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Updated: Oct 21, 2025

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
Advanced airway management and respiratory care in decompensated pulmonary hypertension
Cyrus A Vahdatpour1, John J Ryan2, Joshua M Zimmerman3
1Department of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, P.O Box 100225 JHMHC, Gainesville, FL, 32610-0225, USA. Cyrus.vahdatpour@medicine.ufl.edu.
Abstract:
Meticulous risk stratification is essential when considering intubation of a patient with decompensated pulmonary hypertension (dPH). It is paramount to understand both the pathophysiology of dPH (and associated right ventricular failure) and the complications related to a high-risk intubation before attempting the procedure. There are few recommendations in this area and the literature, guiding these recommendations, is limited to expert opinion and very few case reports/case series. This review will discuss the complex pathophysiology of dPH, the complications associated with intubation, the debates surrounding induction agents, and the available options for the intubation procedure, with specific emphasis on the emerging role for awake fiberoptic intubation. All patients should be evaluated for candidacy for veno-arterial extracorporeal membrane oxygen as a bridge to recovery, lung transplantation, or pulmonary endarterectomy prior to intubation. Only an experienced proceduralist who is both comfortable with high-risk intubations and the pathophysiology of dPH should perform these intubations.
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