Medical

Pulmonary hypertension crisis

Before / During / After / Pitfalls

Before

  • Intubation is high risk; avoid hypoxia, hypercarbia, acidosis, pain, and hypotension.
  • Call critical care/cardiology/anesthesia early and prepare vasopressor/inotrope/pulmonary vasodilator pathway per local practice.
  • Use the least destabilizing oxygenation strategy that works.

During

  • Gentle PPV and avoid excessive PEEP/high pressures.
  • Maintain systemic pressure to support RV perfusion.
  • Be prepared for peri-intubation arrest.

After

  • Ventilator strategy should protect RV: avoid hypoxia/hypercarbia/acidosis and unnecessary intrathoracic pressure.
  • Continue PH/RV therapies and advanced support planning.
  • Reassess EtCO₂, MAP, echo/POCUS if available.

Pitfalls

  • Treating like routine hypoxemic respiratory failure.
  • High PEEP/pressures worsening RV output.
  • Underestimating hypotension risk from induction.

Educational resource only. Use institutional protocols, local policy, and bedside clinical judgment.