pulmonary disorders
Pulmonary Embolism (PE)
Prognosis for Pulmonary Embolism
Most deaths resulting from pulmonary embolism occur withing 1 hour of presentation ( Prognosis references ). Most patients who die as a result of acute PE are never diagnosed before death. In fact, PE is not suspected in most of these patients. Overall in-hospital mortality rate ranges from approximately 8% in stable patients to 25% in those presenting with cardiogenic shock and to 65% in patients requiring cardiopulmonary resuscitation ( The best prospects for reducing mortality involve Improving the frequency of diagnosis (eg, by including PE in the differential diagnosis when patients present with nonspecific but compatible symptoms or signs) Improving the rapidity of diagnosis Improving risk stratification Improving the rapidity of initiation of anticoagulation therapy Providing appropriate prophylaxis in at-risk patients Very high D-dimer levels appear to predict a poor outcome. Patients with chronic thromboembolic disease represent a small, but important fraction of patients with PE who survive. Anticoagulant therapy reduces the rate of recurrence of PE to about 5% and even lower in some cases. 1.Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism.Chest2002;121(3):877-905. doi:10.1378/chest.121.3.877 2.Kasper W, Konstantinides S, Geibel A, et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry.J Am Coll Cardiol1997;30(5):1165-1171. doi:10.1016/s0735-1097(97)00319-7 