Echocardiographic assessment of critically ill patients with pulmonary hypertension

Managing critically ill patients with pulmonary arterial hypertension requires unique hemodynamic considerations. Traditional intensive care monitoring may fail to detect right ventricular failure or response to interventions. Additionally, invasive monitoring poses risks that may be avoided with noninvasive assessments. We review common stressors to right ventricular failure and invasive and noninvasive measures of hemodynamic function. This review also details some of the limitations and cognitive errors associated with echocardiographic measurements. Herein, we also review hemodynamic goals and common interventions for optimizing care in critically ill patients with pulmonary arterial hypertension. We propose an algorithm for the bedside clinician for monitoring these patients while adjusting interventions.