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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -9 مورد

Early resuscitation of patients with pulmonary embolism

Early resuscitation of patients with pulmonary embolism
1. Initiate anticoagulation together with supportive therapies
2. Supportive therapies:
Respiratory support Hemodynamic support
  • Supplemental oxygenation: low-flow or high-flow as needed to keep saturation ≥90%. Inhaled nitric oxide may be rarely used on a trial basis for refractory hypoxemia.
  • Ventilatory support (if needed): NIV, mechanical ventilation (anesthesia with expertise in intubating patients with RV dysfunction*). Avoid hypercapnia and high plateau pressures. Rarely, ECMO may be needed.
  • Secure intravenous access (peripheral is typical).
  • Targeted volume resuscitation with intravenous fluids depending on volume status. Avoid overresuscitation.
  • Vasopressors (typically norepinephrine) may be needed for shock. Inotropic support with dobutamine is rarely used since tachycardia may worsen hemodynamics. Rarely, venoarterial ECMO is needed.

ECMO: extracorporeal membrane oxygenation; NIV: noninvasive ventilation; PE: pulmonary embolism; RV: right ventricular.

* Mechanical ventilation should be a last resort. When feasible, attempts at high-flow oxygen and NIV should be tried first to avoid hemodynamic collapse from induction medications.
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