1. Optimize volume status: avoid filling (± offload) if RV volume-overloaded |
2. Augment CO |
3. Reduce PVR |
   a) Use pulmonary vasodilators (preferably inhaled: less systemic hypotension and V/Q mismatch) |
   b) Treat reversible factors that may increase PVR |
Metabolic state: correct anemia, acidosis, hypoxemia |
Treat respiratory failure: treat hypoxia; limit Pplat by using lung-protective ventilatory strategies, but beware of high pCO2 increasing PVR |
Reduce sympathetic overstimulation |
4. Maintain adequate systemic vascular resistance (SVR): keep PVR well below SVR; use pressors if necessary |