How to perform respiratory support?
Target SpO2 > 90%; consider HFNC for patients with high oxygen demand
If possible, avoid intubation and positive pressure ventilation (PPV).
Extreme caution and specialist consultation is advised if mechanical ventilation is unavoidable.
What are the general treatment goals in hemodynamic support?
Requires very close assessment of volume status and fluid balance monitoring as both hypovolemia and hypervolemia are harmful to cardiac function.
Typically involves careful balancing of IV diuretics for volume overload and IV fluid challenges for hypovolemia.
RV afterload reduction: e.g., with pulmonary vasodilators (prescribed by a PH specialist)
Optimizing cardiac output and peripheral perfusion: typically with a combination of inodilators (e.g., dobutamine) and other vasopressors (e.g, norepinephrine)
What to do in refractory right heart failure?
Consider extracorporeal life support as a bridge to urgent lung or heart-lung transplant
What to do in patients with an IV prostacyclin pump?
Consult the patient's PAH specialist immediately for any mechanical issues (e.g., suspected device failure or problems with tube patency).
Do not stop the infusion or adjust dosage or flow rates without guidance from the treating specialist.
How to manage all patients with acute decompensated PH?
Assess for shock (e.g., cardiogenic shock or obstructive shock).
Consult a PH specialist.
Admit to ICU and start continuous monitoring.
Identify and treat any precipitating factors.
Intravascular catheter infection
Missed or interrupted medical treatment, e.g., IV prostacyclin pump failure