Acute Right Ventricular (RV) Failure in the ICU

  • Failure occurs when the RV fails to maintain enough perfusion through pulmonary circulation to achieve adequate left ventricular filling
  • This occur suddenly in a previously healthy heart (massive PE, right sided MI) or worsening of compensated RV failure in setting of chronic heart/lung disease
  • When RVEDP > LVEDP, septum flattens and ā€œDā€ shape is seen on cross section of ultrasound
  • Management:
    • Reverse the underlying cause and any condition that increase pulmonary vascular tone
    • Optimize right sided filling pressures and reduce after-load (i.e., elevated pulmonary pressures)
    • Use selective pulmonary vasodilators at doses that do not induce systemic hypotension and worsening of oxygenation
    • Use inotropic agents to help improve RV contractility enough to maintain cardiac output
    • Consider ECMO if all else fails while underlying cause of RV failure is being addressed


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