Episode 54: The critically ill patient with pulmonary hypertension, with Ray Foley

In this episode of Critical Care Scenarios, Brandon Odo and Brian Bulling host Dr. Raymond Foley to discuss the complexities of managing a patient with pulmonary hypertension in the ICU. The conversation centers around a case of a 71-year-old female with a history of breast cancer, CTEF, COPD, HFPEF, and diabetes, who presents with pneumonia and sepsis. Dr. Foley emphasizes the importance of understanding the patient's baseline cardiopulmonary hemodynamics and tailoring treatment to avoid complications such as RV failure. The discussion covers various aspects of respiratory and hemodynamic support, including oxygenation strategies, vasopressor choices (vasopressin over norepinephrine), the use of pulmonary vasodilators (inhaled nitric oxide or epoprostanol), and when to consider inotropes or mechanical support like VA-ECMO. The panel also highlights the need to consider transferring patients to specialized PH centers for advanced interventions like CTEF surgery.