Intensive Care Unit Management of the Hemodynamically Significant Pulmonary Embolism

Acute pulmonary embolism remains a major cause of cardiovascular morbidity and mortality, with prognosis determined by right ventricular (RV) adaptation to the abrupt rise in pulmonary vascular resistance. Although most cases can be managed outside the intensive care unit, patients with RV failure, hemodynamic instability, or cardiac arrest require advanced monitoring and intervention. Management in this setting emphasizes rapid diagnosis and risk stratification, timely initiation of reperfusion therapies, and carefully tailored hemodynamic and respiratory support. Optimal outcomes rely on multidisciplinary collaboration, early escalation of care, and individualized, evidence-based decision-making.