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Abstract
Pulmonary hypertension is a rare and progressive pathology defined by abnormally high pulmonary artery pressure mediated by a diverse range of aetiologies. It affects up to twenty-six individuals per one million patients currently living in the United Kingdom (UK), with a median life expectancy of 2.8 years in idiopathic pulmonary hypertension. The diagnosis of pulmonary hypertension is often delayed due to the presentation of non-specific symptoms, leading to a delay in referral to specialists services. The complexity of treatment necessitates a multidisciplinary approach, underpinned by a diverse disease aetiology from managing the underlying disease process to novel specialist treatments. This has led to the formation of dedicated specialist treatment centres within centralised UK cities. The article aimed to provide a concise overview of pulmonary hypertension’s clinical perioperative management, including key definitions, epidemiology, pathophysiology, and risk stratification.
Highlights
Pulmonary hypertension (PH) remains a common comorbid condition in patients presenting for surgery [1]
The severity of PH is classically characterised by pulmonary artery pressure from mild (20-40mmHg) to severe (>55mmHg) (Table 1)
Perioperative risk factors associated with elevated pulmonary pressure include; increased sympathetic tone, hypoxic, fluid overload, acidosis, lung injury, embolisation and left ventricular (LV) systolic and diastolic dysfunction
Summary
Pulmonary hypertension (PH) remains a common comorbid condition in patients presenting for surgery [1]. In group 4 disease, chronic pulmonary emboli lead to localised scarring and restrictive lung volume with impaired DLCO from fibrosis and reduced regional blood flow [38]. Causes of an elevated pulmonary artery pressure include volume overload states (i.e. heart failure, chronic kidney and liver disease), lung disease (i.e. acute and chronic), sleep disorders (i.e. obstructive sleep apnoea), left-sided heart disease, high cardiac output states (i.e. hyperthyroidism), hypertension and obesity.
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Schedule a callMore From: Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures)
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