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Research ArticleSymposium: Current and Evolving Concepts in Critical Care

Postoperative Pulmonary Hypertension: Etiology and Treatment of a Dangerous Complication

Nicholas S Hill, Kari R Roberts and Ioana R Preston
Respiratory Care July 2009, 54 (7) 958-968;
Nicholas S Hill
Division of Pulmonary Critical Care and Sleep Medicine, Tufts Medical Center, Boston Massachusetts.
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  • For correspondence: [email protected]
Kari R Roberts
Division of Pulmonary Critical Care and Sleep Medicine, Tufts Medical Center, Boston Massachusetts.
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Ioana R Preston
Division of Pulmonary Critical Care and Sleep Medicine, Tufts Medical Center, Boston Massachusetts.
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Abstract

Postoperative pulmonary hypertension is a challenging and feared complication of many types of surgery, including lung and heart transplantation, pulmonary thromboendarterectomy, congenital-heart-disease repair, and others. The most severe manifestation is acute right heart syndrome, characterized by right heart failure and cardiovascular collapse—a daunting therapeutic challenge associated with a high mortality. Patients with postoperative pulmonary hypertension must be carefully evaluated to identify reversible contributing factors such as fluid and metabolic imbalance, hypoxemia, and right heart ischemia. A pulmonary arterial catheter and echocardiogram are recommended for evaluation, although their value has not been established in carefully designed trials. Basic principles of management include maintenance of systemic perfusion pressure, optimization of cardiac inotropy, use of lung-protective ventilator strategies, and attempting to reduce right-ventricular afterload using pulmonary vasodilators. Unfortunately, controlled trials upon which to base therapy are lacking, and most approaches are supported only by uncontrolled or anecdotal evidence. Better understanding of the pathophysiology of right heart failure and controlled trials testing therapeutic approaches are needed if we are to make progress in treating this heretofore highly mortal condition.

  • postoperative pulmonary hypertension
  • surgery
  • acute right heart syndrome
  • lung transplantation
  • heart transplantation
  • thromboendarterectomy

Footnotes

  • Correspondence: Nicholas S Hill MD, Division of Pulmonary Critical Care and Sleep Medicine, Tufts Medical Center, 800 Washington Street, #257, Boston MA 02111. E-mail: nhill{at}tuftsmedicalcenter.org.
  • Dr Hill presented a version of this paper at the symposium Current and Evolving Concepts in Critical Care, at the 54th International Respiratory Congress of the American Association for Respiratory Care, held December 13-16, 2008, in Anaheim, California. The symposium was made possible by an unrestricted educational grant from Ikaria.

  • Copyright © 2009 by Daedalus Enterprises Inc.
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Respiratory Care: 54 (7)
Respiratory Care
Vol. 54, Issue 7
1 Jul 2009
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Postoperative Pulmonary Hypertension: Etiology and Treatment of a Dangerous Complication
Nicholas S Hill, Kari R Roberts, Ioana R Preston
Respiratory Care Jul 2009, 54 (7) 958-968;

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Postoperative Pulmonary Hypertension: Etiology and Treatment of a Dangerous Complication
Nicholas S Hill, Kari R Roberts, Ioana R Preston
Respiratory Care Jul 2009, 54 (7) 958-968;
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Keywords

  • postoperative pulmonary hypertension
  • surgery
  • acute right heart syndrome
  • lung transplantation
  • heart transplantation
  • thromboendarterectomy

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