Meticulous risk stratification is essential when considering intubation of a patient with decompensated pulmonary hypertension (dPH). It is paramount to understand both the pathophysiology of dPH (and associated right ventricular failure) and the complications related to a high-risk intubation before attempting the procedure. There are few recommendations in this area and the literature, guiding these recommendations, is limited to expert opinion and very few case reports/case series. This review will discuss the complex pathophysiology of dPH, the complications associated with intubation, the debates surrounding induction agents, and the available options for the intubation procedure, with specific emphasis on the emerging role for awake fiberoptic intubation. All patients should be evaluated for candidacy for veno-arterial extracorporeal membrane oxygen as a bridge to recovery, lung transplantation, or pulmonary endarterectomy prior to intubation. Only an experienced proceduralist who is both comfortable with high-risk intubations and the pathophysiology of dPH should perform these intubations.

在考虑对失代偿性肺动脉高压 (dPH) 患者进行插管时，必须进行细致的风险分层。在尝试手术之前，了解 dPH 的病理生理学（和相关的右心室衰竭）以及与高风险插管相关的并发症至关重要。这方面的建议很少，指导这些建议的文献仅限于专家意见和很少的病例报告/病例系列。这篇综述将讨论 dPH 的复杂病理生理学、插管相关的并发症、围绕诱导剂的争论以及插管程序的可用选择，特别强调清醒光纤插管的新兴作用。在插管前，应评估所有患者是否有资格接受静脉-动脉体外膜氧作为恢复、肺移植或肺动脉内膜切除术的桥梁。只有既熟悉高风险插管又熟悉 dPH 病理生理学的经验丰富的操作人员才能进行这些插管。