Pulmonary vasodilators (PV) are commonly used in the intensive care unit (ICU) to treat pulmonary hypertension and/or hypoxaemia. The choice of drug is based on its pharmacokinetic and pharmacodynamic properties. The inhaled route of administration is preferred to treat hypoxaemia as it improves the ventilation/perfusion ratio. Systemic administration of PVs can lead to a decrease of mean arterial pressure and a worsening of hypoxaemia. Despite their beneficial effects, PVs have not shown improvement in mortality in acute respiratory distress syndrome patients. Rebound of hypoxaemia and/or pulmonary arterial hypertension should be prevented during PV treatment discontinuation with a slow de-escalation protocol. This chapter reviews the use of the main PV available for use in the ICU.
