Etienne Gayat1, Alexandre Mebazaa. 1. Department of Anesthesiology and Intensive Care, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris; Université Paris 7, Paris, France.
Abstract
PURPOSE OF REVIEW: To review the contemporary management of patients with pulmonary hypertension in critical care. RECENT FINDINGS: The normal mean pulmonary artery pressure (mPAP) at rest is 14±3 mmHg and pulmonary hypertension is considered when mPAP is greater than or equal to 25 mmHg at rest. The classification of pulmonary hypertension has been redefined recently and updated in 2009 and could help to guide the management of patients with pulmonary hypertension in critical care. The management of pulmonary hypertension in ICU is based on expert opinion. Among the diagnostic and monitoring tools available, echocardiography provides useful information noninvasively, although pulmonary artery catheter must be used in case of complicated situations. Calcium sensitizers, a new class of inotrope, have inotropic effects and induce dilatation of the pulmonary, systemic, and coronary vasculature and thus could be useful in case of right ventricular failure (RVF), particularly in patients with acute respiratory distress syndrome (ARDS). By increasing the pulmonary vasodilator response to inhaled nitric oxide and preventing the rebound pulmonary vasoconstriction which occurs following cessation of nitric oxide breathing, selective type 5 isoform of phosphodiesterase inhibitors could be useful in critically ill patients. SUMMARY: This article reviews recent and key findings on the management of pulmonary hypertension in critically ill patients.
PURPOSE OF REVIEW: To review the contemporary management of patients with pulmonary hypertension in critical care. RECENT FINDINGS: The normal mean pulmonary artery pressure (mPAP) at rest is 14±3 mmHg and pulmonary hypertension is considered when mPAP is greater than or equal to 25 mmHg at rest. The classification of pulmonary hypertension has been redefined recently and updated in 2009 and could help to guide the management of patients with pulmonary hypertension in critical care. The management of pulmonary hypertension in ICU is based on expert opinion. Among the diagnostic and monitoring tools available, echocardiography provides useful information noninvasively, although pulmonary artery catheter must be used in case of complicated situations. Calcium sensitizers, a new class of inotrope, have inotropic effects and induce dilatation of the pulmonary, systemic, and coronary vasculature and thus could be useful in case of right ventricular failure (RVF), particularly in patients with acute respiratory distress syndrome (ARDS). By increasing the pulmonary vasodilator response to inhaled nitric oxide and preventing the rebound pulmonary vasoconstriction which occurs following cessation of nitric oxide breathing, selective type 5 isoform of phosphodiesterase inhibitors could be useful in critically illpatients. SUMMARY: This article reviews recent and key findings on the management of pulmonary hypertension in critically illpatients.