Pulmonary Hypertension in ICU
Pulmonary hypertension (PH) in ICU represents a critical intersection of elevated pulmonary vascular resistance and righ... CICM Second Part Written, CICM Secon
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Pulmonary Hypertension in ICU
Pulmonary hypertension (PH) in ICU represents a critical intersection of elevated pulmonary vascular resistance and right ventricular (RV) failure. The 2022 ESC/ERS guidelines define PH as mean pulmonary artery pressure (mPAP) ≥20 mmHg at rest (updated from >25 mmHg). ICU management focuses on reducing RV afterload, maintaining RV perfusion pressure (systemic MAP > pulmonary pressures), avoiding hypoxia and hypercarbia, and optimizing preload without volume overload. Inhaled pulmonary vasodilators (nitric oxide, iloprost) are first-line, with systemic therapies (sildenafil, epoprostenol) for stabilization. VA-ECMO is the bridge to recovery or transplant for refractory cases.
Key Points
- 2022 Definition: PH is defined as mPAP ≥20 mmHg at rest (changed from >25 mmHg in 2022 ESC/ERS guidelines). Pre-capillary PH requires PVR >2 Wood units.
- WHO Classification: Group 1 (PAH), Group 2 (left heart disease - most common), Group 3 (lung disease/hypoxia), Group 4 (CTEPH), Group 5 (multifactorial/unclear mechanisms).
Red Flags
Cardiac Arrest in PH: CPR outcomes dismal (<10% survival). Prevention is paramount. Avoid arrest triggers: hypoxia, arrhythmia, intubation without optimization.