Though there are varying definitions, intermediate-high risk patients with a PE are generally defined as those who are hemodynamically stable, have radiographic or laboratory evidence of right heart strain, and an elevated PE risk score.
A few key management pearls include:
Be judicious with IVFs to avoid worsening septal shift and fruther decreases in LV cardiac output.
Consider dobutamine for severe RV dysfunction.
Administer norepinephrine, if needed, to achieve a MAP of 65 mm Hg.
Avoid initiation of positive pressure ventilation, if possible.
If intubation is needed for clinical deterioriation avoid propofol for RSI. Propofol has been associated with increased mortality in this patient population.
References
Weinstein T, et al. Advanced management of intermediate-high risk pulmonary embolism. Crit Care. 2021; 25:311.
