Pulmonary%20arterial%20hypertension Management

Management

Monitoring

A sustained response is considered when treated patients continue in World Health Organization (WHO) functional class I or II with near-normal hemodynamics after several month of treatment

Prevention

General Care

Maintenance of Intravascular Volume

Near-normal intravascular volume is important in the long-term management of idiopathic pulmonary arterial hypertension (IPAH)
- Sodium-restricted (<2400 mg/day) diet, fluid restriction and judicious use of diuretics reduces volume overload in patients with pulmonary hypertension (PH) and right ventricular hypertension

Monitor renal function and blood biochemistry in patients to avoid hypokalemia and the effects of decreased intravascular volume leading to pre-renal failure

Hemoglobin (Hb) Levels

PAH patients are extremely sensitive to decreases in hemoglobin (Hb) levels
- Anemias should be promptly treated

Phlebotomies should be done if hematocrit (Hct) >65% in symptomatic patients (headache, poor concentration)

Concomitant Medications

Avoid drugs that interfere with oral anticoagulants or increase risk of GI bleeding
Empiric use of angiotensin-converting enzyme (ACE) inhibitors or beta-blockers should be discouraged as this may result in hypotension and right heart failure

Prevention of Infection

Due to potentially devastating effects of respiratory tract infection in patients with pulmonary hypertension, immunization with influenza and pneumococcal vaccine is warranted
Respiratory tract infection should be treated aggressively

Follow Up

Ensure compliance of patients to their follow-up schedule, especially those belonging to WHO FC I
Follow-up visit at 3-6 months and 6-12 months after initial follow-up is advised
Baseline measurements of the following should be established during the initial follow-up, and in all patients showing signs of worsening clinical status:
- Medical history
- WHO-FC
- ECG
- 6MWT/Brog dyspnea score
- Basic blood exams (eg CBC, INR, serum creatinine, sodium, potassium, AST/ALT, bilirubin, BNP/NT-proBNP)
- CPET
- Echocardiography
- Specific laboratory tests (eg TSH, troponin, uric acid, iron levels)
- Blood gas analysis
- Right heart catheterization (RHC)
Patient’s medical history and functional class should be assessed using ECG, 6MWT/Borg dyspnea score and basic laboratory exams (eg CBC, INR, serum creatinine, sodium, potassium, AST/ALT, bilirubin, BNP/NT-proBNP levels) every follow-up visit of 3-6 months
CPET, echocardiography, specific laboratory tests (eg TSH, troponin, uric acid, iron levels), blood gas analysis, and RHC should be added at 6-12 months follow-up visit
At 3-6 months after every treatment adjustment, repeat evaluation of the patient’s complete medical history, functional class, ECG, 6MWT, echocardiography, basic blood tests, blood gas analysis and RHC are recommended

Management of MDROs in the ICU and the role of newer antimicrobial agents

Prof. David Paterson, 30 Mar 2021

Intensive care unit (ICU) patients are at risk of developing serious infections with multidrug-resistant organisms (MDROs), which require appropriate and adequate antibiotic coverage. Early empirical coverage is pivotal in saving patients’ lives. At a recent webinar co-organized by the Society of Infectious Disease (Singapore) and Pfizer, renowned Professor David Paterson, Professor of Medicine and Director, The University of Queensland Centre for Clinical Research, and Consultant Infectious Diseases Physician, Royal Brisbane and Women’s Hospital, Brisbane, Australia, discussed the role of newer antimicrobial agents, including ceftazidime-avibactam (Zavicefta) in the management of MDROs in the ICU. Dr Wong Sin Yew, Infectious Disease Physician at Gleneagles Medical Centre and Mount Elizabeth Novena Specialist Centre, Singapore, chaired the event.

Timely treatment of patients at risk for severe COVID-19 prevents severe outcomes

Dr. Asok Kurup, Dr. Alex Soriano, 31 Oct 2022

Despite widespread uptake of vaccinations, COVID-19 remains a serious health issue for high-risk patients, owing to the emergence of new variants of concern (VOCs), waning immunity, and breakthrough infections.

At a recent symposium in Singapore, esteemed experts Dr Asok Kurup, Consultant Infectious Diseases Physician at Mount Elizabeth Medical Centre, Singapore, and Dr Alex Soriano, Head of Infectious Diseases Department, Hospital Clínic of Barcelona and Assistant Professor, University of Barcelona, Spain, gave insights on the evolution of global trends since the start of the COVID-19 pandemic and discussed key challenges in managing high-risk patients with COVID-19 in the ICU. They also highlighted early treatment strategies to minimize the burden of COVID-19 on healthcare systems.

Mepolizumab: Targeting eosinophils in severe asthma with precision medicine

Pearl Toh, 16 Sep 2020

Mepolizumab, a first-in-class anti-IL-5* antibody, effectively prevents asthma exacerbations in patients with severe eosinophilic asthma (SEA), according to a presentation at the ERS 2020 Congress.