Managing a Critically Ill Patient With Pulmonary Arterial Hypertension.

Area of Science:

• Cardiology
• Critical Care Medicine
• Pulmonology

Background:

• Pulmonary hypertension (PH) poses significant challenges in critically ill patients, often leading to right ventricular failure (RVF).
• Acute illness can precipitate decompensated RVF and death in patients with PH, with high mortality rates in intensive care units (ICUs).
• Right ventricular failure is a primary cause of mortality in hospitalized patients with PH.

Purpose of the Study:

• To outline the intensive care unit (ICU) management strategies for acute decompensated right ventricular failure (RVF) in patients with pulmonary arterial hypertension (PAH).
• To emphasize the importance of recognizing and treating reversible precipitants of decompensation.
• To detail supportive measures for optimizing right ventricular (RV) function.

Main Methods:

• Focus on management of acute decompensated RVF in patients with known PAH.
• Implementation of supportive strategies to optimize RV function.
• Continuous monitoring of cardiac function and management of complications like arrhythmias and acute kidney injury (AKI).

Main Results:

• Management centers on treating reversible precipitants and optimizing RV function.
• Key goals include maintaining oxygenation, tissue perfusion, electrolyte balance, and RV preload, contractility, and afterload.
• Extracorporeal life support is considered for persistent RVF.

Conclusions:

• Comprehensive ICU management of PAH patients with RVF requires addressing reversible factors and providing hemodynamic support.
• Continuous monitoring, complication management, and consideration of advanced therapies like extracorporeal life support are crucial.
• Multidisciplinary care, including palliative specialists, is essential for advanced disease and guiding goals of care.