Pulmonary embolism in medical-surgical critically ill patients.

Pulmonary embolism (PE) is the most dangerous complication of venous thrombosis. Objectively confirmed PE is a potentially life-threatening complication of critical illness. In medical-surgical critically ill patients, signs and symptoms are nonspecific, the clinical pretest probability may be low, and diagnostic tests may not be done or may yield ambiguous results. Therefore, PE is often undiagnosed and untreated; autopsy findings indicate that PE is common in intensive care unit (ICU) decedents. PE may delay weaning from mechanical ventilation, increase the length of stay in ICU and hospital, and increase the risk of death. More research is needed on PE in medical-surgical ICU patients including issues on the epidemiologic aspects of PE (including risk factors and attributable morbidity and mortality) and treatment of PE (including pharmacologic and nonpharmacologic approaches, determinants of treatment variation, and predictors of PE outcome adjusted for treatment).