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PE decisions

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8 papers 0 to 25 followers
Mareike Lankeit, Vicente Gómez, Carolin Wagner, Drahomir Aujesky, Mónica Recio, Sem Briongos, Lisa K Moores, Roger D Yusen, Stavros Konstantinides, David Jiménez
BACKGROUND: This study aimed to assess the performance of two prognostic models-the European Society of Cardiology (ESC) model and the simplified Pulmonary Embolism Severity Index (sPESI)-in predicting short-term mortality in patients with pulmonary embolism (PE). METHODS: We compared the test characteristics of the ESC model and the sPESI for predicting 30-day outcomes in a cohort of 526 patients with objectively confirmed PE. The primary end point of the study was all-cause mortality...
April 2012: Chest
Guy Meyer, Antoine Vieillard-Baron, Benjamin Planquette
The aim of this narrative review is to summarize for intensivists or any physicians managing "severe" pulmonary embolism (PE) the main recent advances or recommendations in the care of patients including risk stratification, diagnostic algorithm, hemodynamic management in the intensive care unit (ICU), recent data regarding the use of thrombolytic treatment and retrievable vena cava filters and finally results of direct oral anticoagulants. Thanks to the improvements achieved in the risk stratification of patients with PE, a better therapeutic approach is now recommended from diagnosis algorithm and indication to admission in ICU to indication of thrombolysis and general hemodynamic support in patients with shock...
December 2016: Annals of Intensive Care
A Squizzato, E Rancan, F Dentali, M Bonzini, L Guasti, L Steidl, G Mathis, W Ageno
BACKGROUND: Computed tomographic pulmonary angiography (CTPA) has simplified the diagnostic approach to patients with suspected pulmonary embolism (PE). However, PE diagnosis is still probabilistic and CTPA should be used with caution in some patient groups, such as patients with severe renal insufficiency and pregnant women. Among alternative imaging tests, lung ultrasound is the most promising technique. We aimed to systematically assess the diagnostic accuracy of lung ultrasound for PE diagnosis...
July 2013: Journal of Thrombosis and Haemostasis: JTH
Rolf P Engelberger, Nils Kucher
Pulmonary embolism remains a common and potentially life-threatening disease. For patients with intermediate- and high-risk pulmonary embolism, catheter-based revascularization therapy has emerged as potential alternative to systemic thrombolysis or surgical embolectomy. Ultrasound-assisted catheter-directed thrombolysis is a contemporary catheter-based technique and is the focus of the present review. Ultrasound-assisted catheter-directed thrombolysis is more effective in reversing right ventricular dysfunction and dilatation in comparison with anticoagulation alone in patients at intermediate risk...
March 2014: European Heart Journal
Simone Vanni, David Jiménez, Peiman Nazerian, Fulvio Morello, Michele Parisi, Elena Daghini, Mauro Pratesi, Raquel López, Pedro Bedate, José Luis Lobo, Luis Jara-Palomares, Ana K Portillo, Stefano Grifoni
BACKGROUND: Strategies for identifying normotensive patients with acute symptomatic PE at high risk of PE-related complications remain to be defined. METHODS: This prospective cohort study aimed to determine the role of plasma lactate levels in the risk assessment of normotensive patients with acute PE. Outcomes assessed over the 7 days after the diagnosis of PE included PE-related mortality and haemodynamic collapse, defined as need for cardiopulmonary resuscitation, systolic blood pressure <90 mm Hg for at least 15 min, need for catecholamine administration, or need for mechanical ventilation...
April 2015: Thorax
David Jiménez, Santiago Resano, Remedios Otero, Carolina Jurkojc, Ana Karina Portillo, Pedro Ruiz-Artacho, Jesús Corres, Agustina Vicente, Paul L den Exter, Menno V Huisman, Lisa Moores, Roger D Yusen
This study aimed to determine the effect of an evidence-based clinical decision support (CDS) algorithm on the use and yield of CT pulmonary angiography (CTPA) and on outcomes of patients evaluated in the emergency department (ED) for suspected PE. The study included 1363 consecutive patients evaluated for suspected PE in an ED during 12 months before and 12 months after initiation of CDS use. Introduction of CDS was associated with decreased CTPA use (55% vs 49%; absolute difference (AD), 6.3%; 95% CI 1...
September 2015: Thorax
Robin Condliffe, Charlie A Elliot, Rodney J Hughes, Judith Hurdman, Rhona M Maclean, Ian Sabroe, Joost J van Veen, David G Kiely
BACKGROUND: Physicians treating acute pulmonary embolism (PE) are faced with difficult management decisions while specific guidance from recent guidelines may be absent. METHODS: Fourteen clinical dilemmas were identified by physicians and haematologists with specific interests in acute and chronic PE. Current evidence was reviewed and a practical approach suggested. RESULTS: Management dilemmas discussed include: sub-massive PE, PE following recent stroke or surgery, thrombolysis dosing and use in cardiac arrest, surgical or catheter-based therapy, failure to respond to initial thrombolysis, PE in pregnancy, right atrial thrombus, role of caval filter insertion, incidental and sub-segmental PE, differentiating acute from chronic PE, early discharge and novel oral anticoagulants...
February 2014: Thorax
Wim Lucassen, Geert-Jan Geersing, Petra M G Erkens, Johannes B Reitsma, Karel G M Moons, Harry Büller, Henk C van Weert
BACKGROUND: Clinical probability assessment is combined with d-dimer testing to exclude pulmonary embolism (PE). PURPOSE: To compare the test characteristics of gestalt (a physician's unstructured estimate) and clinical decision rules for evaluating adults with suspected PE and assess the failure rate of gestalt and rules when used in combination with d-dimer testing. DATA SOURCES: Articles in MEDLINE and EMBASE in English, French, German, Italian, Spanish, or Dutch that were published between 1966 and June 2011...
October 4, 2011: Annals of Internal Medicine
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