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/