Thromboembolism occurrence and diagnosis in the medical intensive care unit

Venous thromboembolism (VTE) represents an unrelenting and formidable chall enge in the critical care setting even for the most experienced clinician. The morbidity and mortality attributed to untreated VTE have been substanti ated by increasing series of epidemiologic and postmortem studies. As a lar ger group of the general population grows older, with increasing requiremen ts for critical care services, challenges for the intensivist in the diagno sis and management of VTE are expected to grow. Moreover, despite the treme ndous development of many critical care technologies, complexities of medic al conditions commonly encountered in the critically ill have detracted fro m suspicion of VTE and made prompt recognition difficult. The approach to d iagnosis of VTE should optimize diagnostic yield and outcomes with responsi ble use of resources. Key to an appropriate approach of VTE diagnosis in th e intensive care unit is an understanding of the predisposing risk factors- pretest probability and the strengths and weaknesses of available diagnosti c tools. Rational use of ultrasound, impedance plethysmography, computed to mography (CT), echocardiography, contrast venography, angiography, and D-di mer assays have provided the clinicians with a more substantial armamentari um, albeit incomplete, to facilitate diagnosis of VTE, The best use of thes e diagnostic tests often are dependent on local availability and expertise as part of a multidisciplinary team. With application of sound clinical pri nciples in identifying select patients at risk and disciplined use of diagn ostic technologies using simple algorithms, improvements in the diagnosis a nd management of VTE in the intensive care unit may be expected.