Continuous Pulse Oximetry and the Diagnosis of Pulmonary Embolism in
Critically Ill Trauma Patients. Brathwaite-Collin-E-M. OMalley-Keith-F. Ross-Steven-E. Pappas-Peter. Alexander-James. Spence-Richard-K. The Journal of Trauma. 1992 Oct. 33(4). pp 528-531. The diagnosis of pulmonary embolism (PE) may be difficult to establish in trauma patients, particularly those who are unresponsive or mechanically ventilated. Based on a prior retrospective study, we hypothesized that patients monitored by continuous pulse oximetry who experienced a 10% or greater sudden sustained drop in arterial oxygen saturation (SaO sub 2) without a change in static lung compliance (Cst) were most likely to have had a PE. We followed SaO sub 2 in 972 patients admitted to our trauma ICU during the 18-month period ending in December 1990. Forty-eight patients (5%) with SaO sub 2 changes, but no Cst changes, were evaluated for suspected PE using pulmonary arteriography (PA). Of these, 21 (44%) had a positive PA study. All patients with a positive PA had either clear chest roentgenograms or no change in underlying pulmonary pathologic processes. Of the remainder, 26 had evidence of a new pathologic entity on chest roentgenograms and only one patient had a SaO sub 2 decrease, no change in Cst, and a negative PA. All mechanically ventilated trauma patients should have SaO sub 2 monitored continuously. Patients with a >10% drop in SaO sub 2 with no change in Cst and no new roentgenographic chest findings should undergo PA. Based on our experience, this approach would yield a sensitivity, specificity, and predictive value of 100%, 99.9%, and 95%, respectively, for the diagnosis of clinically significant PE.
Original Text by Clifford R. Wheeless, III, MD.
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