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02-09-2021 | Cardiogenic Shock

Advanced airway management and respiratory care in decompensated pulmonary hypertension

Authors: Cyrus A. Vahdatpour, John J. Ryan, Joshua M. Zimmerman, Samuel J. MacCormick, Harold I. Palevsky, Hassan Alnuaimat, Ali Ataya

Published in: Heart Failure Reviews | Issue 5/2022

Abstract

Meticulous risk stratification is essential when considering intubation of a patient with decompensated pulmonary hypertension (dPH). It is paramount to understand both the pathophysiology of dPH (and associated right ventricular failure) and the complications related to a high-risk intubation before attempting the procedure. There are few recommendations in this area and the literature, guiding these recommendations, is limited to expert opinion and very few case reports/case series. This review will discuss the complex pathophysiology of dPH, the complications associated with intubation, the debates surrounding induction agents, and the available options for the intubation procedure, with specific emphasis on the emerging role for awake fiberoptic intubation. All patients should be evaluated for candidacy for veno-arterial extracorporeal membrane oxygen as a bridge to recovery, lung transplantation, or pulmonary endarterectomy prior to intubation. Only an experienced proceduralist who is both comfortable with high-risk intubations and the pathophysiology of dPH should perform these intubations.

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Title: Advanced airway management and respiratory care in decompensated pulmonary hypertension
Authors: Cyrus A. Vahdatpour
John J. Ryan
Joshua M. Zimmerman
Samuel J. MacCormick
Harold I. Palevsky
Hassan Alnuaimat
Ali Ataya
Publication date: 02-09-2021
Publisher: Springer US
Keywords: Cardiogenic Shock
Pulmonary Hypertension
Cardiogenic Shock
Pulmonary Hypertension
Airway Management
Pulmonary Hypertension
Pulmonary Hypertension
Etomidate
Published in: Heart Failure Reviews / Issue 5/2022
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-021-10168-9

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