CLINICAL CARE IN THE FACE OF RIGHT HEART FAILURE:
The number of critically ill patients with significant PVD has increased
in the past 20 years and pediatric critical care physicians have
increasingly been involved in the care of these
patients.17 These patients appear to be a particularly
morbid subset of the overall ICU population. The use of inhaled nitric
oxide has expanded even as its expense has not been definitively been
addressed by the health care system. The use of systemic and inhaled
prostacyclin medications has increased during this same era. The correct
combination of targeted PH pharmacotherapeutic agents, vasopressors and
other medications is currently tailored to individual patients by
various institutional preferences and protocols. Randomized controlled
studies are rare to non-existent related in part to the small numbers of
patients in any given hospital and the heterogeneous nature of the
pediatric PH population.