{"title":"Pulmonary embolism: a practical approach to update risk stratification and treatment decisions based on the guidelines.","authors":"María Barca-Hernando, Luis Jara-Palomares","doi":"10.1080/17476348.2023.2298826","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary embolism (PE) is a prevalent condition with a substantial morbi-mortality worldwide. Proper risk stratification of PE is essential for identifying the most suitable therapeutic strategy and the optimal care setting for the patient. This process entails evaluating various factors, including symptoms, comorbidities, and right heart dysfunction.</p><p><strong>Areas covered: </strong>This review assesses the tools and methods utilized to identify and stratify individuals based on the probability of developing deterioration or death related to PE. Current guidelines divide PE into three groups: high-risk (previously termed massive) PE, intermediate-risk (sub-massive) PE, and low-risk PE. Various risk scores, such as the simplified pulmonary embolism severity index (sPESI), Bova score, and the FAST score (incorporating Heart-Fatty Acid binding protein [H-ABP], Syncope, Tachycardia), aid in identifying patients at higher risk. Additionally, the Hestia score is instrumental in pinpointing low-risk patients.</p><p><strong>Expert opinion: </strong>Presently, there is a dearth of high-quality frameworks for the optimal management and treatment of PE patients at risk of hemodynamic collapse. A consortium of experts is in the process of formulating a new conceptual model for risk stratification, taking into account a comprehensive array of variables and outcomes to facilitate more individualized management of acute PE.</p>","PeriodicalId":94007,"journal":{"name":"Expert review of respiratory medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Expert review of respiratory medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/17476348.2023.2298826","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/26 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Pulmonary embolism (PE) is a prevalent condition with a substantial morbi-mortality worldwide. Proper risk stratification of PE is essential for identifying the most suitable therapeutic strategy and the optimal care setting for the patient. This process entails evaluating various factors, including symptoms, comorbidities, and right heart dysfunction.
Areas covered: This review assesses the tools and methods utilized to identify and stratify individuals based on the probability of developing deterioration or death related to PE. Current guidelines divide PE into three groups: high-risk (previously termed massive) PE, intermediate-risk (sub-massive) PE, and low-risk PE. Various risk scores, such as the simplified pulmonary embolism severity index (sPESI), Bova score, and the FAST score (incorporating Heart-Fatty Acid binding protein [H-ABP], Syncope, Tachycardia), aid in identifying patients at higher risk. Additionally, the Hestia score is instrumental in pinpointing low-risk patients.
Expert opinion: Presently, there is a dearth of high-quality frameworks for the optimal management and treatment of PE patients at risk of hemodynamic collapse. A consortium of experts is in the process of formulating a new conceptual model for risk stratification, taking into account a comprehensive array of variables and outcomes to facilitate more individualized management of acute PE.
导言:肺栓塞(PE)是一种在全球范围内发病率和死亡率都很高的疾病。对肺栓塞进行适当的风险分层对于确定最合适的治疗策略和最佳的护理环境至关重要。这一过程需要评估各种因素,包括症状、合并症和右心功能不全:本综述评估了根据 PE 导致病情恶化或死亡的概率对患者进行识别和分层的工具和方法。现行指南将 PE 分成三类:高危(以前称为大面积)PE、中危(亚大面积)PE 和低危 PE。各种风险评分,如简化肺栓塞严重程度指数(sPESI)、Bova 评分和 FAST 评分(包含心-脂肪酸结合蛋白 [H-ABP]、晕厥、心动过速),有助于识别高风险患者。此外,Hestia 评分有助于确定低风险患者:目前,对于有血流动力学衰竭风险的 PE 患者的最佳管理和治疗还缺乏高质量的框架。一个专家联盟正在制定一个新的风险分层概念模型,该模型将考虑一系列综合变量和结果,以促进急性 PE 的个体化管理。