Utility of Endoscopy in Hospitalized Patients with Gastrointestinal Hemorrhage and Pulmonary Hypertension

Singh, Amandeep; Siddiqui, Mohamed Tausif; Al-Yaman, Wael; Garg, Rajat; Jang, Sanguk; Chahal, Prabhleen; Vargo, John J.

doi:10.1007/s10620-020-06803-4

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…142 Further clinical predictors for GI bleeding in PH include older age, heart failure, and alcohol abuse. 143…”

Section: Gastrointestinal Emergenciesmentioning

confidence: 99%

“…142 Further clinical predictors for GI bleeding in PH include older age, heart failure, and alcohol abuse. 143 The management of GI bleeding follows similar principles to the management of hemoptysis, and, as in patients with preexisting PH, should mandate very close hemodynamic monitoring and prompt treatment. Small-volume GI bleeds can be treated with supportive care and reversal of precipitating factors, especially anticoagulation.…”

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

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Medical Emergencies in Pulmonary Hypertension

Seitler,

Dimopoulos,

Ernst

et al. 2023

Semin Respir Crit Care Med

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The management of acute medical emergencies in patients with pulmonary hypertension (PH) can be challenging. Patients with preexisting PH can rapidly deteriorate due to right ventricular decompensation when faced with acute physiological challenges that would usually be considered low-risk scenarios. This review considers the assessment and management of acute medical emergencies in patients with PH, encompassing both pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), acknowledging these comprise the more severe groups of PH. Management protocols are described in a systems-based approach. Respiratory emergencies include pulmonary embolism, airways disease, and pneumonia; cardiac emergencies including arrhythmia and chest pain with acute myocardial infarction are discussed, alongside PH-specific emergencies such as pulmonary artery dissection and extrinsic coronary artery compression by a dilated proximal pulmonary artery. Other emergencies including sepsis, severe gastroenteritis with dehydration, syncope, and liver failure are also considered. We propose management recommendations for medical emergencies based on available evidence, international guidelines, and expert consensus. We aim to provide advice to the specialist alongside the generalist, and emergency doctors, nurses, and acute physicians in nonspecialist centers. A multidisciplinary team approach is essential in the management of patients with PH, and communication with local and specialist PH centers is paramount. Close hemodynamic monitoring during medical emergencies in patients with preexisting PH is vital, with early referral to critical care recommended given the frequent deterioration and high mortality in this setting.

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“…142 Further clinical predictors for GI bleeding in PH include older age, heart failure, and alcohol abuse. 143…”

Section: Gastrointestinal Emergenciesmentioning

confidence: 99%

Section: Gastrointestinal Bleedingmentioning

confidence: 99%

Medical Emergencies in Pulmonary Hypertension

Seitler,

Dimopoulos,

Ernst

et al. 2023

Semin Respir Crit Care Med

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“…A U.S. coding study observed gastrointestinal (GI) hemorrhages in 3.2% of patients admitted in relation to PH with survival being worse in patients who did not undergo endoscopy. 64 A single-center study identified 74 GI endoscopies performed in PH patients over a 5-year period. 65 Thirty-seven patients underwent procedures (8 gastroscopy, 10 colonoscopy, 12 combined gastroscopy and colonoscopy, and 7 endoscopic retrograde cholangiopancreatography [ERCP]) with sedation (in 84% of cases) or GA.…”

Section: Pulmonary Hypertension and Surgerymentioning

confidence: 99%

Surgery and Anesthesia in Patients with Pulmonary Hypertension

Condliffe,

Newton,

Bauchmuller

et al. 2023

Semin Respir Crit Care Med

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Pulmonary hypertension is characterized by right ventricular impairment and a reduced ability to compensate for hemodynamic insults. Consequently, surgery can be challenging but is increasingly considered in view of available specific therapies and improved longer term survival. Optimal management requires a multidisciplinary patient-centered approach involving surgeons, anesthetists, pulmonary hypertension clinicians, and intensivists. The optimal pathway involves risk:benefit assessment for the proposed operation, optimization of pulmonary hypertension and any comorbidities, the appropriate anesthetic approach for the specific procedure and patient, and careful monitoring and management in the postoperative period. Where patients are carefully selected and meticulously managed, good outcomes can be achieved.

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