UMEM Educational Pearls

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.