Decompensated right heart failure, intensive care and perioperative management in patients with pulmonary hypertension: Updated recommendations from the Cologne Consensus Conference 2018

Abstract

In June 2016, members of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) met for a Consensus Conference in Cologne, Germany. Aim of this Conference was to compile consensus based practice recommendations based on the 2015 European Pulmonary Hypertension guidelines, aiming at their practical implementation, considering country-specific issues, and including new evidence, where available. This article summarizes the results and updated recommendations 2018 of the working group on decompensated right heart failure (RHF), intensive care and perioperative management in patients with pulmonary hypertension. The RHF section comprises definition and pathophysiology, diagnosis and monitoring, identification of triggering factors and supportive therapy of RHF, volume management as well as PAH targeting therapy, therapy with inotropic, inodilator and vasopressor drugs, extracorporeal support and transplantation. The second part of this article summarizes preoperative management, perioperative monitoring and choice of anesthesia.

Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension

“…RV: right ventricular; PAH: pulmonary arterial hypertension; NO: nitric oxide; ECMO: extracorporeal membrane oxygenation; ECLS: extracorporeal lung support. Reproduced and modified from [80] with permission.…”

“…RV: right ventricle; LV: left ventricle; RVEDP: right ventricular end-diastolic pressure; TR: tricuspid regurgitation; CO: cardiac output. Reproduced and modified from [80] with permission.…”

The right treatment for the right ventricle

“…Hence, these techniques are mainly applied in patients as a bridge to lung transplantation and when the patients’ response to optimal drug treatment is insufficient. In patients with RV failure the veno-arterial ECMO is primarily applied [27,28 ▪ ] and use in nonintubated patients is preferred. Implantable ventricular assist devices (VAD) in RV failure would be more suitable for long-term use.…”

Efficacy and safety of tetramethylpyrazine phosphate on pulmonary hypertension: study protocol for a randomized controlled study

“…[6] Although understanding of the pathophysiology and pathogenesis of PH has increased, and life quality of patients has improved significantly through the use of targeted drugs, however, combination therapy is more effective than mono-therapy, so it is important to find new drugs to improve efficacy. [7][8][9][10] In addition, the use of effective drugs is limited by their high cost, which largely restricts the PH patients from developing countries to afford economic burden of these treatments. Therefore, it is imperative to develop new and affordable medications with strong efficacy and safety profiles.…”