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Venous Thromboembolism in the Intensive Care Unit

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Evidence-Based Critical Care

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Abstract

Pulmonary embolism is a common condition that, when unrecognized, is associated with a high mortality. The pathophysiologic complications of thromboembolism including hypotension and hypoxemia can necessitate intensive care unit management. In addition, pulmonary embolism can be a consequence of critical care. In the beginning sections of this chapter, we review the risk factors, presentation and diagnosis of patients who develop pulmonary embolism within the ICU compared to outside of the ICU. The non-specific symptoms and signs of venous thromboembolism make this disease a challenge to recognize in the ambulatory patient. In the ICU, patients often have co-morbid conditions with overlapping pathophysiologic sequelae that further heightens the challenge of diagnosing this disorder. Although the work up of the patient with suspected venous thromboembolism in the intensive care unit is not necessarily different from that of the ambulatory setting, the physiologic instability that results from massive pulmonary embolism may necessitate a bedside evaluation. In the latter sections of this chapter, we discuss risk stratification and the management of pulmonary embolism for patients with sub-massive and massive disease. In the unstable patient with acute pulmonary embolism, rapid anticoagulation and thrombolysis are indicated. Guidelines state that using thrombolysis in sub-massive/intermediate risk pulmonary embolism should be reserved for patients who fail anticoagulation alone.

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Abbreviations

CT-PA:

Computed-tomography pulmonary angiography

DOAC:

Direct oral anticoagulant

DVT:

Deep venous thrombosis

ECMO:

Extra-corporeal membrane oxygenation

IV:

Intravenous

LMWH:

Low molecular weight heparin

LV:

Left ventricle

PE:

Pulmonary embolism

PERT:

Pulmonary embolism response team

RV:

Right ventricle

TEE:

Transesophageal echocardiography

t-PA:

Tissue plasminogen activator

UFH:

Unfractionated heparin

VTE:

Venous thromboembolism

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Authors and Affiliations

  1. Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA

    Scott J. Denstaedt & Thomas H. Sisson

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  1. Scott J. Denstaedt
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  2. Thomas H. Sisson
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Correspondence to Scott J. Denstaedt .

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Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Robert C. Hyzy

  2. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Jakob McSparron

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Denstaedt, S.J., Sisson, T.H. (2020). Venous Thromboembolism in the Intensive Care Unit. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_25

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  • DOI: https://doi.org/10.1007/978-3-030-26710-0_25

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