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Hypotension in the PAH Patient
- Hypotension in the critically ill patient with pulmonary arterial hypertension (PAH) must be rapidly treated to avoid cardiovascular collapse.
- Hypotension in the PAH patient is not always due to hypovolemia. In fact, excessive volume loading may further decrease LV stroke volume. Consider starting with a fluid bolus of 250 ml of an isotonic crystalloid solution and monitoring response.
- Patients with severe PAH may present to the ED with a continuous flow pump of a pulmonary vasodilator (epoprostenol, treprostinil). These medications can also cause hypotension at excessive doses. Consider decreasing the rate of the infusion by 25% to see if overdosing is the cause.
References
Rubenfire M, Bayram M, Hector-Wood Z. Pulmonary hypertension in the critical care setting: classification, pathophysiology, diagnosis, and management. Crit Care Clin 2007;23: 801-834.