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Updated: Jun 24, 2025
07:44
A Porcine Model of Acute Autologous Pulmonary Embolism
Published on: September 6, 2024
338
Management Strategies for Acute Pulmonary Embolism in the ICU
W Cameron McGuire1, Lauren Sullivan1, Mazen F Odish1
1Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California, San Diego, La Jolla, CA.
Chest
|June 3, 2024
Summary
For high-risk acute pulmonary embolism (PE), norepinephrine is a good first choice for hemodynamic support. Early consideration of venoarterial extracorporeal membrane oxygenation is recommended if deterioration persists despite interventions.
Area of Science:
- Cardiology
- Pulmonology
- Critical Care Medicine
Background:
- Acute pulmonary embolism (PE) is a prevalent condition requiring intensive care for high-risk and intermediate-high-risk patients.
- Management focuses on optimizing right ventricle (RV) function amidst complex clinical and imaging features.
Purpose of the Study:
- To review existing literature on interventions for acute PE.
- To discuss management strategies in the context of RV failure pathophysiology.
Main Methods:
- Literature review of vasoactive agents, IV fluids, diuretics, pulmonary vasodilators, and mechanical ventilation in acute PE.
- Review of venoarterial extracorporeal membrane oxygenation (VA-ECMO) data for acute PE.
- Discussion of interventions based on RV failure mechanisms.
Main Results:
- Norepinephrine is recommended for hemodynamic support, with vasopressin as an adjunct.
- IV loop diuretics may benefit RV dysfunction or volume overload; fluids cautiously used for hypovolemia without RV dilatation.
- Supplemental oxygen is advised, and positive pressure ventilation should be avoided if possible.
Conclusions:
- Early VA-ECMO cannulation is crucial for patients with ongoing deterioration.
- Tailored fluid and diuretic management is essential based on RV status.
- Strategic use of vasoactive agents and respiratory support is key in acute PE management.
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