TY - JOUR
T1 - Continuous pulse oximetry and the diagnosis of pulmonary embolism in critically ill trauma patients
AU - Brathwaite, Collin E.M.
AU - O’Malley, Keith F.
AU - Ross, Steven E.
AU - Pappas, Peter
AU - Alexander, James
AU - Spence, Richard K.
PY - 1992/10
Y1 - 1992/10
N2 - The diagnosis of pulmonary embolism (PE) may be difficult to establish in trauma patients, particularly those who are unresponsive or mechanically ventilated. Based on a prior retrospective study, we hypothesized that patients monitored by continuous pulse oximetry who experienced a 10% or greater sudden sustained drop in arterial oxygen saturation (Sao2) without a change in static lung compliance (Cst) were most likely to have had a PE. We followed Sao2 in 972 patients admitted to our trauma ICU during the 18-month period ending in December 1990. Forty-eight patients (5%) with Sao2 changes, but no Cst changes, were evaluated for suspected PE using pulmonary arteriography (PA). Of these, 21 (44%) had a positive PA study. All patients with a positive PA had either clear chest roentgenograms or no change in underlying pulmonary pathologic processes. Of the remainder, 26 had evidence of a new pathologic entity on chest roentgenograms and only one patient had a Sao2 decrease, no change in Cst, and a negative PA. All mechanically ventilated trauma patients should have Sao2 monitored continuously. Patients with a >10% drop in Sao2 with no change in Cst and no new roentgenographic chest findings should undergo PA. Based on our experience, this approach would yield a sensitivity, specificity, and predictive value of 100%, 99.9%, and 95%, respectively, for the diagnosis of clinically significant PE.
AB - The diagnosis of pulmonary embolism (PE) may be difficult to establish in trauma patients, particularly those who are unresponsive or mechanically ventilated. Based on a prior retrospective study, we hypothesized that patients monitored by continuous pulse oximetry who experienced a 10% or greater sudden sustained drop in arterial oxygen saturation (Sao2) without a change in static lung compliance (Cst) were most likely to have had a PE. We followed Sao2 in 972 patients admitted to our trauma ICU during the 18-month period ending in December 1990. Forty-eight patients (5%) with Sao2 changes, but no Cst changes, were evaluated for suspected PE using pulmonary arteriography (PA). Of these, 21 (44%) had a positive PA study. All patients with a positive PA had either clear chest roentgenograms or no change in underlying pulmonary pathologic processes. Of the remainder, 26 had evidence of a new pathologic entity on chest roentgenograms and only one patient had a Sao2 decrease, no change in Cst, and a negative PA. All mechanically ventilated trauma patients should have Sao2 monitored continuously. Patients with a >10% drop in Sao2 with no change in Cst and no new roentgenographic chest findings should undergo PA. Based on our experience, this approach would yield a sensitivity, specificity, and predictive value of 100%, 99.9%, and 95%, respectively, for the diagnosis of clinically significant PE.
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U2 - 10.1097/00005373-199210000-00007
DO - 10.1097/00005373-199210000-00007
M3 - Article
C2 - 1433398
AN - SCOPUS:0026467071
SN - 0022-5282
VL - 33
SP - 528
EP - 531
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 4
ER -