INVASIVE AND NONINVASIVE DIAGNOSIS OF PUL MONARY-HYPERTENSION IN THE INTENSIVE-CARE UNIT

The diagnosis of chronic primary and secondary pulmonary hypertension is difficult. Important indications result from physical examination a nd the patient's history. Non-invasive diagnostic tools are chest X-ra y, ECG, blood gas analysis and 2-D-Doppler-echocardiography. If, despi te these investigations, no reason for the pulmonary hypertension is f ound, perfusion scintigraphy of the lungs and a right-heart catheter i nvestigation should be performed. If there is no intracardiac shunting and perfusion scintigraphy of the lungs is normal, repeated pulmonary embolism must be excluded by pulmonary angiography. Only after elimin ation of this possibility can primary pulmonary hypertension be regard ed as the reason for the patient's condition. Pulmonary hypertension i s usually more acute in the critically ill patient. Under these circum stances, only direct pressure measurements are of clinical relevance. In the critical care setting, many of the non-invasive methods are eit her difficult to perform or hard to interpret. Furthermore, many of th e typical signs of pulmonary hypertension derived from non-invasive in vestigations do not appear in acute pulmonary hypertension.