Antoine Vieillard-Baron1,2, R Naeije3, F Haddad4, H J Bogaard5, T M Bull6, N Fletcher7, T Lahm8, S Magder9, S Orde10, G Schmidt11, M R Pinsky12. 1. Service de Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France. antoine.vieillard-baron@aphp.fr. 2. INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France. antoine.vieillard-baron@aphp.fr. 3. Professor Emeritus at the Université Libre de Bruxelles, Brussels, Belgium. 4. Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford, USA. 5. Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands. 6. Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. 7. Department of Cardiothoracic Critical Care, St Georges University Hospital NHS Trust, London, SW17 0QT, UK. 8. 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, USA. 9. Department of Critical Care, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada. 10. Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, NSW, Australia. 11. Department of Internal Medicine and Critical Care, University of Iowa, Iowa City, USA. 12. Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA.
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.
INTRODUCTION: This is a state-of-the-art article of the diagnostic process, etiologies and management of acute right ventricular (RV) failure in critically illpatients. 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.
Authors: B Sztrymf; R Souza; L Bertoletti; X Jaïs; O Sitbon; L C Price; G Simonneau; M Humbert Journal: Eur Respir J Date: 2009-11-06 Impact factor: 16.671
Authors: Lauren S Ranard; Justin A Fried; Marwah Abdalla; D Edmund Anstey; Raymond C Givens; Deepa Kumaraiah; Susheel K Kodali; Koji Takeda; Dimitrios Karmpaliotis; LeRoy E Rabbani; Gabriel Sayer; Ajay J Kirtane; Martin B Leon; Allan Schwartz; Nir Uriel; Amirali Masoumi Journal: Circ Heart Fail Date: 2020-06-05 Impact factor: 8.790
Authors: Sneha S Jain; Qi Liu; Jayant Raikhelkar; Justin Fried; Pierre Elias; Timothy J Poterucha; Ersilia M DeFilippis; Hannah Rosenblum; Elizabeth Y Wang; Bjorn Redfors; Kevin Clerkin; Jan M Griffin; Elaine Y Wan; Marwah Abdalla; Natalie A Bello; Rebecca T Hahn; Daichi Shimbo; Shepard D Weiner; Ajay J Kirtane; Susheel K Kodali; Daniel Burkhoff; LeRoy E Rabbani; Allan Schwartz; Martin B Leon; Shunichi Homma; Marco R Di Tullio; Gabriel Sayer; Nir Uriel; D Edmund Anstey Journal: J Am Soc Echocardiogr Date: 2020-06-17 Impact factor: 5.251