title: Pulmonary Hypertension in the Intensive Care Unit.
abstract: Pulmonary hypertension occurs as the result of disease processes increasing pressure within the pulmonary circulation, eventually leading to right ventricular failure. Patients may become critically ill from complications of pulmonary hypertension and right ventricular failure or may develop pulmonary hypertension as the result of critical illness. Diagnostic testing should evaluate for common causes such as left heart failure, hypoxemic lung disease and pulmonary embolism. Relatively few patients with pulmonary hypertension encountered in clinical practice require specific pharmacologic treatment of pulmonary hypertension targeting the pulmonary vasculature. Management of right ventricular failure involves optimization of preload, maintenance of systemic blood pressure and augmentation of inotropy to restore systemic perfusion. Selected patients may require pharmacologic therapy to reduce right ventricular afterload by directly targeting the pulmonary vasculature, but only after excluding elevated left heart filling pressures and confirming increased pulmonary vascular resistance. Critically-ill patients with pulmonary hypertension remain at high risk of adverse outcomes, requiring a diligent and thoughtful approach to diagnosis and treatment.
authors.affiliation: University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, PA, USA Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Jentzer
authors.affiliation: University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, PA, USA mathierm@upmc.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mathier
mesh_terms: D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000628:therapy*; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000379:methods*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
keywords: pulmonary arterial hypertension; pulmonary hypertension; pulmonary vasodilators; right heart failure; right ventricular failure