Cite this post as:
Scott Weingart, MD FCCM. Podcast 181 – Pulmonary Hypertension and Right Ventricular Failure with Susan Wilcox. EMCrit Blog. Published on September 5, 2016. Accessed on May 29th 2023. Available at [https://emcrit.org/emcrit/pulmonary-hypertension-right-ventricular-failure/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: September 5, 2016
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
You finished the 'cast,
Now Join EMCrit!
As a member, you can...
- Get CME hours
- Get the On Deeper Reflection Podcast
- Support the show
- Write it off on your taxes or get reimbursed by your department
.
Get the EMCrit Newsletter
If you enjoyed this post, you will almost certainly enjoy our others. Subscribe to our email list to keep informed on all of the Resuscitation and Critical Care goodness.
This Post was by the EMCrit Crew, published 7 years ago. We never spam; we hate spammers! Spammers probably work for the Joint Commission.
Awesome review of a topic that, frankly, gets glossed over to a great degree in most EMS education resources! For those of us without access to POCUS, any thoughts on correlation between ECG signs such as RVH and pulmonary disease patterns to RV failure that might serve as guidance for treating these patients prehospital?
Fantastic and much-needed post. Several years ago I had a terrible experience intubating a young man on the heart-lung transplant list with severe pneumonia. We spent several hours trying to get him to stay alive on a ventilator and ultimately were unsuccessful. This case suggested two additional considerations when intubating the crashing pulmonary hypertension patient: (1) If you’re really worried the patient will die on the ventilator, might be worth preparing and/or starting inhaled epoprostenol or nitric acid via the ventilator immediately after intubation. This takes a bit of time to set up, so ideally should be ready to go… Read more »
Thank you for this awesome post. I am wondering what the optimal O2 target is for patients in acute RV failure who also happen to be chronic CO2 retainers. I recently had a patient with severe COPD and unrevascularized RCA disease who was admitted with a submassive PE, and was not a candidate for thrombolysis or intubation. She was hypotensive. I found it difficult to decide on a O2 target for her – balancing the risk of worsened V/Q mismatch/loss of hypoxic respiratory against the need to minimize RV afterload and maximize DO2 to the RV. I ended up going… Read more »
think you are in good shape >90%
Great interview with Dr. Wilcox about a subject that is poorly understood and treated. Fantastic!
Using hi flow oxygen would stave off intubation in many of these patients with hypoxic respiratory failure.
Wow, thanks for this post. Something that I don’t know enough about and will be definitely deep diving into!
Thank you Susan and Chris for writing absolutely the best article hitherto on PH and critically ill. It is a must read for anybody managing critically ill patients. Who should be screened- In my ED experience I screen everyone with SOB. I have had two surgical patients who I found had severe PH and my advice to my surgical colleagues was to not attempt to operate here and transfer to a tertiary center for management. Everybody with Systemic hypotension should be screened for pulmonary hypertension. Thus Hypertensive hypotension is a reality. My suggestion would be for colleagues doing echo to… Read more »
Such fantastic points! When I looked at the ketamine literature for other projects, I came across nothing regarding pulm vasoconstrict. If you find it again, send it my way.
I looked again and I have to say, I would go along with you, as recent papers seem to suggest no clinically significant increase in PVR with Ketamine.
I’m interested in your approach of loading with milrinone. In theory this would be more easily implemented than inhaled pulmonary vasodilators. If the load were given with noradrenaline to preserve your MAP – have you ever tried this or are you aware of any evidence for this approach?
Mark, most of my knowledge is through theory and fear. I have had the opportunity to manage three such patients and all did poorly. I have dealt with a few others, but in them Ceiling of care was discussed and felt appropriate not to be aggressive. I haven’t come across any evidence in the acute setting comparing the use of these vaspressor/inotrope/inodilator therapies.. There is some coming through from anesthetic literature perioperative. Inhaled milrinone is also getting good reviews. In short, I can’t say that I have a lot of expertise in managing this group of patients but my fear… Read more »
Hi! Greetings from Argentina! Amazing podcast! Recently used in my blog as refference. Look out this case:
https://interconsulta.online/caso-clinico-20-perdida-de-conciencia-y-cambios-en-ecg/
Excellent presentation