Right heart failure in the intensive care unit.
OBJECTIVE
This review summarizes the approach to and recent developments in the evaluation and treatment of acute right heart failure in the ICU. Right heart failure, defined as failure of the right ventricle to provide sufficient blood flow through the pulmonary circulation at normal central venous pressure, is a common problem caused by a combination of increased right-ventricular afterload and right-ventricular contractile dysfunction.


RESULTS
Management of acute right heart failure continues to be challenging because of insufficient understanding of its pathophysiology, a lack of guidelines, and few available tools. Recent research has contributed to an improved understanding of its mechanisms, helping to guide therapy and suggest future options. Right-ventricular assist devices are emerging as a promising approach to treatment when optimization of hemodynamics and conventional medical therapy fail.


CONCLUSIONS
Right heart failure causes venous congestion and systemic hypoperfusion. Once right heart failure is identified, the primary goal is to alleviate any reversible cause of excessive load or right-ventricular contractile failure. When the underlying abnormalities cannot be alleviated, trials of diuretic, vasodilator, or inotropic therapy may be required. Invasive monitoring helps guide therapy. Medically refractory right heart failure may potentially be treated with right-ventricular assist devices.
Department of Veterans Affairs Medical Center and the University of Colorado School of Medicine, Denver, Colorado 80220, USA. Clifford.Greyson@UCDenver.edu
Clifford R
CR
Greyson
D000208:Acute Disease; D002302:Cardiac Output; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D011652:Pulmonary Circulation; D011660:Pulmonary Heart Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology