Skip to main content

Table 3 Management principles in pulmonary vascular dysfunction

From: Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

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 Pplat 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