Arterial pulmonary hypertension in noncardiac intensive care unit

Mykola V. Tsapenko, Arseniy V. Tsapenko, Thomas B.O. Comfere, Girish K. Mour, Sunil V. Mankad, Ognjen Gajic

Research output: Contribution to journalReview article

26 Scopus citations

Abstract

Pulmonary artery pressure elevation complicates the course of many complex disorders treated in a noncardiac intensive care unit. Acute pulmonary hypertension, however, remains underdiagnosed and its treatment frequently begins only after serious complications have developed. Significant pathophysiologic differences between acute and chronic pulmonary hypertension make current classification and treatment recommendations for chronic pulmonary hypertension barely applicable to acute pulmonary hypertension. In order to clarify the terminology of acute pulmonary hypertension and distinguish it from chronic pulmonary hypertension, we provide a classification of acute pulmonary hypertension according to underlying pathophysiologic mechanisms, clinical features, natural history, and response to treatment. Based on available data, therapy of acute arterial pulmonary hypertension should generally be aimed at acutely relieving right ventricular (RV) pressure overload and preventing RV dysfunction. Cases of severe acute pulmonary hypertension complicated by RV failure and systemic arterial hypotension are real clinical challenges requiring tight hemodynamic monitoring and aggressive treatment including combinations of pulmonary vasodilators, inotropic agents and systemic arterial vasoconstrictors. The choice of vasopressor and inotropes in patients with acute pulmonary hypertension should take into consideration their effects on vascular resistance and cardiac output when used alone or in combinations with other agents, and must be individualized based on patient response.

Original languageEnglish (US)
Pages (from-to)1043-1060
Number of pages18
JournalVascular health and risk management
Volume4
Issue number5
StatePublished - Dec 4 2008

Keywords

  • Acute cor pulmonale
  • Acute pulmonary hypertension
  • Cor pulmonale
  • Pulmonary hypertension
  • Right heart failure

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hematology
  • Public Health, Environmental and Occupational Health
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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  • Cite this

    Tsapenko, M. V., Tsapenko, A. V., Comfere, T. B. O., Mour, G. K., Mankad, S. V., & Gajic, O. (2008). Arterial pulmonary hypertension in noncardiac intensive care unit. Vascular health and risk management, 4(5), 1043-1060.