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Management of Intermediate-High Risk PE Patients
- Though there are varying definitions, intermediate-high risk patients with a PE are generally defined as those who are hemodynamically stable, have radiographic or laboratory evidence of right heart strain, and an elevated PE risk score.
- A few key management pearls include:
- Be judicious with IVFs to avoid worsening septal shift and fruther decreases in LV cardiac output.
- Consider dobutamine for severe RV dysfunction.
- Administer norepinephrine, if needed, to achieve a MAP of 65 mm Hg.
- Avoid initiation of positive pressure ventilation, if possible.
- If intubation is needed for clinical deterioriation avoid propofol for RSI. Propofol has been associated with increased mortality in this patient population.
References
Weinstein T, et al. Advanced management of intermediate-high risk pulmonary embolism. Crit Care. 2021; 25:311.