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Acute Management of High-Risk and Intermediate-Risk Pulmonary Embolism in Children
- Source :
- Chest
- Publication Year :
- 2022
- Publisher :
- Elsevier BV, 2022.
-
Abstract
- Severe forms of pulmonary embolism (PE) in children are rare but cause significant morbidity and mortality. In this article, we review the pathophysiology of severe (high- and intermediate-risk) PE and suggest novel pediatric-specific risk stratifications and an acute treatment algorithm to expedite emergent decision making. We define pediatric high-risk PE as causing cardiopulmonary arrest, sustained hypotension or normotension with signs or symptoms of shock. Rapid primary reperfusion should be pursued with either surgical embolectomy or systemic thrombolysis in conjunction with a heparin infusion and supportive care as appropriate. We define pediatric intermediate-risk PE as those without systemic hypotension nor compensated shock but with evidence of right ventricular strain by imaging and/or myocardial necrosis by elevated cardiac troponin levels. The decision to pursue primary reperfusion in this group is complex and should be reserved for patients with more severe disease; anticoagulation alone may also be appropriate in some cases. If primary reperfusion is pursued, catheter-based therapies may be beneficial. In summary, acute management of severe PE in children may include systemic thrombolysis, surgical embolectomy, catheter-based therapies or anticoagulation alone, and may depend on patient and institutional factors. Pediatric emergency and intensive care physicians should be familiar with the risks and benefits of each therapy in order to expedite care. PE Response Teams may also have added benefit in streamlining care during these critical events.
- Subjects :
- Pulmonary and Respiratory Medicine
medicine.medical_specialty
medicine.medical_treatment
Pediatric advanced life support
Embolectomy
Critical Care and Intensive Care Medicine
Risk Factors
medicine.artery
Intensive care
medicine
Humans
Thrombolytic Therapy
Child
Intensive care medicine
business.industry
Thrombolysis
medicine.disease
Pulmonary embolism
Catheter
Treatment Outcome
Shock (circulatory)
Acute Disease
Pulmonary Vascular: CHEST Reviews
Pulmonary artery
medicine.symptom
Pulmonary Embolism
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 00123692
- Volume :
- 161
- Database :
- OpenAIRE
- Journal :
- Chest
- Accession number :
- edsair.doi.dedup.....b74d5dbd6f75556d745e7f2bcd4b2d75