| Author/Editor | Krivec, Bojan; Voga, Gorazd; Žuran, Ivan; Skale, Rafael; Parežnik, Roman; Podbregar, Matej; Noč, Marko | |
| Title | Diagnosis and treatment of shock due to massive pulmonary embolism: approach with transesophageal echocardiography and intrapulmonary thrombolysis | |
| Type | članek | |
| Source | Chest | |
| Vol. and No. | Letnik 112, št. 5 | |
| Publication year | 1997 | |
| Volume | str. 1310-6 | |
| Language | eng | |
| Abstract | Study objectives: To evaluate the diagnostic value of transesophageal echocardiography (TEE) as an initial diagnostic tool in shocked patients. The second objective was to study therapeutic impact of intrapulmonary thrombolysis in patients with diagnosed massive pulmonary embolism. Design: Prospective observational study. Setting: Medical ICU in 800-bed general hospital. Patients: Twenty-four consecutive patients with unexplained shock and distended jugular veins. Measurements and mciin results: In 18 patients, right ventricular dilatation with global or segmental hypokinesis was documented. In addition, central pulmonary thromboemboli ( 12 patients), reduced contrast flow in right pulmonary artery (one patient), and right ventricular free wall akinesis (one patient) were found. No sdditional echocardiographic findings were apparent in four patients. According to pulmonary scintigraphy or autopsy, sensitivity oF TEE for diagnosis of massive pulmonary embolism (MPE) in patients with right veatricular dilatation was 92% and specificity was 100%. In patients without right ventricular dilatation,1eR ventricular dysfunction (four pstients) or cardiac tamponade (two patients) wss confirmed, Intrapulmonsry thrombolysis was evaluated in 11 of 13 patients with MPE. Two patients died prior to attempted thrombolysis. Three patients received streptokinase and eight received urokinase. Twenty-four hours after beginning of treatment, total pulmonary resistance index signifcantly decreased for 59% and mean pulmonary artery pressure for 3l%. Cardiac index increased for 74%. Nine of 11 patients receiving thrombolysis survived to hospitsl discharge. Conclusion: Bedside TEE is a valuable tool for diagnosis of MPE. It enables immediate intrapulmonary thrombolysis, which seems to be an effective therapeutic alternative in our group of patients with obstructive shock. | |
| Descriptors | PULMONARY EMBOLISM SHOCK ECHOCARDIOGRAPHY, TRANSESOPHAGEAL FIBRINOLYTIC AGENTS THROMBOLYTIC THERAPY HEART CATHETERIZATION INFUSIONS, INTRAVENOUS PULMONARY ARTERY SENSITIVITY AND SPECIFICITY STREPTOKINASE TREATMENT OUTCOME UROKINASE PROSPECTIVE STUDIES |