High and intermediate risk pulmonary embolism in the ICU

Scott J Millington; Nadia Aissaoui; Emma Bowcock; Daniel Brodie; Karine E A Burns; Ghislaine Douflé; François Haddad; Tim Lahm; Gregory Piazza; Olivier Sanchez; Laurent Savale; Antoine Vieillard-Baron

doi:10.1007/s00134-023-07275-6

High and intermediate risk pulmonary embolism in the ICU

Intensive Care Med. 2024 Feb;50(2):195-208. doi: 10.1007/s00134-023-07275-6. Epub 2023 Dec 19.

Authors

Scott J Millington¹, Nadia Aissaoui², Emma Bowcock³, Daniel Brodie⁴, Karine E A Burns^{5

6}, Ghislaine Douflé^{5

7}, François Haddad^{8

9

10}, Tim Lahm¹¹, Gregory Piazza¹², Olivier Sanchez^{13

14}, Laurent Savale^{15

16}, Antoine Vieillard-Baron^{17

18}

Affiliations

¹ Critical Care, The University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada.
² Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre & Université Paris Cité, Paris, France.
³ Department of Intensive Care, Nepean Hospital, University of Sydney, Sydney, Australia.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.
⁶ Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto, Canada.
⁷ Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada.
⁸ Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
¹⁰ Vera Moulton Wall Center for Pulmonary Vascular Disease at Stanford University, Stanford, CA, USA.
¹¹ Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado, Rocky Mountain Regional VA Medical Center, Denver, CO, USA.
¹² Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹³ Service de pneumologie et soins intensifs, Hopital Européen Georges Pompidou, APHP, Paris, France.
¹⁴ INSERM UMR S 1140, Innovative Therapies in Hemostasis, Université Paris Cité, Paris, France.
¹⁵ Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
¹⁶ INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
¹⁷ Medical and Surgical ICU, University Hospital Ambroise Pare, GHU Paris-Saclay, APHP, Boulogne-Billancourt, France. antoine.vieillard-baron@aphp.fr.
¹⁸ Inserm U1018, CESP, Universite Versailles Saint-Quentin en Yvelines, Guyancourt, France. antoine.vieillard-baron@aphp.fr.

PMID: 38112771
DOI: 10.1007/s00134-023-07275-6

Abstract

Pulmonary embolism (PE) is a common and important medical emergency, encountered by clinicians across all acute care specialties. PE is a relatively uncommon cause of direct admission to the intensive care unit (ICU), but these patients are at high risk of death. More commonly, patients admitted to ICU develop PE as a complication of an unrelated acute illness. This paper reviews the epidemiology, diagnosis, risk stratification, and particularly the management of PE from a critical care perspective. Issues around prevention, anticoagulation, fibrinolysis, catheter-based techniques, surgical embolectomy, and extracorporeal support are discussed.

Keywords: Circulatory shock; Fibrinolysis; High-risk pulmonary embolism.

Publication types

Review

MeSH terms

Critical Care
Embolectomy / methods
Humans
Intensive Care Units
Pulmonary Embolism* / epidemiology
Pulmonary Embolism* / etiology
Pulmonary Embolism* / therapy
Thrombolytic Therapy / adverse effects