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Venous Thromboembolism in the Intensive Care Unit

  • Scott J. DenstaedtEmail author
  • Thomas H. Sisson
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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.

Keywords

Embolism Thrombosis Anticoagulation Thrombolysis Pulmonary 

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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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Pulmonary and Critical Care MedicineUniversity of Michigan Health SystemAnn ArborUSA

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