Patients with severe pulmonary hypertension have a poor prognosis. Those admitted to the ICU may have a higher mortality. Cardiopulmonary resuscitation is rarely effective in these patients. (HOEPER et al., AJRCCM VOL 165, 2002) Sedation may pose a significant risk for patients with severe pulmonary hypertension due to loss of sympathetic drive and preload. Our purpose was to address the outcome of patients admitted to the ICU with pulmonary hypertension not secondary to left ventricular failure who underwent endotracheal intubation.
Retrospective chart review (5 years) at The Ohio State University Medical Center of patients admitted to the ICU with pulmonary hypertension.
One hundred and twenty four patients with pulmonary hypertension who died were identified. Nine of these patients had normal left ventriclar function. Three of these patients died immediately following sedation with midazolam and endotracheal intubation for impending respiratory arrest.
Demographics of Patients Who Died Following Endotracheal IntubationAge/RaceSexSystolic Pulmonary Artery PressureCause of Pulmonary Hypertensiom44/CaucasianMale100 mmHg. (Echocardiogram)CREST51/CaucasianFemale73 mmHg(Swan Ganz)Rheumatoid Arthritis with Interstitial Lung Disease46/CaucasianMale89 mmHg (Echocardiogram)Hepatitis CCONCLUSIONS: Attempt at sedation and endotracheal intubation in patients with pulmonary hypertension may carry a high mortality. ICU admission may also be a poor prognostic indicator in this category of patients with pulmonary hypertension and normal left ventricular function.
Efforts to reduce this mortality may include use of drugs with less effects on circulation and preload reduction (such as etomidate). Nasotracheal intubation while the patient is awake may also prove to be an alternative measure in patients with pulmonary hypertension who have respiratory failure.
R. Tandon, None.