Management of ICU patient-pulmonary hypertension

• Avoid tachyarrhythmias & overly aggressive volume resuscitation

• Caution w/ vasodilators if any L-sided dysfunction

• Intubation can cause hemodynamic collapse

• Dobutamine and inhaled NO or prostacyclin

• Consider R-sided mechanical support (Circ 2015;132:536)

• Consider fibrinolysis if acute, refractory decompensation (eg, TPA 100 mg over 2 h)