Hemodynamic decompensation in normotensive patients admitted to the ICU with pulmonary embolism

J Crit Care. 2019 Dec;54:105-109. doi: 10.1016/j.jcrc.2019.07.017. Epub 2019 Jul 27.

Abstract

Purpose: Many normotensive patients with acute pulmonary embolism (PE) are admitted to an intensive care unit (ICU) to monitor for hemodynamic decompensation. We investigated the incidence and causes of early hemodynamic decompensation in normotensive patients admitted to an ICU with PE.

Materials and methods: This was a single-center, retrospective study of normotensive patients admitted to an ICU with primary diagnosis of PE between 2010 and 2017. The primary outcome was hemodynamic decompensation, defined as need for vasopressors within 48 h of ICU admission.

Results: Of 293 patients included in the study, hemodynamic decompensation occurred in 8 patients (2.7%). The two most common precipitants of hemodynamic decompensation were acute hemorrhage and PE-related right ventricular dysfunction - each contributing to hemodynamic decompensation in 3 patients.

Conclusions: Among patients admitted to the ICU with acute normotensive PE, early hemodynamic decompensation was rare. In patients who experienced decompensation, major bleeding and thrombotic complications were equally likely to have been the precipitant- highlighting the risks of diagnostic anchoring in this population. As our results suggest that ICU-level care may not be necessary for many of these patients, additional tools are needed to assist in the triage of normotensive patients with PE.

Keywords: Critical care; Precipitants of decompensation; Pulmonary Embolism; Shock.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Female
  • Heart Failure / drug therapy
  • Heart Failure / etiology
  • Heart Failure / physiopathology*
  • Hemodynamics / physiology*
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Pulmonary Embolism / complications
  • Pulmonary Embolism / physiopathology*
  • Retrospective Studies
  • Vasoconstrictor Agents / therapeutic use*

Substances

  • Vasoconstrictor Agents