Management of right heart failure in the critically ill

Crit Care Clin. 2014 Jul;30(3):475-98. doi: 10.1016/j.ccc.2014.03.003.

Abstract

Right ventricular failure complicates several commonly encountered conditions in the intensive care unit. Right ventricular dilation and paradoxic movement of the interventricular septum on echocardiography establishes the diagnosis. Right heart catheterization is useful in establishing the specific cause and aids clinicians in management. Principles of treatment focus on reversal of the underlying cause, optimization of right ventricular preload and contractility, and reduction of right ventricular afterload. Mechanical support with right ventricular assist device or veno-arterial extracorporeal membrane oxygenation can be used in select patients who fail to improve with optimal medical therapy.

Keywords: Acute respiratory distress syndrome; Pulmonary hypertension; Right ventricular dysfunction; Right ventricular failure.

Publication types

  • Review

MeSH terms

  • Critical Care / methods*
  • Critical Illness / therapy*
  • Heart Failure / complications
  • Heart Failure / diagnosis*
  • Heart Failure / therapy*
  • Humans
  • Hypertension, Pulmonary / complications
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / therapy
  • Practice Guidelines as Topic
  • Respiratory Distress Syndrome / complications
  • Respiratory Distress Syndrome / diagnosis
  • Respiratory Distress Syndrome / therapy
  • Ventricular Dysfunction, Right / complications
  • Ventricular Dysfunction, Right / diagnosis*
  • Ventricular Dysfunction, Right / therapy*