Critical Care Management of Acute Pulmonary Embolism

TY - JOUR

T1 - Critical Care Management of Acute Pulmonary Embolism

AU - Yuriditsky, Eugene

AU - Lyhne, Mads Dam

AU - Horowitz, James M

AU - Dudzinski, David M

PY - 2025/1/9

Y1 - 2025/1/9

N2 - The unprimed right ventricle is exquisitely sensitive to acute elevations in afterload. High pulmonary vascular tone incurred with acute pulmonary embolism has the potential to induce obstructive shock and circulatory collapse. While emergent pulmonary reperfusion is essential in severe circumstances, an important subset of pulmonary embolism patients may exhibit a less extreme presentation posing a management dilemma. As intensive care therapies have the potential to both salvage and harm the failing right ventricle, a keen understanding of the pathophysiology is requisite in the care of the contemporary patient with hemodynamically significant pulmonary embolism. Here, we review right ventricular pathophysiology, an approach to risk stratification, and offer guidance on the medical and mechanical supportive and therapeutic strategies for the critically ill patient with acute pulmonary embolism.

AB - The unprimed right ventricle is exquisitely sensitive to acute elevations in afterload. High pulmonary vascular tone incurred with acute pulmonary embolism has the potential to induce obstructive shock and circulatory collapse. While emergent pulmonary reperfusion is essential in severe circumstances, an important subset of pulmonary embolism patients may exhibit a less extreme presentation posing a management dilemma. As intensive care therapies have the potential to both salvage and harm the failing right ventricle, a keen understanding of the pathophysiology is requisite in the care of the contemporary patient with hemodynamically significant pulmonary embolism. Here, we review right ventricular pathophysiology, an approach to risk stratification, and offer guidance on the medical and mechanical supportive and therapeutic strategies for the critically ill patient with acute pulmonary embolism.

KW - acute right ventricular failure

KW - hemodynamic support

KW - high-risk pulmonary embolism

KW - pulmonary embolism

KW - pulmonary reperfusion

UR - https://www.scopus.com/pages/publications/85215108019

U2 - 10.1177/08850666241311512

DO - 10.1177/08850666241311512

M3 - Review

C2 - 39784110

SN - 0885-0666

SP - 8850666241311512

JO - Journal of Intensive Care Medicine

JF - Journal of Intensive Care Medicine

ER -