Critical care management of pulmonary hypertension

AbstractPatients with pulmonary hypertension (PH) can be extremely challenging to manage in the critical care setting. In this article we review the classification, diagnosis, and chronic management of PH. An approach to the management of the critically unwell PH patient is discussed. Initial management involves treating underlying precipitants of deterioration and optimizing right ventricular (RV) preload. Reduction of RV afterload with pulmonary vasodilators is also required. Augmentation of cardiac function and perfusion pressures with inotropes and vasopressors may additionally be needed. Advanced renal and respiratory support may be appropriate depending on the clinical context. Patients with known PH who have undergone major surgery or who are in the immediate postpartum period are also at significant risk of deterioration and require management in the critical care setting. Although pulmonary vasodilators are associated with improvements in pulmonary haemodynamics and oxygenation in patients with acute respiratory distress syndrome or after cardiac surgery, there is currently no evidence demonstrating improved outcomes.
Source: Continuing Education in Anaesthesia, Critical Care and Pain - Category: Anesthesiology Source Type: research

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HORSHAM, PA, September 30, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson announced today that the U.S. Food and Drug Administration (FDA) has approved SIMPONI ARIA® (golimumab) for patients 2 years of age and older for the treatment of active pJIA and has extended the PsA indication for this same patient population. “This latest FDA approval of SIMPONI ARIA for pediatric use in active pJIA and active PsA not only brings a new option to young patients living with these diseases but also adds to the growing body of evidence for this treatment,” said Mathai Mammen, M.D., Ph.D., Glob...
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In this study, except for troponin elevation,Gestalt was the best predictor.The article does not specify the QT correction methodWhy is right ventricular hypertrophy (RVH) not found in this large study of syncope?  Probably because it is not common enough to be identified in a general syncope study.  Not every high risk factor will be identified in such studies, but it is obvious that RVH is a dangerous condition and that, if identified on ECG, needs further workup.  Why were so few ECG findings predictive?Because most abnormal ECG findings were considered adverse outcomes in their own right and not eva...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Abstract CASE PRESENTATION: A 59-year-old woman presented to the ED with syncope. She had progressive shortness of breath with minimal activity and precordial resting chest pain for 1 month prior to presentation. She had a medical history of heart failure with preserved ejection fraction, severe OSA well controlled with CPAP of 11 cm H2O, and a history of DVT and pulmonary embolism, diagnosed 10 years ago for which she was maintained on warfarin. The patient also had chronic myeloid leukemia in the chronic phase; she had initially been treated with imatinib but was later switched to dasatinib about 4.5 y...
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