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Semin Thromb Hemost 2021; 47(06): 631-642
DOI: 10.1055/s-0041-1722847
Review Article

Venous Thromboembolism among Critically Ill Children: A Narrative Review

Anthony A. Sochet
1   Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
2   Division of Pediatric Critical Care Medicine, Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
3   Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
,
Amy Kiskaddon
3   Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
4   Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
,
Marisol Betensky
3   Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
5   Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
6   Thrombosis Program, Johns Hopkins All Children's Cancer and Blood Disorder Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
,
Neil Goldenberg
3   Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
5   Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
6   Thrombosis Program, Johns Hopkins All Children's Cancer and Blood Disorder Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
7   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality among hospitalized patients, including children. In recent years, it has become clear that hospitalization and critical illness bestow an increased VTE risk in pediatrics and relate to mortality and life-limiting comorbidities. For critically ill children, reported rates of VTE vary by study sampling techniques, presence of inherited or acquired thrombophilia, acute and chronic immobility, underlying illness prompting hospitalization, and clinical factors related to illness severity such as central venous catheterization, length of stay, mechanical ventilation, and patient age. Accordingly, critically ill children with new signs of venous congestion, acute inflammation, or unexplained acute organ dysfunction should be routinely evaluated for VTE. This narrative review summarizes recent and historical literature regarding risk factors, prevention, presentation, treatment, and outcomes of VTE in critically ill children. In addition, we identify knowledge gaps and priorities for future collaborative research on this vital condition. Special attention is given to the clinical trial opportunities, challenges, and ongoing efforts in thromboprophylaxis in critically ill children, including those hospitalized for disease related to novel coronavirus (COVID-19) and multisystem inflammatory disease in children.

Keywords

hospital-acquired VTE - pediatrics - critical care medicine - pediatric intensive care unit - thromboprophylaxis


Publication History

Article published online:
31 May 2021

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