The management of pulmonary embolism

Pulmonary embolism (PE) is a significant cause of hospitalization, morbidity and mortality and frequently triggers referral to critical care services. Critically ill patients are also at increased risk of developing venous thrombo-embolism (VTE) and acute PE. Critical care clinicians should be confident in their approach to the patient with suspected and diagnosed PE. Furthermore, the co-morbid conditions in this patient group may present additional challenges both in diagnosis (e.g. safe access to radiology) and management (e.g. absolute and relative contraindications to anticoagulation/thrombolysis in critically ill patients). This brief review summarizes the contemporary evidence base regarding both diagnosis and treatment strategies and draws upon this to suggest a simple algorithm for investigation, risk stratification and management, particularly tailored to patients within a critical care setting.