Critical Care Scenarios Episode 54: The critically ill patient with pulmonary hypertension, with Ray Foley
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Dec 7, 2022 AI Snips
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Use Gentle Positive Pressure
- Use modest noninvasive pressures and avoid high PEEP which can raise PVR and reduce venous return.
- Aim for SpO2 ≥90% and monitor blood gases to avoid hypercapnia and acidosis.
Protect RV Perfusion With Higher MAP
- Avoid hypotension; target MAP ≥65 and consider higher MAP (70–80) when CVP is elevated to perfuse the RV.
- Use MAP minus CVP concept to guide perfusion goals for the right ventricle.
Choose Vasopressin Over High‑Dose Norepinephrine
- Prefer vasopressin to raise systemic vascular resistance because it has neutral or minimal effect on pulmonary vascular resistance.
- Add epinephrine for combined vasopressor and inotropic support if needed.