Great lecture exploring the grey zone of high risk intermediate PE. To me a very interesting area. Don’t let anyone tell you there is clear evidence on how to manage these patients – there isn’t. There’s a lot of nuance and we don’t quite yet have a grasp on how to really know who needs more aggressive management. People like Asher and those pushing the envelope with PERT teams and exploring this space will hopefully get us there.

My personal take is that the answers will be in using combined markers of congestion and forward flow (because obstructive shock both congests and restricts CO) along with some (CT?) measures of anticoagulation-responsiveness of clot burden, with dynamic cardiopulmonary reserve measures.

Enjoy the talk!

cheers

Philippe

ps in case you didn’t know, we are holding a VExUS & Hemodynamics course in NYC in a few weeks, learn to look at both congestion and forward flow and join us for an afternoon of shared knowledge! https://thinkingcriticalcare.com/2025/09/07/vexus-hemodynamics-nyc-dec-4th-2025/

We’re super excited about coming to NYC, but even more about unleashing The VExUS Course 2.0, which will include the integration of venous congestion into our comprehensive hemodynamic interface framework. So participants will have an all-new version of the course, along with an introduction to the interface concept which is gaining a lot of traction, and (of course we are biased) we feel is the way forward in assessing and managing any hemodynamic issue. So this will be 4 hours of hands-on workshop and case discussion. We will also introduce participants to the use of the FlowPatch, a Doppler system for the neck veins that assesses both forward flow and congestion, and fits very well into the interface system. This course is for those who believe (as we do) that tailoring treatment to the individual patient’s pathophysiology is the way forward. Participants will leave having levelled up.

Who Should Attend?: Any clinician looking after sick patients, particularly those involved in resuscitation, congestive heart failure, and kidney injury. Learning Objectives: (1) To understand the pathophysiology behind venous congestion, (2) To be able to analyse venous congestion with bedside ultrasound, both with traditional devices and with the Flosonics FloPatch, (3) To be introduced to the Hemodynamic Interfaces and learn how to incorporate findings of venous Doppler within this framework.  Course Format: flipped classroom with 4hr Pre-Course Material and 4h Hands-On Workshop. Cost: $499 Physicians/$399 Trainees. No CME.

Register here: https://ccusinstitute.wixsite.com/ccus/events/vexus-nyc-feat-flopatch. Only 30 spaces available, REGISTER NOW!

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