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Reduction in deep vein thrombosis incidence in intensive care after a clinician education program Boddi M; Barbani F; Abbate R; Bonizzoli M; Batacchi S; Lucente E; Chiostri M; Gensini GF; Peris AJ Thromb Haemost 2010[Jan]; 8 (1): 121-8BACKGROUND: Deep vein thrombosis (DVT) is a major complication in intensive care units (ICU) but dedicated guidelines on its management are still lacking. OBJECTIVES AND METHODS: This study investigated the effect of a 1-year educational program for the implementation of DVT prophylaxis on the incidence of inferior limb DVT in a mixed-bed ICU that admits high-risk surgical and trauma patients, investigated during a first retrospective phase [126 patients, SAPS II score 42 (28-54)] and a following prospective phase [264 patients, SAPS II score II 41 (27-55)]. The role of baseline and time-dependent DVT risk factors in DVT occurrence was also investigated during the prospective phase. RESULTS: The educational program on implementation of DVT prophylaxis was associated with a significant decrease in DVT incidence from 11.9% to 4.5% (P < 0.01) and in the mean length of ICU stay (P < 0.01). Combined with pharmacological prophylaxis, the use of elastic compressive stockings significantly also increased in the prospective phase (P < 0.01). The duration of mechanical ventilation, vasopressor administration and neuromuscular block were significantly different between DVT-positive and DVT-negative patients (P < 0.01). Multivariate analysis identified neuromuscular block as the strongest independent predictor for DVT incidence. CONCLUSION: One-year ICU-based educational programs on implementation of DVT prophylaxis were associated with a significant decrease in the incidence of DVT and also in the length of stay in ICU.|*Education, Medical, Continuing[MESH]|*Intensive Care Units[MESH]|*Intermittent Pneumatic Compression Devices[MESH]|*Stockings, Compression[MESH]|Adult[MESH]|Aged[MESH]|Combined Modality Therapy[MESH]|Curriculum[MESH]|Female[MESH]|Fibrinolytic Agents/*therapeutic use[MESH]|Hematology/*education[MESH]|Humans[MESH]|Incidence[MESH]|Italy/epidemiology[MESH]|Length of Stay[MESH]|Logistic Models[MESH]|Male[MESH]|Middle Aged[MESH]|Neuromuscular Blockade/adverse effects[MESH]|Practice Guidelines as Topic[MESH]|Prevalence[MESH]|Program Evaluation[MESH]|Prospective Studies[MESH]|Respiration, Artificial/adverse effects[MESH]|Retrospective Studies[MESH]|Risk Assessment[MESH]|Risk Factors[MESH]|Time Factors[MESH]|Treatment Outcome[MESH]|Ultrasonography[MESH]|Vasoconstrictor Agents/adverse effects[MESH]|Venous Thrombosis/diagnostic imaging/epidemiology/etiology/*prevention & control[MESH] |
