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Scintigraphic lung scans and clinical assessment in critically ill patients with suspected acute pulmonary embolism
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PII SO736-4679(96)000174-6
Abstracts
0 ARTERIAL BLOOD GAS ANALYSIS IN THE ASSESSMENT OF SUSPECTED ACUTE PULMONARY EMBOLISM. Stein PD, Goldhaber SZ, Henry JW, et al.
hypoxemic on room air ( pa02 c: 50 mmHg ) ( n = 89) and not given ventilatory support; patients given ventilatory support (n = 46) ; patients in intensive care units but not given ventilatory support (n = 46) ; and hypotensive patients who were not hypoxemic or given ventilatory support. These patients were compared with 627 patients who did not have these characteristics. All patients received V/Q scanning and detinitive diagnosis with pulmonary angiography. Of 89 patients who were hypoxemic and not on ventilatory support, 27 ( 30% ) had Pulmonary Embolism (PE) and 62 (70%) did not have PE. The sensitivity of high probability interpretation of V/Q scan was 17 of 27 (63%). which was higher than the sensitivity of V/Q scanning in noncritically ill patients (87/227 = 38%). The positive predictive values of high, low, and near normal or normal interpretations of V/Q scans did not differ signilicantly from positive predictive values in non-critically ill patients. Intermediate probability interpretations of the V/Q scan showed a lower positive predictive value in hypoxemic patients when compared with non-critically ill patients. None of the other groups of critically ill patients showed any statistical difference in the results of their V/Q scanning sensitivity or specificity when compared with the non-critical group of patients. The authors conclude that V/Q scanning is as sensitive and specific in critically ill patients as it is in non-critically ill patients. f James 1.. LAIYOIL MD]
Chest. 1996: 109:78-81. The authors of this study examined the arterial blood gas (ABG) data from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) to determine the utility of arterial blood gas analysis in the exclusion of pulmonary emboli. All patients had an ABG and had pulmonary embolism (PE) diagnosed or excluded by pulmonary angiography. There were two groups of subjects. Group one included 330 patients with no prior history of cardiopulmonary disease. Of these patients, 130 had PE and 200 did not. Group two included 438 patients with prior cardiopulmonary disease; 147 had PE and 291 did not. ABG parameters defined as abnormal were PaOZ < 80 mmHg, PaCO> < 35 mmHg, and an alveolar-arterial oxygen (A-a) gradient over 20 mmHg. In patients with no prior cardiac disease, a normal PaO,, PaCO*, and A-a gradient, 16 of 42 ( 38%) had PE. Four of 28 patients ( 14%) with prior cardiopulmonary disease and normal ABG values had PE. Other combinations of these blood gas values failed to exclude more patients from having PE. The authors conclude that arterial blood gas values are of insufficient discriminant value to permit the exclusion of PE. 1James L. Larson, MD ] Editor’s comment: The A-a gradient appears to be less useful in excluding PE than previously thought.
0 RELATION BETWEEN TROPONIN T AND THE RISK OF SUBSEQUENT CARDIAC EVENTS IN UNSTABLE CORONARY ARTERY DISEASE. Lindahl B,
3 SCINTIGRAPHIC LUNG SCANS AND CLINICAL ASSESSMENT IN CRITICALLY ILL PATIENTS WITH SUSPECTED ACUTE PULMONARY EMBOLISM. Henry JW. Stein PD, Gottschalk A, et al. Chest.
Venge P. Wallentin L, et al. Circulation. 1996;93: 16.51- 7. Troponin T (tn-T) levels have been found to be elevated in 30-50% of patients with non-Q wave myocardial infarcts (MI) or unstable angina. This randomized, prospective study looked at the possible predictive values of m-T values for future cardiac events in these patients: 976 patients with myocardial ischemia demonstrated both by symptoms (new onset angina pectoris. increasing angina the last 2 months, or ongoing chest pain within the last 72 h) and signs of ischemia (resting electrocardiogram with ST depressions in
1996; 109:462--66. The authors of this study compared the use of ventilation/ perfusion (V/Q) lung scanning in critically ill patients versus non-critically ill patients. The data were taken from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). Critically ill patients were defined as patients who were
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Abstracts is coordinated by Jedd Roe, MD, of Denver General Hospital. Denver, Colorado. Abstracts are prepared by the Emergency Medicine Residents and Stephen R. Hayden, MD, of the University of California, San Diego; Denver Affiliated Residency in Emergency Medicine, Denver, Colorado: and the University of California--San Diego Medical Center, San Diego, California .--...------__ 787
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PII SO736-4679(96)000174-6
Abstracts
0 ARTERIAL BLOOD GAS ANALYSIS IN THE ASSESSMENT OF SUSPECTED ACUTE PULMONARY EMBOLISM. Stein PD, Goldhaber SZ, Henry JW, et al.
