Characteristics, incidence and outcome of patients admitted to intensive care because of pulmonary embolism.
Despite the clinical significance of major pulmonary embolism (PE), little is known about patients with a presentation severe enough to lead to intensive care unit (ICU) admission and nothing is known about PE requiring mechanical ventilation (MV). We aimed to examine the characteristics, incidence and outcome of patients with PE as their reason for ICU admission.



We performed a retrospective, cross-sectional study of patients admitted to Australia's and New Zealand's ICUs because of PE from 2005 to 2013. We compared survivors with non-survivors and mechanically ventilated with non-ventilated patients. We analysed variations in incidence and mortality over time.



We studied 2797 patients. PE accounted for 0.3% of all ICU admissions and had a population incidence of 11 cases/million people/year, which increased significantly during the study period (P < 0.0001). Co-morbidities were common (24.1%) and the emergency department was the most common admission source (49.1%). However, patients who died were more commonly admitted from the wards (P < 0.0001). Overall mortality was 14.1% but reached 41.0% in patients requiring MV (P < 0.0001). Illness severity-adjusted mortality rate did not change during the study period.



The incidence of PE requiring admission to ICU has increased over time; its mortality rate remains high, especially in mechanically ventilated patients, and its prognosis has not improved over time. Our findings imply the need for focused research in this high-risk patient group.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy.
Dario
0000-0003-1207-8289
D
Winterton
Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
Michael
M
Bailey
Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
David
D
Pilcher
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy.|Vita-Salute San Raffaele University, Milano, Italy.
Giovanni
G
Landoni
Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
Rinaldo
R
Bellomo
D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010343:Patient Admission; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies
epidemiology; intensive care unit; mechanical ventilation; mortality; pulmonary embolism