Table 3 Management principles in pulmonary vascular dysfunction

1. Optimize volume status: avoid filling (± offload) if RV volume-overloaded

2. Augment CO

3. Reduce PVR

   a) Use pulmonary vasodilators (preferably inhaled: less systemic hypotension and V/Q mismatch)

   b) Treat reversible factors that may increase PVR

Metabolic state: correct anemia, acidosis, hypoxemia

Treat respiratory failure: treat hypoxia; limit P_plat by using lung-protective ventilatory strategies, but beware of high pCO₂ increasing PVR

Reduce sympathetic overstimulation

4. Maintain adequate systemic vascular resistance (SVR): keep PVR well below SVR; use pressors if necessary