Mechanical Ventilation in Patients with Pulmonary HTN 

• In the critically ill patient with pulmonary HTN and respiratory failure, improper mechanical ventilator settings can be disastrous.
• Large lung volumes and high levels of PEEP can result in acute cardiovascular collapse.
• When setting the ventilator is these patients, select low tidal volumes and relatively low levels of PEEP (3-5 cm H₂O).
• In addition, small studies suggest avoiding permissive hypercapnia, as this may increase pulmonary vascular resistance and mean pulmonary arterial pressure.

References

1. Zamanian RT, et al. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med 2007; 35:2037-50.
2. Gayat E, et al. Pulmonary hypertension in critical care. Curr Opin Crit Care 2011; 17:439-448.