hypoxemic on room air ( pa02 c: 50 mmHg ) ( n = 89) and not given ventilatory support; patients given ventilatory support (n = 46) ; patients in intensive care units but not given ventilatory support (n = 46) ; and hypotensive patients who were not hypoxemic or given ventilatory support. These patients were compared with 627 patients who did not have these characteristics. All patients received V/Q scanning and detinitive diagnosis with pulmonary angiography. Of 89 patients who were hypoxemic and not on ventilatory support, 27 ( 30% ) had Pulmonary Embolism (PE) and 62 (70%) did not have PE. The sensitivity of high probability interpretation of V/Q scan was 17 of 27 (63%). which was higher than the sensitivity of V/Q scanning in noncritically ill patients (87/227 = 38%). The positive predictive values of high, low, and near normal or normal interpretations of V/Q scans did not differ signilicantly from positive predictive values in non-critically ill patients. Intermediate probability interpretations of the V/Q scan showed a lower positive predictive value in hypoxemic patients when compared with non-critically ill patients. None of the other groups of critically ill patients showed any statistical difference in the results of their V/Q scanning sensitivity or specificity when compared with the non-critical group of patients. The authors conclude that V/Q scanning is as sensitive and specific in critically ill patients as it is in non-critically ill patients. f James 1.. LAIYOIL MD]
Chest. 1996: 109:78-81. The authors of this study examined the arterial blood gas (ABG) data from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) to determine the utility of arterial blood gas analysis in the exclusion of pulmonary emboli. All patients had an ABG and had pulmonary embolism (PE) diagnosed or excluded by pulmonary angiography. There were two groups of subjects. Group one included 330 patients with no prior history of cardiopulmonary disease. Of these patients, 130 had PE and 200 did not. Group two included 438 patients with prior cardiopulmonary disease; 147 had PE and 291 did not. ABG parameters defined as abnormal were PaOZ < 80 mmHg, PaCO> < 35 mmHg, and an alveolar-arterial oxygen (A-a) gradient over 20 mmHg. In patients with no prior cardiac disease, a normal PaO,, PaCO*, and A-a gradient, 16 of 42 ( 38%) had PE. Four of 28 patients ( 14%) with prior cardiopulmonary disease and normal ABG values had PE. Other combinations of these blood gas values failed to exclude more patients from having PE. The authors conclude that arterial blood gas values are of insufficient discriminant value to permit the exclusion of PE. 1James L. Larson, MD ] Editor’s comment: The A-a gradient appears to be less useful in excluding PE than previously thought.
0 RELATION BETWEEN TROPONIN T AND THE RISK OF SUBSEQUENT CARDIAC EVENTS IN UNSTABLE CORONARY ARTERY DISEASE. Lindahl B,
3 SCINTIGRAPHIC LUNG SCANS AND CLINICAL ASSESSMENT IN CRITICALLY ILL PATIENTS WITH SUSPECTED ACUTE PULMONARY EMBOLISM. Henry JW. Stein PD, Gottschalk A, et al. Chest.
Venge P. Wallentin L, et al. Circulation. 1996;93: 16.51- 7. Troponin T (tn-T) levels have been found to be elevated in 30-50% of patients with non-Q wave myocardial infarcts (MI) or unstable angina. This randomized, prospective study looked at the possible predictive values of m-T values for future cardiac events in these patients: 976 patients with myocardial ischemia demonstrated both by symptoms (new onset angina pectoris. increasing angina the last 2 months, or ongoing chest pain within the last 72 h) and signs of ischemia (resting electrocardiogram with ST depressions in
1996; 109:462--66. The authors of this study compared the use of ventilation/ perfusion (V/Q) lung scanning in critically ill patients versus non-critically ill patients. The data were taken from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). Critically ill patients were defined as patients who were
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Abstracts is coordinated by Jedd Roe, MD, of Denver General Hospital. Denver, Colorado. Abstracts are prepared by the Emergency Medicine Residents and Stephen R. Hayden, MD, of the University of California, San Diego; Denver Affiliated Residency in Emergency Medicine, Denver, Colorado: and the University of California--San Diego Medical Center, San Diego, California .--...------__ 787