Reduction in deep vein thrombosis incidence in intensive care after a clinician education program.
BACKGROUND
Deep vein thrombosis (DVT) is a major complication in intensive care units (ICU) but dedicated guidelines on its management are still lacking.


OBJECTIVE
This study investigated the effect of a 1-year educational program for the implementation of DVT prophylaxis on the incidence of inferior limb DVT in a mixed-bed ICU that admits high-risk surgical and trauma patients, investigated during a first retrospective phase [126 patients, SAPS II score 42 (28-54)] and a following prospective phase [264 patients, SAPS II score II 41 (27-55)]. The role of baseline and time-dependent DVT risk factors in DVT occurrence was also investigated during the prospective phase.


RESULTS
The educational program on implementation of DVT prophylaxis was associated with a significant decrease in DVT incidence from 11.9% to 4.5% (P < 0.01) and in the mean length of ICU stay (P < 0.01). Combined with pharmacological prophylaxis, the use of elastic compressive stockings significantly also increased in the prospective phase (P < 0.01). The duration of mechanical ventilation, vasopressor administration and neuromuscular block were significantly different between DVT-positive and DVT-negative patients (P < 0.01). Multivariate analysis identified neuromuscular block as the strongest independent predictor for DVT incidence.


CONCLUSIONS
One-year ICU-based educational programs on implementation of DVT prophylaxis were associated with a significant decrease in the incidence of DVT and also in the length of stay in ICU.
Boddi
M
M
Clinica Medica Generale e Medicine Specialistiche, Dipartimento di Area Critica Medico-Chirurgica, Azienza Ospedaliera-Universitaria Careggi, Florence, Italy. m.boddi@dac.unifi.it
Barbani
F
F
Abbate
R
R
Bonizzoli
M
M
Batacchi
S
S
Lucente
E
E
Chiostri
M
M
Gensini
G F
GF
Peris
A
A
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003479:Curriculum; D004502:Education, Medical, Continuing; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006405:Hematology / Q000193:education*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D048228:Intermittent Pneumatic Compression Devices; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015397:Program Evaluation; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014662:Vasoconstrictor Agents / Q000009:adverse effects; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D014662:Vasoconstrictor Agents