Management of Pulmonary Hypertension in the ICU.pptx

1、ICU Management of Pulmonary Hypertension,Anthony Carnicelli,MD FACCDirector,Cardiac Intensive Care UnitMedical University of South Carolina,Disclosures,Research support from Acorai and Johnson&Johnson MedTechConsulting and advisory board fees from Johnson&Johnson MedTechConsulting fees from Precisio

2、n Cardiovascular,36-year-old female w/2 years of SOBMultiple family members with PAH including sister on IV meds and several with early deathED-CT PE negative,V/Q negativeRHC:RA 20mmHgPA 100/50/65mmHgPCWP 15mmHgCO/CI 1.40/0.94Initially stable-hypotensive,lactate 9.7mmol/L,Airway Management,Alviar CL

3、 et al.JACC 2018;72:1532-1553.,1,More PEEP,Less PEEP,Airway Management,Alviar CL et al.JACC 2018;72:1532-1553.,1,Airway Management,1,RV preload RV afterload/PVR LV preload LV afterload/SVRInduction of anesthesiaApnea,Unpredictable Frank-Starling CurveAlready way too high!Already low!Removes compensa

4、tory vasoconstrictionVasodilationVery little PaO2 reserve(further PVR),Avoid intubation if possible,MCS Considerations,Carnicelli AP,Kanwar M et al.JHLT 2024;43(11).,2,“A failing RV requires RV-focused mechanical support.”,MCS Considerations,2,Kapur NK et al.Circ 2017;136.,Centrimag IFU,Device flow(

5、Q)=,RPM,a very high number,A very low number,=,MCS Considerations,2,Kapur NK et al.Circ 2017;136.,Centrimag IFU,Device flow(Q)=,RPM,a very high number,A very low number,=,MCS Considerations,2,3,Serial Hemodynamics,Viray MC,Tedford RJ et al.Circ HF 2020;13(11).,Tedford RJ et al.Texas J of Hemodynam 2

6、025;12(6).,4,New Therapeutics,Humbert M et al.NEJM 2021;384.,Sildenafil,ambrisentan,epoprostenol,trepostinil,Sotatercept?,Humbert M et al.Circ 2014;130.,Clinical Case,Prolonged intubation,reintubation(while on ecmo)GIB w/multiple clips,arte