The diagnosis of deep venous thrombosis and pulmonary embolism in medical-surgical intensive care unit patients

There is no diagnostic test for DVT that is both highly accurate and feasible in medical-surgical ICU patients. Diagnostic testing for PE in such patients poses an even greater challenge. Despite a lack of studies of CUS in critically ill patients, it is the most widely used and accepted DVT diagnostic test in such patients. Because the likelihood of PE from undiagnosed, untreated proximal DVT is high, strategies that screen for proximal DVT in critically ill patients, therefore, have the potential to reduce the risk of PE and its cardiopulmonary consequences through early treatment. However, systematic screening for DVT with CUS cannot be recommended currently; this requires a randomized trial to evaluate whether this approach does more good than harm. In critically ill patients with suspected PE, spiral CT scanning is the principal method to diagnose PE although may not reliably exclude PE. Emerging clinical management studies that involve spiral CT in patients with suspected PE should inform clinical practice and would be relevant also to critically ill patients.