Critical Care Management of the Patient with Pulmonary Hypertension

Pulmonary hypertension, defined as an elevation of the mean pulmonary artery pressure above 20 mm Hg, is an increasingly common diagnosis in patients admitted to the intensive care unit either as a primary pathology or as the result of other medical conditions. Proper assessment to identify the contributing factors and identify key specific etiologies is essential to properly manage these patients and improve patient outcomes. A subset of patients with causes of pulmonary hypertension such as Group 1 pulmonary arterial hypertension or Group 4 chronic thromboembolic pulmonary hypertension require specific treatments that deviate from usual intensive unit care and are critical to patients’ survival. These patients and patients with advanced pulmonary hypertension from other causes may benefit from specialized treatments targeting the right ventricle and pulmonary circulation complex, and warrant transfer to a center with pulmonary hypertension expertise. This review will discuss pulmonary hypertension epidemiology, physiology of the right ventricle and pulmonary circulation complex, stepwise diagnosis and classification of patients, management of cardiorespiratory support medications and devices, perioperative considerations, and special populations such as transplant candidates and pregnancy.