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Prospective study of device-related complications in intensive care unit detected by virtual autopsy - 14/6/2018

Br J Anaesth 2018; 120: 1229-36


There has been increasing use of invasive techniques, such as extracorporeal organ support, in intensive care units (ICU), and declining autopsy rates. This raises the need for new measures to maintain high-quality standards. These authors investigated the potential of computed tomography (CT)-based virtual autopsy to substitute for medical autopsy in this setting.


The authors investigated the potential of virtual autopsy by post-mortem CT to identify complications associated with medical devices in a prospective study of patients who had died in the ICU. They reviewed clinical records to determine the number and types of medical devices used, and compared findings from medical and virtual autopsies, related and unrelated to the medical devices.



Medical and virtual autopsies could be performed in 61 patients (Group M/V), and virtual autopsy only in 101 patients (Group V). In Group M/V, 41 device-related complications and 30 device malpositions were identified, but only with a low inter-method agreement. Major findings unrelated to a device were identified in about 25% of patients, with a high level of agreement between methods. In Group V, eight device complications and 36 device malpositions were identified.



The authors conclude that device-related complications are frequent in ICU patients. They found that virtual and medical autopsies showed clear differences in the detection of complications and device malpositions. They suggest that both methods should supplement each other rather than using one alone for the quality control of medical devices in the ICU. Thy propose that further studies should focus on the identification of special patient populations in which virtual autopsy might be of particular benefit.

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