What are the hemodynamic changes that occur after intubation which may be deleterious to patients with a large pulmonary embolus?

• sedative hypnotics used for intubation can blunt catecholamine surge on which patient is dependent for vasoconstriction and maintenance of venous return


• hyperventilation can also decrease venous return


• pulmonary vascular resistance may increase

Despite these hemodynamic changes which may be deleterious to patients with large PE, these patients often require mechanical ventilation. Consider starting norepinephrine to counter some of these hemodynamic effects.

Source

Wood, Kenneth. "Major Pulmonary Embolism review of a Pathophysiologic Approach to the Golden Hour fo Hemodynamically Significant Pulmonary Embolism." Chest. V 121 Issue 3. March 2002.