Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI.
Division of Critical Care, Department of Internal Medicine, Stanford University, Palo Alto, CA; and.
J Cardiovasc Pharmacol. 2022 Jan 1;79(1):e11-e17. doi: 10.1097/FJC.0000000000001155.
Pulmonary arterial hypertension (PAH) is a rare and progressive cardiopulmonary disease, characterized by pulmonary vasculopathy. The disease can lead to increase pulmonary arterial pressures and eventual right ventricle failure due to elevated afterload. The prevalence of PAH in patients admitted to the intensive care unit (ICU) is unknown, and pulmonary hypertension (PH) in the ICU is more commonly the result of left heart disease or hypoxic lung injury (PH due to left heart disease and PH due to lung diseases and/or hypoxia, respectively), as opposed to PAH. Management of patients with PAH in the ICU is complex as it requires a careful balance to maintain perfusion while optimizing right-sided heart function. A comprehensive understanding of the underlying physiology and underlying hemodynamics is crucial for the management of this population. In this review, we summarized the evidence for use of vasopressors and inotropes in the management of PH and extrapolated the data to patients with PAH. We strongly believe that the understanding of the hemodynamic consequences of inotropes and vasopressors, especially from data in the PH population, can lead to better management of this complex patient population.
肺动脉高压（PAH）是一种罕见且进行性的心肺疾病，其特征为肺血管病变。由于后负荷增加，该疾病可导致肺动脉压升高，并最终导致右心衰竭。在重症监护病房（ICU）收治的患者中，PAH 的患病率尚不清楚，而 ICU 中的肺动脉高压（PH）更常见于左心疾病或低氧性肺损伤（分别为左心疾病相关 PH 和肺疾病/低氧相关 PH），而非 PAH。由于需要在维持灌注的同时优化右心功能，因此 ICU 中 PAH 患者的管理较为复杂。全面了解基础生理学和血流动力学对于此类人群的管理至关重要。在这篇综述中，我们总结了血管加压素和正性肌力药在 PH 管理中的应用证据，并将这些数据外推至 PAH 患者。我们坚信，对正性肌力药和血管加压药的血流动力学后果的理解，特别是从 PH 人群中的数据中获得的理解，可以导致对这一复杂患者群体的更好管理。
