Pulmonary Hypertension and Cor Pulmonale

Abstract Summary Intensive care management of pulmonary hypertension (PH) and acute cor pulmonale or right ventricular (RV) failure can be challenging, with the high risk of pulmonary hypertensive crises, cardiovascular collapse, and associated high mortality. Indeed, the presence of PH and RV dysfunction predicts mortality in patients with pre-existing PH, as well as acute respiratory distress syndrome, acute pulmonary embolism, and following surgical procedures (including certain cardiothoracic procedures and surgery in patients with pre-existing PH). The key to managing PH in the intensive care unit setting is early recognition and prevention of RV failure. Patients with chronic PH should have elective interventions carefully planned, with provision for management of PH crises in experienced centres. Management of acute PH and RV dysfunction often lies outside a clear evidence base and is based on physiological principles, with novel interventions including the impact of extracorporeal circuits such as extracorporeal membrane oxygenation considered in this chapter.