Management of Right Heart Failure in the Critically Ill - 03/07/14

Doi : 10.1016/j.ccc.2014.03.003

Christopher King, MD ^a,^⁎ , Christopher W. May, MD ^b, Jeffrey Williams, MD ^c, Oksana A. Shlobin, MD ^d
^a Medical Critical Care Service, Inova Fairfax Hospital, 618 South Royal Street, Alexandria, VA 22314, USA
^b Advanced Heart Failure and Cardiac Transplant Program, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
^c Medical Critical Care Service, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
^d Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA

^∗Corresponding author.

Résumé

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.

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