Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA.
Department of Anesthesia, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA.
J Intensive Care Med. 2023 Dec;38(12):1087-1098. doi: 10.1177/08850666231188290. Epub 2023 Jul 16.
High-risk pulmonary embolism (PE) also known as massive PE carries a high rate of morbidity and mortality. The incidence of high-risk PE continues to increase, yet the outcomes of high-risk PE continue to remain poor. Patients with high-risk PE are often critically ill, with complex underlying physiology, and treatment for the high-risk PE patient almost always requires care and management from an intensivist. Treatment options for high-risk PE continue to evolve rapidly with multiple options for definitive reperfusion therapy and supportive care. A thorough understanding of the physiology, risk stratification, treatment, and support options for the high-risk PE patient is necessary for all intensivists in order to improve outcomes. This article aims to provide a review from an intensivist's perspective highlighting the physiological consequences, risk stratification, and treatment options for these patients as well as providing a proposed algorithm to the risk stratification and acute management of high-risk PE.
高危肺栓塞（PE）也称为大块 PE，其发病率和死亡率都很高。高危 PE 的发病率持续上升，但高危 PE 的治疗结果仍不理想。高危 PE 患者通常病情危急，潜在生理机能复杂，高危 PE 患者的治疗几乎总是需要重症监护医生的护理和管理。高危 PE 的治疗选择继续快速发展，有多种明确再灌注治疗和支持性治疗的选择。为了提高治疗效果，所有重症监护医生都需要深入了解高危 PE 患者的生理学、风险分层、治疗和支持选择。本文旨在从重症监护医生的角度提供综述，强调这些患者的生理学后果、风险分层和治疗选择，并提出高危 PE 风险分层和急性管理的建议算法。
