Ventricular Arrhythmias During Bedside Pulmonary Artery Catheterization of the Critically Ill

Sprung, Charles L.; Jacobs, Lawrence J.; Caralis, Panagiota; Karpf, Michael; Eisler, Barry R.

doi:10.1097/00003246-198004000-00196

Cited by 1 publication

(1 citation statement)

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“…[103][104][105] Placement of a PAC is not without risks; it can induce arrhythmias, right bundle-branch block, complete heart block in patients with an existing left bundle-branch block, and, rarely, pulmonary arterial branch rupture during flow-directed advancement. [106][107][108] Of note, PA pressures will remain elevated in PH even when RV function, RAP, and cardiac index are optimized. Thus, PA pressures may not reflect that a patient with PAH has achieved low-risk status and poorly correlate with RV performance and perioperative risk if these other parameters have been optimized.…”

Section: Intraoperative Monitoringmentioning

confidence: 99%

Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association

Rajagopal¹,

Ruetzler²,

Ghadimi³

et al. 2023

Circulation

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Pulmonary hypertension, defined as an elevation in blood pressure in the pulmonary arteries, is associated with an increased risk of death. The prevalence of pulmonary hypertension is increasing, with an aging population, a rising prevalence of heart and lung disease, and improved pulmonary hypertension survival with targeted therapies. Patients with pulmonary hypertension frequently require noncardiac surgery, although pulmonary hypertension is associated with excess perioperative morbidity and death. This scientific statement provides guidance on the evaluation and management of pulmonary hypertension in patients undergoing noncardiac surgery. We advocate for a multistep process focused on (1) classification of pulmonary hypertension group to define the underlying pathology; (2) preoperative risk assessment that will guide surgical decision-making; (3) pulmonary hypertension optimization before surgery to reduce perioperative risk; (4) intraoperative management of pulmonary hypertension to avoid right ventricular dysfunction and to maintain cardiac output; and (5) postoperative management of pulmonary hypertension to ensure recovery from surgery. Last, this scientific statement highlights the paucity of evidence to support perioperative pulmonary hypertension management and identifies areas of uncertainty and opportunities for future investigation.

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