• Het Patel, Jenny A Shih, Ryan Gardner, Parth V Patel, Catherine Ross, Margaret M Hayes, Ari Moskowitz, and Michael W Donnino.
• Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States. Electronic address: hpatel12@bidmc.harvard.edu.
• J Crit Care. 2019 Dec 1; 54: 105-109.

PurposeMany normotensive patients with acute pulmonary embolism (PE) are admitted to an intensive care unit (ICU) to monitor for hemodynamic decompensation. We investigated the incidence and causes of early hemodynamic decompensation in normotensive patients admitted to an ICU with PE.Materials And MethodsThis was a single-center, retrospective study of normotensive patients admitted to an ICU with primary diagnosis of PE between 2010 and 2017. The primary outcome was hemodynamic decompensation, defined as need for vasopressors within 48 h of ICU admission.ResultsOf 293 patients included in the study, hemodynamic decompensation occurred in 8 patients (2.7%). The two most common precipitants of hemodynamic decompensation were acute hemorrhage and PE-related right ventricular dysfunction - each contributing to hemodynamic decompensation in 3 patients.ConclusionsAmong patients admitted to the ICU with acute normotensive PE, early hemodynamic decompensation was rare. In patients who experienced decompensation, major bleeding and thrombotic complications were equally likely to have been the precipitant- highlighting the risks of diagnostic anchoring in this population. As our results suggest that ICU-level care may not be necessary for many of these patients, additional tools are needed to assist in the triage of normotensive patients with PE.Copyright © 2019. Published by Elsevier Inc.

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