Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism
González Suárez, Susana (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Camacho Oviedo, John (Hospital Universitari Vall d'Hebron)
Suriñach Caralt, José María (Universitat Autònoma de Barcelona. Departament de Medicina)
Grao Roca, Maria (Hospital Universitari Vall d'Hebron)
Dammala Liyanage, Isuru Maduranga (Hospital Universitari Vall d'Hebron)
Pérez Lafuente, Mercedes (Hospital Universitari Vall d'Hebron)
Mena Muñoz, Elisabeth (Hospital Universitari Vall d'Hebron)
González Junyent, Carla (Hospital Universitari Vall d'Hebron)
Martínez-Martínez, Maríam (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Barnés Navarro, Daniel (Hospital Universitari Vall d'Hebron)
Ruíz-Rodríguez, Juan Carlos (Hospital Universitari Vall d'Hebron. Institut de Recerca)

Título variante:	Manejo de la inestabilidad hemodinámica y respiratoria y procedimientos anestésicos en pacientes sometidos a trombectomía pulmonar por embolia pulmonar
Fecha:	2025
Descripción:	14 pàg.
Resumen:	Background/Objectives: The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients with high-risk or intermediate-high-risk pulmonary embolism (PE) undergoing pulmonary mechanical thrombectomy (PMT) remain poorly understood. This hemodynamic and respiratory instability can lead to modifications in the anesthetic management. This study investigates these key factors and quantifies the 30-day mortality following thrombectomy. Methods: A retrospective study was conducted on 98 patients aged ≥18 years who underwent PMT. Patients were categorized based on the occurrence of cardiac arrest (CA). Results: Of the 98 patients, 34 had high-risk PE, 62 intermediate/high-risk, and 2 low risk. There were 27 cases of CA, 17 pre- and 10 intra-PMT. An SBP < 90 mmHg increases the risk of CA by 33 (p < 0. 001); men have an 8-fold higher risk than women (p = 0. 004); SpO2 <90% by 6 (p = 0. 012); and pre-existing respiratory conditions increase the risk by 4 (p = 0. 047)). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were 8206 ± 11660. 86 and 2388. 50 ± 5683. 71 pg/mL (p = 0. 035) in patients with and without CA, respectively. During PMT, 14% of patients required increased vasoactive drug use, and 38. 77% were intubated, including 12 who required ECMO support. Sedation was administered in 64. 3% of patients, while general anesthesia was used in 38. 8%, with a preemptive indication in 23. 5%. The survival rate of patients without CA before and/or during PMT was 96%. Conclusions: While PMT was successfully performed in all patients, hemodynamic and respiratory instability remained a significant concern. More than 10% of patients experienced severe hemodynamic instability, primarily during thrombus extraction, requiring conversion from sedation to general anesthesia. Male sex, pre-existing respiratory disease, SpO2 < 90%, and SBP < 90 mmHg were associated with an increased risk of CA. Additionally, elevated NT-proBNP levels were linked to a higher incidence of CA.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Pulmonary embolism ; Pulmonary mechanical thrombectomy ; Hemodynamic instability ; Hypotension ; Cardiorespiratory arrest
Publicado en:	Journal of clinical medicine, Vol. 14, Núm. 8 (April 2025) , ISSN 2077-0383

DOI: 10.3390/jcm14082704
PMID: 40283535

14 p, 1.7 MB

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