THROMBOEMBOLISM AND CARDIOGENIC SHOCK IN THE ICU: PATHOPHYSIOLOGICAL MECHANISMS, CLINICAL MANAGEMENT, AND PROGNOSIS

Abstract

Introduction: Pulmonary embolism (PE) and cardiogenic shock are life-threatening conditions that require early diagnosis and specialized management in intensive care units (ICUs). Although they involve distinct pathophysiological mechanisms, both can compromise cardiac output, lead to systemic hypoperfusion, and progress to multiple organ dysfunction. Objective: To analyze the pathophysiological mechanisms, diagnostic methods, therapeutic strategies, and prognostic factors associated with pulmonary embolism and cardiogenic shock in critically ill patients. Methodology: A narrative literature review based on clinical guidelines and scientific publications concerning pulmonary embolism, cardiogenic shock, and intensive care medicine. The review covers aspects related to pathophysiology, diagnosis, treatment, and clinical outcomes. Discussion: High-risk PE can cause an acute increase in pulmonary vascular resistance, right ventricular failure, and obstructive shock. Cardiogenic shock, in turn, results from the heart's inability to maintain sufficient cardiac output to meet the metabolic demands of the tissues; it is frequently associated with acute myocardial infarction. The therapeutic approach includes hemodynamic support, anticoagulation (when indicated), reperfusion (in appropriate cases), and treatment of the underlying cause. Clinical progression depends on the severity of the cardiovascular dysfunction, the promptness of the intervention, and the occurrence of organ failure. Conclusion: Distinguishing between obstructive and cardiogenic shock is crucial for guiding treatment and reducing complications. Integrated hemodynamic assessment, continuous monitoring, and a multidisciplinary approach are essential for the care of critically ill patients.