Pulmonary Embolism in the ICU , An Issue of Critical Care Clinics (Volume 36-3)

Description:

This issue of Critical Care Clinics, guest edited by Drs. Geno Merli, Bharat Awsare, and Michael Baram, focuses on Pulmonary Embolism in the ICU. This is one of four issues each year selected by the series consulting editor, Dr. John Kellum. Articles in this issue include, but are not limited to: Making the Diagnosis of Pulmonary Embolism: Stable Versus Unstable; Risk Stratification; Overview of Management of Sub-massive and Massive Pulmonary Embolism; Standard Therapy: Systemic Thrombolytics; IR Therapy: IVC Filter and Catheter-based Therapies; Surgical Therapy: Embolectomy; Supportive Therapy: Management of Acute RV Failure; Supportive Therapy: ECMO/RVAD; Special Considerations; Therapy in Sub-populations; and Post-ICU Follow-up.

Table of Contents:

Pulmonary Embolism in Intensive Care Unit

Key points

Introduction

Epidemiology of pulmonary embolism

Pathophysiology

Role of the intensive care unit

The intensive care unit and multiorgan failure

Pulmonary embolism response teams

Summary

Risk Stratification of Pulmonary Embolism

Key points

Introduction

Clot burden

Clinical parameters

Markers of right ventricular dysfunction

Summary

Overview of Management of Intermediate- and High-Risk Pulmonary Embolism

Key points

Introduction

Definitions

Potential benefits of acute pulmonary embolism therapy

Acute pulmonary embolism: supportive therapy and general concepts

Treatment of high-risk pulmonary embolism

Treatment of intermediate-risk pulmonary embolism

Summary

Thrombolysis in Pulmonary Embolism: An Evidence-Based Approach to Treating Life-Threatening Pulmonary Emboli

Key points

Introduction

Rationale for thrombolysis

The evolving evidence for thrombolysis

Massive pulmonary embolism

Submassive pulmonary embolism

Practical considerations in thrombolysis

Summary

Interventional Radiology Therapy: Inferior Vena Cava Filter and Catheter-based Therapies

Key points

Catheter-directed therapies

Inferior vena cava filters

Summary

Surgical Pulmonary Embolectomy

Key points

Introduction

Indications

Current surgical approach

Supporting evidence

Comparisons with other therapies

Summary

Management of Right Ventricular Failure in Pulmonary Embolism

Key points

Introduction

Pathophysiology of right ventricular failure

Preload optimization: volume management

Early priority for clot reduction

The role for vasopressors and inotropes

Maintaining systemic pressure and coronary perfusion: vasopressors

Maintaining cardiac output: inotropes

Managing right ventricular afterload: pulmonary vasodilators

Managing respiratory failure: intubation and mechanical ventilation

Managing right ventricular failure with mechanical support: extracorporeal membrane oxygenation and right ventricular assist device

Summary

Supportive Therapy: Extracorporeal Membrane Oxygenation

Key points

Introduction

Cardiac arrest

Cardiogenic shock

Pregnancy

Cannulation strategies

Pulmonary embolism response team

Summary

Special Considerations in Pulmonary Embolism: Clot-in-Transit and Incidental Pulmonary Embolism

Key points

Introduction

Clot-in-transit

Epidemiology

Types of right heart thrombi

Pathophysiology

Diagnosis

Prognosis

Treatment

Outcomes

Incidental pulmonary embolism

Summary

Pulmonary Embolism in the Intensive Care Unit: Therapy in Subpopulations

Key points

The pregnant patient

Risk factors

Incidence

Pathophysiology of pulmonary embolism in the pregnant patient

Diagnosis

Imaging

Treatment

Advanced therapies

Systemic thrombolysis

Catheter-directed therapies

Surgical embolectomy

Extracorporeal membrane oxygenation

Inferior vena cava filters

Cancer and pulmonary embolism

Diagnosis

Risk assessment

Treatment

Thrombolytic therapy

Catheter-directed therapies and pulmonary embolectomy

Inferior vena cava filters

Summary

Post-Intensive Care Unit Follow-up of Pulmonary Embolism

Key points

Introduction

Duration of intensive care unit stay

Outpatient follow-up

Duration of anticoagulation

Assessment for post–pulmonary embolism sequelae, including chronic thromboembolic pulmonary hypertension, chronic thromboembolic disease, and post–pulmonary embolism syndrome

Summary