Pulmonary Hypertensive Crisis/Acute RV Failure — free guideline decision tool
This tool outlines ICU management of pulmonary hypertensive crisis and acute right ventricular failure: optimizing RV preload and afterload, lowering pulmonary vascular resistance, and maintaining systemic perfusion.
Open guideline tool →Guideline-based
Implements the decision logic from published clinical guidelines.
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No installation. Enter the patient's values and get a guideline recommendation instantly.
Data stays local
Nothing is uploaded. Results are for licensed clinicians only.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Main problem | Hypotension/RV failure with low output |
|---|
→PH crisis managementSee management points
- Vasopressors (maintain SVR > PVR)：Norepinephrine first-line (raises PVR less than phenylephrine); low-dose vasopressin as adjunct (lowers PVR, avoid high dose); avoid phenylephrine (raises PVR); dopamine with caution (higher mortality)
- Inotropes：Dobutamine (low dose ≤ 5 μg/kg/min, lowers PVR; may cause tachycardia/hypotension, needs a vasopressor) or milrinone (PDE-3 inhibitor, pulmonary vasodilation but systemic hypotension, needs a vasopressor); levosimendan may be considered
- Lower pulmonary vascular resistance：Inhaled NO or inhaled epoprostenol/iloprost (selective, no systemic hypotension); for treatment-naïve severe PAH, IV epoprostenol first-line (used by PH specialists under monitoring)
Common questions
What is Pulmonary Hypertensive Crisis/Acute RV Failure?
This tool outlines ICU management of pulmonary hypertensive crisis and acute right ventricular failure: optimizing RV preload and afterload, lowering pulmonary vascular resistance, and maintaining systemic perfusion.
How is Pulmonary Hypertensive Crisis/Acute RV Failure calculated? What is the core formula?
Management by problem: hypotension (norepinephrine + dobutamine/milrinone, inhaled NO/epoprostenol); hypoxia/hypercapnia (correct triggers, lung-protective ventilation); arrhythmia (restore sinus rhythm, AV synchrony); peri-intubation (pre-start vasopressors, minimal sedation).
When is Pulmonary Hypertensive Crisis/Acute RV Failure used?
Use when a PH patient deteriorates with hypotension, hypoxia/hypercapnia, tachyarrhythmia, or impending intubation, to organize support around preserving the right ventricle and keeping SVR above PVR.
What are the key clinical points for Pulmonary Hypertensive Crisis/Acute RV Failure?
Keep RV preload appropriate, lower PVR, augment RV contractility, and maintain SVR > PVR to prevent RV ischemia; never abruptly stop home PAH-targeted therapy. (original synthesis · not guideline verbatim) Norepinephrine is the preferred vasopressor (raises PVR less than phenylephrine); inhaled NO or epoprostenol selectively lowers PVR without systemic hypotension. Intubation can precipitate sudden, hard-to-reverse collapse; for drug-refractory cases consider VA-ECMO as a bridge.
What are the limits and cautions when using Pulmonary Hypertensive Crisis/Acute RV Failure?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
How is Pulmonary Hypertensive Crisis/Acute RV Failure calculated in practice? Can you show a worked example?
Inputs: Main problem Hypotension/RV failure with low output → Result: PH crisis management See management points（Vasopressors (maintain SVR > PVR): Norepinephrine first-line (raises PVR less than phenylephrine); low-dose vasopressin as adjunct (lowers PVR, avoid high dose); avoid phenylephrine (raises PVR); dopamine with caution (higher mortality), Inotropes: Dobutamine (low dose ≤ 5 μg/kg/min, lowers PVR; may cause tachycardia/hypotension, needs a vasopressor) or milrinone (PDE-3 inhibitor, pulmonary vasodilation but systemic hypotension, needs a vasopressor); levosimendan may be considered, Lower pulmonary vascular resistance: Inhaled NO or inhaled epoprostenol/iloprost (selective, no systemic hypotension); for treatment-naïve severe PAH, IV epoprostenol first-line (used by PH specialists under monitoring)）
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This tool outlines ICU management of pulmonary hypertensive crisis and acute right ventricular failure: optimizing RV preload and afterload, lowering pulmonary vascular resistance, and maintaining systemic perfusion.
Open guideline tool →For licensed clinicians. Not a substitute for clinical judgement.
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