Journal article
Diagnostic workup, etiologies and management of acute right ventricle failure: A state-of-the-art paper
Intensive care medicine, Vol.44(6), pp.774-790
06/2018
DOI: 10.1007/s00134-018-5172-2
PMID: 29744563
Abstract
This is a state-of-the-art article of the diagnostic process, etiologies and management of acute right ventricular (RV) failure in critically ill patients. It is based on a large review of previously published articles in the field, as well as the expertise of the authors.The authors propose the ten key points and directions for future research in the field. RV failure (RVF) is frequent in the ICU, magnified by the frequent need for positive pressure ventilation. While no universal definition of RVF is accepted, we propose that RVF may be defined as a state in which the right ventricle is unable to meet the demands for blood flow without excessive use of the Frank–Starling mechanism (i.e. increase in stroke volume associated with increased preload). Both echocardiography and hemodynamic monitoring play a central role in the evaluation of RVF in the ICU. Management of RVF includes treatment of the causes, respiratory optimization and hemodynamic support. The administration of fluids is potentially deleterious and unlikely to lead to improvement in cardiac output in the majority of cases. Vasopressors are needed in the setting of shock to restore the systemic pressure and avoid RV ischemia; inotropic drug or inodilator therapies may also be needed. In the most severe cases, recent mechanical circulatory support devices are proposed to unload the RV and improve organ perfusionRV function evaluation is key in the critically-ill patients for hemodynamic management, as fluid optimization, vasopressor strategy and respiratory support. RV failure may be diagnosed by the association of different devices and parameters, while echocardiography is crucial.
Details
- Title: Subtitle
- Diagnostic workup, etiologies and management of acute right ventricle failure: A state-of-the-art paper
- Creators
- Antoine Vieillard-Baron - INSERM U-1018, CESP, Team 5 University of Versailles Saint-Quentin en Yvelines Villejuif FranceR Naeije - 0000 0001 2348 0746 grid.4989.c Professor Emeritus at the Université Libre de Bruxelles Brussels BelgiumF Haddad - Division of Cardiovascular Medicine Stanford Cardiovascular Institute Stanford USAH Bogaard - 0000 0004 0435 165X grid.16872.3a Department of Pulmonary Medicine VU University Medical Center Amsterdam The NetherlandsT Bull - 0000 0001 0703 675X grid.430503.1 Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Anschutz Medical Campus Aurora CO USAN Fletcher - grid.264200.2 Department of Cardiothoracic Critical Care St Georges University Hospital NHS Trust London SW17 0QT UKT Lahm - 0000 0001 2287 3919 grid.257413.6 Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine Indiana University School of Medicine and Richard L. Roudebush VA Medical Center Indianapolis IN USAS Magder - 0000 0000 9064 4811 grid.63984.30 Department of Critical Care McGill University Health Centre 1001 Decarie Blvd Montreal QC H4A 3J1 CanadaS Orde - 0000 0004 0453 1183 grid.413243.3 Intensive Care Unit Nepean Hospital Kingswood Sydney NSW AustraliaG Schmidt - 0000 0004 1936 8294 grid.214572.7 Department of Internal Medicine and Critical Care University of Iowa Iowa City USAM Pinsky - 0000 0004 1936 9000 grid.21925.3d Department of Critical Care Medicine University of Pittsburgh Pittsburgh USA
- Resource Type
- Journal article
- Publication Details
- Intensive care medicine, Vol.44(6), pp.774-790
- DOI
- 10.1007/s00134-018-5172-2
- PMID
- 29744563
- NLM abbreviation
- Intensive Care Med
- ISSN
- 0342-4642
- eISSN
- 1432-1238
- Publisher
- Springer Berlin Heidelberg
- Language
- English
- Date published
- 06/2018
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984094724202771
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