1
Q
pHTN Definition
A
Normal pulm pressures 25/10, mean 15
Mean > 25 at rest
Mean > 30 while exercising
HTN Crisis - Near systemic or suprasystemic with sever right heart failure
2
Q
pHTN Classification
A
- Pulmonary artery htn
- PHTN with left heart failure
- PHTN with lung disease and hypoxemia
- PHTN secondary to chronic thrombotic events or embolic disease
- Misc
3
Q
R=delta P/ flow
A
4
Q
How do you treat pHTN Crisis?
A
- 100% FiO2
- Alkalosis
- Bicarb
- Hyperventilate (decrease PaCO2)
- Decreased PVR
- FRC, lung volumes
- Sedation
- Support RV (support LV, preload)
- Avoid pulm vasoconstrictors
5
Q
A
6
Q
Single Ventricle
Description?
Goal?
A
- Aortic and pulm artery saturations are approximately equal
- Goal -> achieve balance between puml and systemic circulations
- Qp=Qs
- Qp=CO to pulm circulation
- Qs=CO to systemic circulation
- Total CO shared between pulm and systemic circulations
- Qp:Qs determined by SVR and PVR
- High Qp:Qs low systemic O2 delivery
7
Q
Single Ventricle Management
A
- Optimize DO2 without increase in SaO2
- Goal Qp:Qs 0.5-1
- Increase CO = increase DO2
Ex Qp:Qs 2:1 -> pumping 3 COs
8
Q
Resistance to Pulm BF
A
- Valvular and subvalvular PS
- Pum arteriolar R (PVR)
- Pulm venous and LA Pressure
- AV valve restrictions
9
Q
Resistance to Systemic BF
A
- Presence of anatomic obstructive lesions:
- Aortic stenosis
- Arch hypoplasia/ Coarc
- Subaortic obstruction
- SVR
10
Q
How to increase Qs?
A
- Reduce SVR
- sedation - decrease sympathetic output
- nipride - venous and arteriolar vasodilation
- milrinone
- alpha blockers
- Increase DO2 via increase CO
11
Q
How to decrease Qp?
A
- Increase PVR
- PEEP -> increased lung volumes –> increase PVR
- Increase pCO2 -> hypovent, bleed 2-5% CO2
- Decrease pH-> acidosis
- Decrease fiO2
12
Q
pHTN Pathophysiology
A
13
Q
A
PICU Concepts
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