Pérez-Nieto Orlando Rubén, Gómez-Oropeza Irene, Quintero-Leyra Andrés, Kammar-García Ashuin, Zamarrón-López Éder Iván, Soto-Estrada Maximiliano, Morgado-Villaseñor Luis Antonio, Meza-Comparán Héctor David
Unidad de Cuidados Intensivos, Hospital General San Juan del Río, Querétaro, Mexico.
Department of Health Science, Universidad de las Américas Puebla, San Andrés Cholula, Puebla, Mexico.
Front Med (Lausanne). 2023 Jun 2;10:1123793. doi: 10.3389/fmed.2023.1123793. eCollection 2023.
Pulmonary embolism is a common and potentially fatal disease, with a significant burden on health and survival. Right ventricular dysfunction and hemodynamic instability are considered two key determinants of mortality in pulmonary embolism, which can reach up to 65% in severe cases. Therefore, timely diagnosis and management are of paramount importance to ensure the best quality of care. However, hemodynamic and respiratory support, both major constituents of management in pulmonary embolism, associated with cardiogenic shock or cardiac arrest, have been given little attention in recent years, in favor of other novel advances such as systemic thrombolysis or direct oral anticoagulants. Moreover, it has been implied that current recommendations regarding this supportive care lack enough robustness, further complicating the problem. In this review, we critically discuss and summarize the current literature concerning the hemodynamic and respiratory support in pulmonary embolism, including fluid therapy, diuretics, pharmacological support with vasopressors, inotropes and vasodilators, oxygen therapy and ventilation, and mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation and right ventricular assist devices, while also providing some insights into contemporary research gaps.
肺栓塞是一种常见且可能致命的疾病，对健康和生存造成重大负担。右心室功能障碍和血流动力学不稳定被认为是肺栓塞死亡率的两个关键决定因素，在严重情况下死亡率可达65%。因此，及时诊断和管理对于确保最佳护理质量至关重要。然而，作为肺栓塞管理主要组成部分的血流动力学和呼吸支持，与心源性休克或心脏骤停相关，近年来很少受到关注，而更倾向于其他新进展，如全身溶栓或直接口服抗凝剂。此外，有人认为目前关于这种支持性护理的建议缺乏足够的稳健性，这使问题更加复杂。在这篇综述中，我们批判性地讨论并总结了当前关于肺栓塞血流动力学和呼吸支持的文献，包括液体疗法、利尿剂、血管加压药、正性肌力药和血管扩张剂的药物支持、氧疗和通气，以及静脉-动脉体外膜肺氧合和右心室辅助装置的机械循环支持，同时也对当代研究差距提供了一些见解。
