Pulmonary Hypertension in the Critically Ill

Michelle   S.   Chew; Lill      Bergenzaun; Hans      Ohlin; Anders      Ersson

Abstract

Pulmonary hypertension is not uncommonly seen in the critically ill. It may be encountered in patients with pre-existing diseases or may occur acutely without predisposing conditions. The diagnosis and management of pulmonary hypertension can be very challenging, given that critically ill patients are often concurrently haemodynamically unstable. Commonly used therapies in the Intensive Care Unit, such as fluid resuscitation, mechanical ventilation, vasopressors and inotropes may have deleterious effects in this population. We review the pathophysiology, diagnosis and current management strategies of this disease, with special emphasis on the critically ill adult population.

Keywords: Pulmonary hypertension, right ventricular failure, nitric oxide, sildenafil, levosimendan, prostacyclin, pulmonary artery catheter, echocardiography, intensive care