o diagnóstico e a heparina não fracionada a principal forma de tratamento.
INTRODUCTION: The clinical profile as well as the therapeutic and diagnostic strategies for patients with pulmonary embolism, describes clinical practice in the approach of the disease. Such information, scarce in national studies, enables a better understanding of pulmonary embolism. METHODS: A multicenter trial included 727 patients with pulmonary embolism who were admitted in emergency or intensive care unit. Diagnostic criteria for inclusion were: 1. Visibility of thrombus in the pulmonary artery at pulmonary arteriography, helical computer tomography, magnetic resonance or echocardiogram. 2. High probability at pulmonary scintigraphy. 3. Venous duplex-scan with thrombus and clinical manifestations of pulmonary embolism. Clinical and complementary exams were analyzed. RESULTS: Mean age was 68 years, 42% were male. Most prevalent risk factors were: age>40 years, bed rest and neoplasm. More frequent signs and symptoms were: dyspnea, tachypnea, sinus tachycardia, and chest pain. Changes were observed at electrocardiogram in 30%, at chest X-ray in 45%, at venous duplex-scan in 67%, at transthoracic echocardiogram in 37%. . D-dimer, troponin I and CKMB were positive in, respectively, 93, 9 and 8%. Most frequently used methods to confirm diagnosis were helical computer tomography and non-fractioned heparin was the treatment most used. In-hospital mortality was 19.5%. CONCLUSIONS: It was observed that age>40 years, prolonged rest and neoplasms were the most prevalent risk factors and dyspnea and tachypnea were the more frequent clinical manifestations. Helical computer tomography was the most often used method to confirm diagnosis and non-fractioned heparin was the main form of treatment.
INTRODUCTION: The clinical profile as well as the therapeutic and diagnostic strategies for patients with pulmonary embolism, describes clinical practice in the approach of the disease. Such information, scarce in national studies, enables a better understanding of pulmonary embolism. METHODS: A multicenter trial included 727 patients with pulmonary embolism who were admitted in emergency or intensive care unit. Diagnostic criteria for inclusion were: 1. Visibility of thrombus in the pulmonary artery at pulmonary arteriography, helical computer tomography, magnetic resonance or echocardiogram. 2. High probability at pulmonary scintigraphy. 3. Venous duplex-scan with thrombus and clinical manifestations of pulmonary embolism. Clinical and complementary exams were analyzed. RESULTS: Mean age was 68 years, 42% were male. Most prevalent risk factors were: age>40 years, bed rest and neoplasm. More frequent signs and symptoms were: dyspnea, tachypnea, sinus tachycardia, and chest pain. Changes were observed at electrocardiogram in 30%, at chest X-ray in 45%, at venous duplex-scan in 67%, at transthoracic echocardiogram in 37%. . D-dimer, troponin I and CKMB were positive in, respectively, 93, 9 and 8%. Most frequently used methods to confirm diagnosis were helical computer tomography and non-fractioned heparin was the treatment most used. In-hospital mortality was 19.5%. CONCLUSIONS: It was observed that age>40 years, prolonged rest and neoplasms were the most prevalent risk factors and dyspnea and tachypnea were the more frequent clinical manifestations. Helical computer tomography was the most often used method to confirm diagnosis and non-fractioned heparin was the main form of treatment.
Description
Palavras-chave
Tomography, X-ray computed, Heparin, Pulmonary embolism, Tomografia computadorizada por raios-x, Heparina, Embolia pulmonar
Citação
Volschan A, Albuquerque DC de, Tura BR, Knibel M de F, Souza PCP da S e, Toscano ML. Embolia pulmonar: registro multicêntrico da prática clínica em hospitais terciários. Rev bras ter intensiva [Internet]. 2009Jul;21(3):237–46. Available from: https://doi.org/10.1590/S0103-507X2009000300002