Cowen J, Kelley MA.
Pulmonary embolism in the critically ill: strategies for prevention and treatment.
J Crit Illn 1994 Nov;9(11):988-91

Department of pulmonary and critical care medicine, Hospital of the University of
Pennsylvania, Philadelphia, USA.

Most ICU patients are at high risk for developing deep venous thrombosis; thus,
they should be considered candidates for prophylaxis against pulmonary emboli (PE).
If early ambulation is not an option, give low-dose heparin or apply lower
extremity pneumatic compression. When PE cannot be prevented, rapid treatment is
mandatory. Inotropic agents can be used to improve right ventricular contractility;
however, the role of volume loading for augmenting preload is controversial.
Heparin is the first-line therapy for halting ongoing thrombosis; administer a
5,000- to 10,000-U bolus, followed by a continuous infusion of about 35,000 U/d.
Thrombolysis, embolectomy, and occlusive devices are other therapeutic options.