Early intervention in massive pulmonary embolism

PREVIEW In about 50% of patients with pulmonary embolism, the embolism is massive, that is, accompanied by at least one of several potentially compromising conditions. Unfortunately, about three fourths of patients who die of pulmonary embolism do so within 1 hour of symptom onset. Thus, expeditious assessment of patients with suspected massive pulmonary embolism is crucial. In this article, Dr Gossage discusses prompt recognition of this condition and presents several management strategies.

[1]  A. Perkins,et al.  Pulmonary Embolism in Veterans Affairs Medical Centers: Is Vena Cava Interruption Underutilized? , 1999, The American surgeon.

[2]  J. Gossage Acute myocardial infarction. Reperfusion strategies. , 1994, Chest.

[3]  W. Mitch,et al.  PRESSOR EFFECT OF NALOXONE IN SEPTIC SHOCK , 1981, The Lancet.

[4]  D. DeMets,et al.  The clinical features of submassive and massive pulmonary emboli. , 1977, The American journal of medicine.

[5]  R. Lefering,et al.  Steroid controversy in sepsis and septic shock: a meta-analysis. , 1995, Critical care medicine.

[6]  S. Rahimtoola,et al.  Hemodynamic studies and results of therapy in 50 patients with bacteremic shock. , 1973, The American journal of medicine.

[7]  J. Timsit,et al.  Pulmonary embolectomy by catheter device in massive pulmonary embolism. , 1991, Chest.

[8]  C. F. Schaefer,et al.  Rapid reduction of intestinal cytochrome a,a3 during lethal endotoxemia. , 1991, The Journal of surgical research.

[9]  G. Meyer,et al.  Pulmonary embolectomy: a 20-year experience at one center. , 1991, The Annals of thoracic surgery.

[10]  J. Alpert,et al.  Treatment of massive pulmonary embolism: the role of pulmonary embolectomy. , 1975, American heart journal.

[11]  J. Alpert,et al.  The natural history of pulmonary embolism. , 1984, Clinics in chest medicine.

[12]  C. Manthous,et al.  The effect of mechanical ventilation on oxygen consumption in critically ill patients. , 1995, American journal of respiratory and critical care medicine.

[13]  A. Guerguerian,et al.  Therapy of shock with naloxone: a meta-analysis. , 1998, Critical care medicine.

[14]  M. Oz,et al.  Vasopressin pressor hypersensitivity in vasodilatory septic shock. , 1997, Critical care medicine.

[15]  M. Olschewski,et al.  Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. , 1997, Journal of the American College of Cardiology.

[16]  P. Bollaert,et al.  Reversal of late septic shock with supraphysiologic doses of hydrocortisone. , 1998, Critical care medicine.

[17]  Y. Castaing,et al.  Influence of cardiac output on oxygen exchange in acute pulmonary embolism. , 1992, The American review of respiratory disease.

[18]  C. Manthous,et al.  Effect of cooling on oxygen consumption in febrile critically ill patients. , 1995, American journal of respiratory and critical care medicine.

[19]  S. Liljedahl,et al.  Plasma volume changes after infusion of various plasma expanders. , 1976, Resuscitation.

[20]  L. Girling,et al.  Treatment of shock in a canine model of pulmonary embolism. , 1984, The American review of respiratory disease.

[21]  J. Vincent,et al.  Methylene blue administration in septic shock: a clinical trial. , 1995, Critical care medicine.

[22]  A. Torbicki,et al.  Noninvasive diagnosis of suspected severe pulmonary embolism: transesophageal echocardiography vs spiral CT. , 1997, Chest.

[23]  G. Hernández,et al.  Use of methylene blue in patients with refractory septic shock: impact on hemodynamics and gas exchange. , 1998, Journal of critical care.

[24]  L. Papazian,et al.  Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? , 1992, Chest.

[25]  E. Braunwald,et al.  Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion , 1993, The Lancet.

[26]  M. Weil,et al.  Early impairment of oxidative metabolism and energy production in severe sepsis. , 1988, Circulatory shock.

[27]  E. Martin,et al.  Bolus injection of thrombolytic agents during cardiopulmonary resuscitation for massive pulmonary embolism. , 1994, Resuscitation.

[28]  F. Schiele,et al.  Streptokinase vs alteplase in massive pulmonary embolism. A randomized trial assessing right heart haemodynamics and pulmonary vascular obstruction. , 1997, European heart journal.

[29]  G. Schmidt,et al.  Sodium bicarbonate for the treatment of lactic acidosis. , 2000, Chest.

[30]  L. Greenfield,et al.  Cardiopulmonary effects of volume loading of primates in endotoxin shock. , 1974, Surgery.

[31]  M. Weil,et al.  Hemodynamic response to fluid repletion in patients with septic shock: evidence for early depression of cardiac performance. , 1987, Circulatory shock.

[32]  S. Arcasoy,et al.  Thrombolytic therapy of pulmonary embolism: a comprehensive review of current evidence. , 1999, Chest.

[33]  H. Bruining,et al.  Vasopressin deficiency contributes to the vasodilation of septic shock. , 1998, Circulation.

[34]  P. Brunel,et al.  Vena Tech-LGM filter: long-term results of a prospective study. , 1993, Radiology.

[35]  W. Knaus,et al.  Hypoxemia in acute pulmonary embolism. , 1985, Chest.

[36]  J Ean,et al.  Efficacy and safety of recombinant human activated protein C for severe sepsis. , 2001, The New England journal of medicine.

[37]  J. Holaday,et al.  Naloxone reversal of endotoxin hypotension suggests role of endorphins in shock , 1978, Nature.

[38]  J. Scannell,et al.  A reappraisal of the application of the Trendelenburg operation to massive fatal embolism. Report of a successful pulmonary-artery thrombectomy using a cardiopulmonary bypass. , 1963, The New England journal of medicine.

[39]  M. Noc,et al.  Diagnosis and treatment of shock due to massive pulmonary embolism: approach with transesophageal echocardiography and intrapulmonary thrombolysis. , 1997, Chest.

[40]  I. Belenkie,et al.  Effects of volume loading during experimental acute pulmonary embolism. , 1989, Circulation.

[41]  Robert Raschke,et al.  The Weight-based Heparin Dosing Nomogram Compared with a Standard Care Nomogram , 1993, Annals of Internal Medicine.

[42]  T. Chevalier,et al.  The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads--80 case reports. , 1997, Chest.

[43]  J. Teboul,et al.  Hemodynamic effects of fluid loading in acute massive pulmonary embolism. , 1999, Critical care medicine.

[44]  D. Brun-Ney,et al.  Dobutamine: A hemodynamic evaluation in pulmonary embolism shock , 1985, Critical care medicine.

[45]  Lain,et al.  A CLINICAL TRIAL OF VENA CAVAL FILTERS IN THE PREVENTION OF PULMONARY EMBOLISM IN PATIENTS WITH PROXIMAL DEEP-VEIN THROMBOSIS , 2000 .

[46]  G. Raskob,et al.  Sensitivity and specificity of helical computed tomography in the diagnosis of pulmonary embolism: a systematic review. , 2000, Annals of internal medicine.

[47]  J. Gossage Of emperors, emboli, and echocardiography. , 1997, Chest.

[48]  W. Shoemaker,et al.  Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. , 1988, Chest.

[49]  V. Tapson,et al.  Pharmacologic hemodynamic support in massive pulmonary embolism. , 1997, Chest.