What is the primary concern with intubating a patient with pulmonary embolism?

In patients with pulmonary embolism, intubation poses a significant risk of further worsening hypoxemia. This occurs because intubation can disrupt the delicate balance of ventilation and perfusion in the lungs, especially in the context of existing hypoxia due to reduced blood flow caused by the embolism.

When the airway is secured with intubation, if adequate ventilation strategies are not implemented immediately—such as ensuring proper oxygenation and ventilation settings—the patient may experience hypoxemia secondary to inadequate gas exchange. Moreover, pulmonary embolism can already compromise the lungs’ ability to oxygenate blood efficiently, and the stress and changes introduced by intubation may exacerbate this condition.

In contrast, while hypotension, intracranial pressure, and infection risk are important clinical considerations, they are not as directly linked to the immediate effects of intubation on a patient with pulmonary embolism. Intubation's primary concern is thus centered on maintaining and improving oxygenation in an already compromised respiratory status.