Dobutamine, milrinone, inhaled nitric oxide, and intravenous prostacyclin are the most supported therapies for right ventricular failure in pulmonary hypertension patients in critical care.
In critically ill patients with pulmonary hypertension, dobutamine, milrinone, inhaled nitric oxide, and intravenous prostacyclin are the most supported therapies for right ventricular failure, while treating the primary cause is preferred for PH secondary to critical illness.
Pulmonary hypertension presents a particular challenge in critically ill patients, because typical therapies such as volume resuscitation and mechanical ventilation may worsen hemodynamics in patients with pulmonary hypertension and right ventricular failure. Patients with decompensated pulmonary hypertension, including those with pulmonary hypertension associated with cardiothoracic surgery, require therapy for right ventricular failure. Very few human studies have addressed the use of vasopressors and pulmonary vasodilators in these patients, but the use of dobutamine, milrinone, inhaled nitric oxide, and intravenous prostacyclin have the greatest support in the literature. Treatment of pulmonary hypertension resulting from critical illness or chronic lung diseases should address the primary cause of hemodynamic deterioration, and pulmonary vasodilators usually are not necessary.
Zamanian et al. (2007) studied this question. Dobutamine, milrinone, inhaled nitric oxide, and intravenous prostacyclin are the most supported therapies for right ventricular failure in pulmonary hypertension patients in critical care.