Key result
Norepinephrine leads initial shock regimens in pulmonary arterial hypertension, used in ~46% of patients.
Why the study?
The optimal use of vasoactive medications in patients with pulmonary arterial hypertension presenting with shock remains unknown.
Cohort (n=2,347)
Yes
Answers are grounded in this paper and cite their sources.
Benchmarking of initial vasoactive strategies in PAH patients with shock revealed wide practice variation, including frequent use of potentially unfavorable agents like phenylephrine, highlighting the need for comparative effectiveness studies.
The optimal use of vasoactive medications in patients with pulmonary arterial hypertension with shock remains unknown. Using a national database, we benchmarked initial vasoactive practices. Twenty-five distinct strategies were identified, most commonly norepinephrine, vasopressin, phenylephrine, and milrinone. Marked practice variation underscores clinical equipoise and the need for comparative effectiveness studies.
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Pinzon et al. (2026) conducted a cohort in Pulmonary arterial hypertension with shock (n=2,347). Vasoactive medications (e.g., norepinephrine, milrinone, phenylephrine) vs. Other vasoactive combinations or monotherapies was evaluated on Frequency of initial vasoactive medication use on hospital day 1 (norepinephrine use rate reported). In adults with pulmonary arterial hypertension and shock, 25 distinct initial vasoactive strategies were used, with norepinephrine (45.8%) and milrinone (32.1%) being the most common.
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