Acute right ventricular dysfunction: real-time management with echocardiography.
In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.
Department of Anesthesia, University of Iowa, Iowa City, IA.
Sundar
S
Krishnan
Department of Internal Medicine, University of Iowa, Iowa City, IA. Electronic address: gregory-a-schmidt@uiowa.edu.
Gregory A
GA
Schmidt
D000208:Acute Disease; D016638:Critical Illness; D004452:Echocardiography; D005440:Fluid Therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D015995:Prevalence; D012121:Respiration, Artificial; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*