@article {Hassen1531, author = {Mohamed Fekih Hassen and Nejla Tilouche and Oussama Jaoued and Souheil Elatrous}, title = {Incidence and Impact of Pulmonary Embolism During Severe COPD Exacerbation}, volume = {64}, number = {12}, pages = {1531--1536}, year = {2019}, doi = {10.4187/respcare.06661}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Patients with COPD are at a high risk for pulmonary embolism (PE) because of systemic inflammation and co-existing comorbidities. We aimed to determine the incidence, risk factors, and impact of PE during COPD exacerbation requiring mechanical ventilation.METHODS: This prospective cohort study was conducted between March 2013 and May 2017. Subjects with severe COPD exacerbation requiring mechanical ventilation were included. A lower-limb ultrasonography or a multidetector helical computed tomography scan (MDCT) was performed according to Wells score. Subjects with ultrasonographic signs of phlebitis underwent MDCT to confirm PE.RESULTS: During the study period, 131 COPD subjects were admitted to the ICU for severe COPD exacerbation. The incidence of PE was 13.7\%. Factors independently associated with PE were increased sputum volume (odds ratio [OR] = 0.106, 95\% CI 0.029{\textendash}0.385, P = .001), recent immobilization >= 7 d (OR = 5.024, 95\% CI 1.470{\textendash}17.170, P = .01), age >= 70 y (OR = 5.483, 95\% CI 1.269{\textendash}23.688, P = .02), and invasive mechanical ventilation at ICU admission (OR = 3.615, 95\% CI 1.005{\textendash}13.007, P = .049). ICU mortality was higher in the PE group (44\% vs 11\%). Predictive factors of mortality were PE (OR = 7.135, 95\% CI 2.042{\textendash}24.931, P = .002), SAPS II score at admission OR = 1.040, 95\% CI 1.005{\textendash}1.077, P = .02), and duration of mechanical ventilation (OR = 1.098, 95\% CI 1.044{\textendash}1.154, P \< .001).CONCLUSION: PE was found to be a common etiology of severe exacerbation of COPD, leading to high mortality. Age, invasive mechanical ventilation, and immobilization were risk factors for PE.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/64/12/1531}, eprint = {https://rc.rcjournal.com/content/64/12/1531.full.pdf}, journal = {Respiratory Care} }