The Crashing Patient with PAH

• In recent weeks, we've highlighted some pearls regarding the management of patients with pulmonary arterial hypertension (PAH).
• In the crashing patient with PAH, think about the following:
  • Catheter occlusion or malfunction (for those receiving IV prostacyclin analogues)
  • PE (for those inadequately anticoagulated)
  • Pneumonia
  • RV ischemia
  • GI bleeding
  • Ischemic bowel
• In the patient receiving IV epoprostenol (Flolan) who presents with a catheter occlusion or malfunction, time is of the essence. Restart the medication through a peripheral IV as soon as possible.

References

Rubenfire M, Bayram M, Hector-Wood Z. Pulmonary hypertension in the critical care setting: classification, pathophysiology, diagnosis, and management. Crit Care Clin 2007;23: 801-834.