Pulmonary Hypertension - When pressure within the lungs become abnormally elevated. The mPAP is > the systemic BP. , Right to Left Shunt - Post ductal SATs are lower, Pulmonary Hypertensive Crisis - Sudden, acute rise in pulmonary vascular resistance, causing pressure overload of the RV and an increase in volume. Cardiac output is simultaneously decreased, and more blood is shunted away from the lungs, Cardiac ECHO - Non- invasive test used to evaluate the severity of PHTN, Oxygen - Too little can worsen PHTN, too much can augment over circulation by increasing the left to right shunt., Tachycardia - Impairs diastolic filling, leading to decreased cardiac output and coronary perfusion., Bradycardia - Leads to RV distension, decreasing LV preload and causes cardiac output to decrease further., High Airway Pressure - Impaired cardiac filling and output, particularly in the failing RV , Epinephrine - Used to increase the systemic BP, decreasing the difference between pulmonary and systemic pressures, leading to a decrease in shunting., O2 Sat goal - Pre-ductal O2 SATs 85-95% in patient with CDH, Target istat results - pCO2 50-65mm and pH > 7.25 in patient with CDH, Gentle Ventilation - PIP limited to < 25 cm H2O and pre ductal sats > 85%, Milrinone - Used to improve LV/RV function, Inhaled prostacyclin (Veletri) - Max dose is 100 ng/kg/min. Inhibits platelet aggregation. May not be used if patient on ECMO., Nursing Care - Minimize noxious stimuli, Enforce minimal stimulation practices, provide breaks as needed, maximize use of PRN medications,

PHTN Pathophysiology- NICU addition

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