Critical Care Management of Decompensated Right Heart Failure in Pulmonary Arterial Hypertension Patients - An Ongoing Approach

J Crit Care Med (Targu Mures). 2021 Aug 5;7(3):170-183. doi: 10.2478/jccm-2021-0020. eCollection 2021 Jul.

Abstract

Despite substantial advancements in diagnosis and specific medical therapy in pulmonary arterial hypertension patients' management, this condition continues to represent a major cause of mortality worldwide. In pulmonary arterial hypertension, the continuous increase of pulmonary vascular resistance and rapid development of right heart failure determine a poor prognosis. Against targeted therapy, patients inexorable deteriorate over time. Pulmonary arterial hypertension patients with acute right heart failure who need intensive care unit admission present a complexity of the disease pathophysiology. Intensive care management challenges are multifaceted. Awareness of algorithms of right-sided heart failure monitoring in intensive care units, targeted pulmonary hypertension therapies, and recognition of precipitating factors, hemodynamic instability and progressive multisystem organ failure requires a multidisciplinary pulmonary hypertension team. This paper summarizes the management strategies of acute right-sided heart failure in pulmonary arterial hypertension adult cases based on recently available data.

Keywords: acute right heart failure; hemodynamic; intensive care admission; management; pulmonary arterial hypertension; specific therapy.