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Venous Thromboembolism in the Intensive Care Unit

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Evidence-Based Critical Care

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Abstract

Pulmonary embolism is a common condition that, when unrecognized, is associated with a high mortality. The pathophysiologic complications of thromboembolism including hypotension and hypoxemia can necessitate intensive care unit management. In addition, pulmonary embolism can be a consequence of critical care. In the beginning sections of this chapter, we review the risk factors, presentation and diagnosis of patients who develop pulmonary embolism within compared to outside of the ICU. The non-specific symptoms and signs of venous thromboembolism make this disease a challenge to recognize in the ambulatory patient. In the ICU, patients often have co-morbid conditions with overlapping pathophysiologic sequelae that further heightens the challenge of recognizing this disorder. Although the work up of the patient with suspected venous thromboembolism in the intensive care unit is not necessarily different from that of the ambulatory setting, the physiologic instability that results from massive pulmonary embolism may necessitate a bedside evaluation. In the latter sections of this chapter, we discuss risk stratification and the management of pulmonary embolism for patients with sub-massive and massive disease. In the unstable patient with acute pulmonary embolism, rapid anticoagulation and thrombolysis are indicated. The use of thrombolysis in the patient with sub-massive disease remains controversial.

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Author information

Authors and Affiliations

  1. Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA

    Scott J. Denstaedt

  2. Pulmonary and Critical Care Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA

    Thomas H. Sisson

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  1. Scott J. Denstaedt
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  2. Thomas H. Sisson
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Correspondence to Thomas H. Sisson .

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Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, USA

    Robert C. Hyzy

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Denstaedt, S.J., Sisson, T.H. (2017). Venous Thromboembolism in the Intensive Care Unit. In: Hyzy, R. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-43341-7_25

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  • DOI: https://doi.org/10.1007/978-3-319-43341-7_25

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  • Publisher Name: Springer, Cham

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