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Intensive care unit management of patients with severe pulmonary hypertension and right heart failure.

Authors
  • Hoeper, Marius M
  • Granton, John
Type
Published Article
Journal
American Journal of Respiratory and Critical Care Medicine
Publisher
American Thoracic Society
Publication Date
Nov 15, 2011
Volume
184
Issue
10
Pages
1114–1124
Identifiers
DOI: 10.1164/rccm.201104-0662CI
PMID: 21700906
Source
Medline
License
Unknown

Abstract

Despite advances in medical therapies, pulmonary arterial hypertension (PAH) continues to cause significant morbidity and mortality. Although the right ventricle (RV) can adapt to an increase in afterload, progression of the pulmonary vasculopathy that characterizes PAH causes many patients to develop progressive right ventricular failure. Furthermore, acute right ventricular decompensation may develop from disorders that lead to either an acute increase in cardiac demand, such as sepsis, or to an increase in ventricular afterload, including interruptions in medical therapy, arrhythmia, or pulmonary embolism. The poor reserve of the right ventricle, RV ischemia, and adverse right ventricular influence on left ventricular filling may lead to a global reduction in oxygen delivery and multiorgan failure. There is a paucity of data to guide clinicians caring for acute right heart failure in PAH. Treatment recommendations are frequently based on animal models of acute right heart failure or case series in humans with other causes of pulmonary hypertension. Successful treatment often requires that invasive hemodynamics be used to monitor the effect of strategies that are based primarily on biological plausibility. Herein we have developed an approach based on the current understanding of RV failure in PAH and have attempted to develop a treatment paradigm based on physiological principles and available evidence.

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