Venous thromboembolism deserves your attention 英文参考文献.docVIP

Available online /content/5/6/277 Commentary Venous thromboembolism deserves your attention Charles Marc Samama Department of Anesthesiology and Intensive Care, Hopital Avicenne, Bobigny, France Correspondence: Charles Marc Samama, cmsamama@ Published online: 3 November 2001 Critical Care 2001, 5:277-279 ? 2001 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) See Research, page 336 Abstract The survey of how Canadian intensive care units (ICUs) prevent and diagnose venous thromboembolism (VTE) presented in this issue of Critical Care illustrates considerable variability. Lack of optimal patient care reflects how VTE is rated in ICUs. The discussion should no longer focus on the incidence of thrombosis, but rather on its prevention. Unfractionated heparin remains the most commonly used agent to prevent VTE, despite the recognized efficacy and safety of low-molecular- weight heparins (LMWHs) in the ICU setting. In addition, too few ICU directors consider the use of mechanical prophylactic measures, such as graded elastic stockings and venous foot pump. The present situation calls for large randomized controlled trials in either medical or surgical ICU patients, and for new education programmes in order to modify the care of ICU patients with regard to VTE. Keywords compression, intensive care unit, low-molecular-weight heparin, thromboembolism Deep vein thrombosis (DVT) remains an underestimated inappropriate sense of security. Moreover, the diagnosis is not always easy to confirm. The insensitivity of Doppler ultrasound and the major difficulty in performing venography in ICU patients generally lead to blind anticoagulant prophylaxis. Even when a pulmonary embolism leads to death, diagnosis is often difficult to confirm in a patient who has already been treated and ventilated for a pulmonary condition because autopsies are rarely conducted in trauma victims. As stated at th