title: Impact of unsuspected subsegmental pulmonary embolism in ICU patients.
abstract: BACKGROUND
  Critically ill patients in intensive-care units are at high risk for pulmonary embolism (PE). As a result of modern multi-detector computed tomographic angiography (MDCT) increased visualization of peripheral pulmonary arteries, isolated subsegmental pulmonary embolisms (ISSPE) are increasingly being detected.
  
  
  OBJECTIVE
  The aim of this study was to investigate the rate, impact on treatment, and outcome of unsuspected ISSPE in critically ill patients receiving MDCT. The secondary aim was to investigate the potential impact of contrast media-induced nephropathy (CIN) in our cohort.
  
  
  METHODS
  We conducted a retrospective single-centre analysis on critically ill adult patients treated between January 2009 and December 2012 who underwent a contrast-enhanced chest MDCT. We excluded patients with clinical suspicion of PE/ISSPE prior to CT and patients with MDCT confirmed central PE. Clinical findings, laboratory parameters, and outcome data were recorded.
  
  
  RESULTS
  We identified 240 ICU patients not suspected for PE receiving MDCT. A total of 12 Patients (5%) showed unexpected ISSPE representing increased 24 h mortality (16.7 vs. 3.5%; p = 0.026) compared to non-ISPPE/non-PE patients. A 30-days mortality did not differ between the groups (33.3 vs. 33.8%; p = 0.53). Highest mean creatinine serum level in our cohort (n = 240) was found before MDCT with a significant decrease to day 5 (1.4 ± 1.1 vs. 1.1 ± 0.9 mg/dl: p < 0.0001) after contrast media administration.
  
  
  CONCLUSIONS
  Critically ill patients are at relevant risk for ISSPE. ISSPE was associated with a poor 24 h outcome. In addition, in our cohort, contrast media application was not associated with increased serum creatinine.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany. christian.koch@chiru.med.uni-giessen.de.
authors.forename: C
authors.initials: C
authors.lastname: Koch
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schramm
authors.affiliation: Department of Radiology, University Hospital of Giessen and Marburg, 35392, Giessen, Germany.
authors.forename: F C
authors.initials: FC
authors.lastname: Roller
authors.affiliation: Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital of Giessen and Marburg, 35392, Giessen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hecker
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Henrich
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Schneck
authors.affiliation: Department of Radiology, University Hospital of Giessen and Marburg, 35392, Giessen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Krombach
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.|Department of Anaesthesiology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany.
authors.forename: M A
authors.initials: MA
authors.lastname: Weigand
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.|Department of Anaesthesiology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Lichtenstern
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D015331:Cohort Studies; D003287:Contrast Media / Q000009:adverse effects; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000139:chemically induced / Q000453:epidemiology; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Intensive care medicine; Multi-detector computed tomographic angiography; Outcome prediction; Subsegmental pulmonary embolism