Diagnostic workup, etiologies and management of acute right ventricle failure: A state-of-the-art paper

Antoine Vieillard-Baron, R. Naeije, F. Haddad, H. J. Bogaard, T. M. Bull, N. Fletcher, Tim Lahm, S. Magder, S. Orde, G. Schmidt, M. R. Pinsky

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Introduction: 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. Results: 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 perfusion Conclusion: RV 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.

Original languageEnglish (US)
Pages (from-to)1-17
Number of pages17
JournalIntensive Care Medicine
DOIs
StateAccepted/In press - May 9 2018

Fingerprint

Heart Ventricles
Hemodynamics
Critical Illness
Echocardiography
Right Ventricular Function
Equipment and Supplies
Positive-Pressure Respiration
Treatment Failure
Cardiac Output
Stroke Volume
Shock
Ischemia
Perfusion
Pressure
Pharmaceutical Preparations
Therapeutics
Direction compound

Keywords

  • Critically ill patients
  • Echocardiography
  • Pulmonary hypertension
  • Right ventricle failure
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Vieillard-Baron, A., Naeije, R., Haddad, F., Bogaard, H. J., Bull, T. M., Fletcher, N., ... Pinsky, M. R. (Accepted/In press). Diagnostic workup, etiologies and management of acute right ventricle failure: A state-of-the-art paper. Intensive Care Medicine, 1-17. https://doi.org/10.1007/s00134-018-5172-2

Diagnostic workup, etiologies and management of acute right ventricle failure : A state-of-the-art paper. / Vieillard-Baron, Antoine; Naeije, R.; Haddad, F.; Bogaard, H. J.; Bull, T. M.; Fletcher, N.; Lahm, Tim; Magder, S.; Orde, S.; Schmidt, G.; Pinsky, M. R.

In: Intensive Care Medicine, 09.05.2018, p. 1-17.

Research output: Contribution to journalArticle

Vieillard-Baron, A, Naeije, R, Haddad, F, Bogaard, HJ, Bull, TM, Fletcher, N, Lahm, T, Magder, S, Orde, S, Schmidt, G & Pinsky, MR 2018, 'Diagnostic workup, etiologies and management of acute right ventricle failure: A state-of-the-art paper', Intensive Care Medicine, pp. 1-17. https://doi.org/10.1007/s00134-018-5172-2
Vieillard-Baron, Antoine ; Naeije, R. ; Haddad, F. ; Bogaard, H. J. ; Bull, T. M. ; Fletcher, N. ; Lahm, Tim ; Magder, S. ; Orde, S. ; Schmidt, G. ; Pinsky, M. R. / Diagnostic workup, etiologies and management of acute right ventricle failure : A state-of-the-art paper. In: Intensive Care Medicine. 2018 ; pp. 1-17.
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