Diuretics Versus Volume Expansion in the Initial Management of Acute Intermediate High-Risk Pulmonary Embolism

Ferrari, Émile; Sartre, Benjamin; Labbaoui, Mohamed; Heme, Nathan; Asarisi, Florian; Redjimi, Nassim; Fourrier, E; Squara, Fabien; Bun, Sithy; Berkane, Nathalie; Breittmayer, Jean‐Philippe; Doyen, Denis; Moceri, Pamela

doi:10.1007/s00408-022-00530-5

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…Although changes in troponin kinetics and echocardio-graphic parameters of RV dysfunction did not differ between groups (with and without diuretic), normalization of BNP was achieved more rapidly in the diuretic group. This finding, which needs to be confirmed in controlled clinical trials, may reflect a rapid improvement in RV function with a 40-mg dose of intravenous furosemide [ 19 ]. In the absence of high RV filling pressures, cautious volume loading guided by central venous pressure monitoring may be appropriate [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Bedside Ultrasound to Guide the Diagnosis and Treatment of Fulminant Right Heart Failure: A Case Report

Arango-Granados,

Osorio-González,

Muñoz-Patiño

2024

Am J Case Rep

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Patient: Male, 72-year-old Final Diagnosis: Right heart failure Symptoms: Acute severe dyspnea • bilateral edema of the lower limbs • epigastric pain Clinical Procedure: — Specialty: Critical Care Medicine Objective: Challenging differential diagnosis Background: Right ventricular (RV) failure can result from acute or chronic cardiac or pulmonary conditions, or both, resulting in increased afterload, reduced contractility, changes in preload, ventricular interdependence, or dysrhythmias. Notably, increased afterload, particularly among previously healthy individuals, is often the primary cause of RV failure in cases of pulmonary and cardiac origin. Massive pulmonary thromboembolism is a common cause of impending RV failure, and chronic conditions like atrial septal defects can also contribute to pulmonary hypertension. Case Report: A 72-year-old patient, with no known past medical history, presented to the emergency department in profound shock, rapidly progressing to cardiorespiratory arrest. Bedside ultrasound revealed marked right chambers dilatation, severe mitral and tricuspid insufficiency, a large atrial septal defect, mild pericardial effusion, and global hypokinesia. This case illustrates how multiple mechanisms of RV dysfunction can converge, leading to fulminant RV failure and subsequent cardiac arrest, including increased afterload, decreased contractility, dysrhythmias, and ventricular interdependence. Conclusions: This article emphasizes the usefulness of bedside ultrasound in diagnosing and elucidating the causes of circulatory collapse. In this patient, ultrasound played an important role in identifying 3 contributing factors: chronic RV overload from an extensive atrial septal defect, left ventricular impact due to ventricular interdependence, and acute pulmonary thromboembolism. Being aware of these factors, along with the practicality of bedside ultrasound, allowing emergency physicians to make prompt diagnoses and effectively manage RV failure-related emergencies.

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Section: Discussionmentioning

confidence: 99%

Bedside Ultrasound to Guide the Diagnosis and Treatment of Fulminant Right Heart Failure: A Case Report

Arango-Granados,

Osorio-González,

Muñoz-Patiño

2024

Am J Case Rep

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“…Ferrari et al performed a multicenter, randomized clinical trial comparing diuresis to volume expansion in 60 patients with intermediate-high risk PE. 16 Early diuresis resulted in more rapid normalization of the basic natriuretic peptide level, with no effect on troponin kinetics or right ventricular echocardiographic parameters. Importantly, the diuresis group did not demonstrate an increased risk of acute kidney injury.…”

Section: Introductionmentioning

confidence: 92%

“…Schmidt, et al 12 There was no change in all-cause mortality and severe disability or neurologic outcomes in low vs high PaO2 target following out-of-hospital cardiac arrest. Pulmonary embolism Ferrari, et al 16 Diuresis in intermediate-risk pulmonary embolism patients was well-tolerated and did not increase rates of AKI. It reduced BNP levels and did not affect troponin kinetics or right ventricular echocardiographic parameters.…”

Section: Cardiacmentioning

confidence: 98%

Year in Review 2022: Noteworthy Literature in Cardiothoracic Critical Care

Alber

Tanabe

Tregear

et al. 2023

Semin Cardiothorac Vasc Anesth

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The past year in critical care medicine was notable for ongoing sequelae of the COVID-19 pandemic, including nationwide shortages and critical care demand in many regions in excess of usual operating capacity. Despite these challenges, evidence-based medicine and investigations into the optimal management of the critically ill continued to be at the forefront. This article is a collection of studies published in 2022 which are specifically relevant to cardiothoracic critical care. These noteworthy publications add to the existing literature across a broad spectrum of topics, from optimal timing of mechanical circulatory support (MCS), delirium prevention, updates in nutrition guidelines, alternative defibrillation techniques, novel ventilator management, and observing the downstream psychological impact of extracorporeal membrane oxygenation (ECMO) therapy.

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“…PE hinders both circulation and gas exchange (2). In this sense, supportive care (namely hemodynamic and respiratory support) plays a critical role in the comprehensive management of PE patients, especially in cases of respiratory failure and RVD (8), yet this very early management has been seldom studied (9) and given little attention in the recent literature, in favor of the novel advances concerning systemic thrombolysis, catheter-directed thrombolysis, direct oral anticoagulants, among others. Additionally, it has been pointed out that the available evidence concerning the use of supportive care in PE lacks sufficient robustness (8), which further complicates this problem.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic and respiratory support in pulmonary embolism: a narrative review

Pérez-Nieto,

Gómez-Oropeza,

Quintero-Leyra

et al. 2023

Front. Med.

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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.

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Diuretics Versus Volume Expansion in the Initial Management of Acute Intermediate High-Risk Pulmonary Embolism

Cited by 8 publications

References 24 publications

Bedside Ultrasound to Guide the Diagnosis and Treatment of Fulminant Right Heart Failure: A Case Report

Bedside Ultrasound to Guide the Diagnosis and Treatment of Fulminant Right Heart Failure: A Case Report

Year in Review 2022: Noteworthy Literature in Cardiothoracic Critical Care

Hemodynamic and respiratory support in pulmonary embolism: a narrative review

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