Advances in the Management of Pediatric Acute Pulmonary Hypertension Crisis

Acute pulmonary hypertension complicates the course of diseases in Pediatric Intensive Care Units. Pulmonary hypertension is defined as mean pulmonary artery pressure > 25 mmHg in children > 3 month of age at sea level. Pulmonary arterial pressure = left arterial pressure + (pulmonary flow x pulmonary vascular resistance).The management of acute pulmonary hypertension in the Pediatric Intensive Care Unit is focused on the therapy to lower right ventricular afterload. These treatments should help maintain myocardial perfusion and sufficient cardiac output. The therapeutic goals include the prevention and treatment of active pulmonary vasoconstriction, the support of right ventricle function and treatment of the underlying disease.Acute pulmonary hypertensive crises are managed with sedation, pain control, alkalinization and oxygenation. Although theses methods have been mentioned as a part of the initial resuscitation strategy for neonatal sepsis, an aggressive hyperventilation and oxygenation can cause secondary lung injury in neonate with PPHN. Other treatments include endothelial based therapies, novel therapies such as endothelial nitric oxide synthase and smooth muscle based therapies. Reduction in right ventricular afterload, optimization of right ventricular volume, augmentation of right ventricular contractility, increase systemic vascular resistance and creation of right to left shunt are considered to improve cardiac output and support the right heart.

Keywords:

pulmonary hypertension , critical care , pediatric , management