Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism
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 instabi...
| Autores: | ; ; ; ; ; ; ; ; ; ; |
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| Tipo de documento: | Artículo |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Lenguaje: | Inglés |
| OAI Identifier: | oai:ddd.uab.cat:311310 |
| Acceso en línea: | https://ddd.uab.cat/record/311310 https://dx.doi.org/urn:doi:10.3390/jcm14082704 |
| Nivel de acceso: | Acceso abierto |
| Palabra clave: | Pulmonary embolism Pulmonary mechanical thrombectomy Hemodynamic instability Hypotension Cardiorespiratory arrest |
| _version_ | 1878737704219312128 |
|---|---|
| author | González Suárez, Susana|||0000-0001-7119-1092 |
| author2 | Camacho Oviedo, John Suriñach Caralt, José María|||0000-0001-6814-7963 Grao Roca, Maria Dammala Liyanage, Isuru Maduranga Pérez Lafuente, Mercedes Mena Muñoz, Elisabeth González Junyent, Carla|||0000-0001-6999-5876 Martínez-Martínez, Maríam Barnés Navarro, Daniel Ruíz-Rodríguez, Juan Carlos |
| author2_role | author author author author author author author author author author |
| author_browse | Barnés Navarro, Daniel Camacho Oviedo, John Dammala Liyanage, Isuru Maduranga González Junyent, Carla|||0000-0001-6999-5876 González Suárez, Susana|||0000-0001-7119-1092 Grao Roca, Maria Martínez-Martínez, Maríam Mena Muñoz, Elisabeth Pérez Lafuente, Mercedes Ruíz-Rodríguez, Juan Carlos Suriñach Caralt, José María|||0000-0001-6814-7963 |
| author_facet | González Suárez, Susana|||0000-0001-7119-1092 Camacho Oviedo, John Suriñach Caralt, José María|||0000-0001-6814-7963 Grao Roca, Maria Dammala Liyanage, Isuru Maduranga Pérez Lafuente, Mercedes Mena Muñoz, Elisabeth González Junyent, Carla|||0000-0001-6999-5876 Martínez-Martínez, Maríam Barnés Navarro, Daniel Ruíz-Rodríguez, Juan Carlos |
| author_role | author |
| collection | Dipòsit Digital de Documents de la UAB |
| description | 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. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_a3b245a9d422995dd2e89542aecb6eb5 |
| institution | Universitat Autònoma de Barcelona |
| instname_str | Universitat Autònoma de Barcelona |
| language | eng |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:ddd.uab.cat:311310 |
| publishDate | 2025 |
| publishDateSort | 2025 |
| reponame_str | Dipòsit Digital de Documents de la UAB |
| spelling | Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism Manejo de la inestabilidad hemodinámica y respiratoria y procedimientos anestésicos en pacientes sometidos a trombectomía pulmonar por embolia pulmonar González Suárez, Susana|||0000-0001-7119-1092 Camacho Oviedo, John Suriñach Caralt, José María|||0000-0001-6814-7963 Grao Roca, Maria Dammala Liyanage, Isuru Maduranga Pérez Lafuente, Mercedes Mena Muñoz, Elisabeth González Junyent, Carla|||0000-0001-6999-5876 Martínez-Martínez, Maríam Barnés Navarro, Daniel Ruíz-Rodríguez, Juan Carlos Pulmonary embolism Pulmonary mechanical thrombectomy Hemodynamic instability Hypotension Cardiorespiratory arrest 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. https://ddd.uab.cat/record/311310 https://dx.doi.org/urn:doi:10.3390/jcm14082704 |
| spellingShingle | Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism González Suárez, Susana|||0000-0001-7119-1092 Pulmonary embolism Pulmonary mechanical thrombectomy Hemodynamic instability Hypotension Cardiorespiratory arrest |
| title | Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism |
| title_full | Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism |
| title_fullStr | Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism |
| title_full_unstemmed | Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism |
| title_short | Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism |
| title_sort | Management of Hemodynamic and Respiratory Instability and Anesthetic Approaches in Patients Undergoing Pulmonary Thrombectomy for Pulmonary Embolism |
| topic | Pulmonary embolism Pulmonary mechanical thrombectomy Hemodynamic instability Hypotension Cardiorespiratory arrest |
| topic_facet | Pulmonary embolism Pulmonary mechanical thrombectomy Hemodynamic instability Hypotension Cardiorespiratory arrest |
| url | https://ddd.uab.cat/record/311310 https://dx.doi.org/urn:doi:10.3390/jcm14082704 |