Pulmonary embolism in the critically ill: strategies for prevention and treatment.
Most ICU patients are at high risk for developing deep venous thrombosis; thus, they should be considered candidates for prophylaxis against pulmonary emboli (PE). If early ambulation is not an option, give low-dose heparin or apply lower extremity pneumatic compression. When PE cannot be prevented, rapid treatment is mandatory. Inotropic agents can be used to improve right ventricular contractility; however, the role of volume loading for augmenting preload is controversial. Heparin is the first-line therapy for halting ongoing thrombosis; administer a 5,000- to 10,000-U bolus, followed by a continuous infusion of about 35,000 U/d. Thrombolysis, embolectomy, and occlusive devices are other therapeutic options.
Cowen
J
J
Department of pulmonary and critical care medicine, Hospital of the University of Pennsylvania, Philadelphia, USA.
Kelley
M A
MA
D001458:Bandages; D016638:Critical Illness; D016903:Drug Monitoring; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000517:prevention & control*