Pulmonary embolism in intensive care unit "literature review"

Venous thromboembolism (VTE) remains a major challenge in the care of critically ill patients. Subjects in the intensive care unit (ICU) are at high risk for both deep-vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary embolism (PE) is the major complication of VTE. Pulmonary embolism is a cardiovascular emergency. By occluding the pulmonary arterial bed it may lead to acute life-threatening but potentially reversible right ventricular failure. The diagnosis of PE is usually suspected by the presence of common symptoms (include difficulty breathing, chest pain on inspiration, and palpitations) and clinical signs include low blood oxygen saturation (hypoxia), rapid breathing (tachypnea), and rapid heart rate (tachycardia). However in ICU, the most of patients required sedation and mechanical ventilation. The clinical manifestations usually observed in this condition (PE) cannot be exhibited by theses patients and clinical presentation is usually atypical. While the gold standard for diagnosis is the finding of a clot on pulmonary angiography, CT pulmonary angiography is the most commonly used imaging modality today. Pulmonary embolism causing hemodynamic instability is termed massive; once it is suspected, a diagnostic plan and supportive measures are essential. Oxygen supplementation, intubation, and mechanical ventilation are instituted as necessary for respiratory failure. If saline is infused for hypotension, it should be done with caution. Vasopressor therapy (e.g., dopamine, norepinephrine) should be considered if the blood pressure is not rapidly restored; there is little information about the use of inotropic agents in general. Anticoagulant treatment plays a pivotal role in the management of patients with PE. Heparin, low molecular weight heparins (such as enoxaparin and dalteparin), or fondaparinux is administered initially. Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (tPA) or may require surgical intervention via pulmonary thrombectomy. Prevention is highly warranted. (C) 2011 Elsevier Ltd. All rights reserved.