Assessing the optimal MAP target in pre-capillary PH patients with RV failure: A retrospective analysis

Niala Moallem; Garrett Fiscus; David M O'Sullivan; Michael Perkins; Andrew Scatola; Raj Parikh

doi:10.1002/pul2.12292

Assessing the optimal MAP target in pre-capillary PH patients with RV failure: A retrospective analysis

Pulm Circ. 2023 Oct 8;13(4):e12292. doi: 10.1002/pul2.12292. eCollection 2023 Oct.

Authors

Niala Moallem¹, Garrett Fiscus², David M O'Sullivan³, Michael Perkins⁴, Andrew Scatola⁵, Raj Parikh⁴

Affiliations

¹ Department of Internal Medicine University of Connecticut Farmington Connecticut USA.
² Department of Pulmonary and Critical Care Fellowship University of Connecticut Farmington Connecticut USA.
³ Department of Research Administration Hartford HealthCare Hartford Connecticut USA.
⁴ Division of Pulmonary, Critical Care and Sleep Hartford Hospital Hartford Connecticut USA.
⁵ Division of Cardiology, Advanced Heart Failure and Transplant Hartford Hospital Hartford Connecticut USA.

Abstract

Right ventricular failure (RVF) in pre-capillary pulmonary hypertension (PH) is associated with high morbidity and mortality. While mean arterial pressure (MAP) goals have been well established in critical care literature, the optimal MAP target for patients with RVF secondary to pre-capillary PH remains unknown. The objective of this study was to evaluate the difference in outcomes between patients who were managed with different MAP targets. We retrospectively analyzed records of 60 patients who were admitted to the intensive care unit for decompensated RVF secondary to pre-capillary PH. The records were stratified into two groups: 30 patients who were treated with a static MAP goal of either 65 or 70 mmHg (MAP_65/70) and 30 patients who received a dynamic MAP goal (MAP_CVP) determined by invasively obtained central venous pressure or right atrial pressure. The dynamic MAP group had a statistically significant decrease in in-hospital mortality and incidence of acute kidney injury compared to the static MAP cohort.

Keywords: acute kidney injury; cardiogenic shock; central venous perfusion; pulmonary arterial hypertension; right ventricular failure.