title: Fluid therapy in critically ill patients: perspectives from the right heart.
abstract: As right heart function can affect outcome in the critically ill patient, a thorough understanding of factors determining right heart performance in health and disease is pivotal for the critical care physician. This review focuses on fluid therapy, which remains controversial in the setting of impending or overt right heart failure. In this context, we will attempt to elucidate which patients are likely to benefit from fluid administration and for which patients fluid therapy would likely be harmful. Following a general discussion of right heart function and failure, we specifically focus on important causes of right heart failure in the critically ill, i.e. sepsis induced myocardial dysfunction, the acute respiratory distress syndrome, acute pulmonary embolism and the effects of positive pressure ventilation. It is argued that fluid therapy should always be cautiously administered with the right heart in mind, which calls for close multimodal monitoring.
authors.affiliation: Department of Intensive Care Medicine, VU University Medical Center Amsterdam, Netherlands. p.elbers@vumc.nl.
authors.forename: Paul
authors.initials: P
authors.lastname: Elbers
authors.forename: Tim
authors.initials: T
authors.lastname: Rodrigus
authors.forename: Esther
authors.initials: E
authors.lastname: Nossent
authors.forename: Manu L N G
authors.initials: ML
authors.lastname: Malbrain
authors.forename: Anton
authors.initials: A
authors.lastname: Vonk-Noordegraaf
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D005440:Fluid Therapy; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D009200:Myocardial Contraction; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000628:therapy; D014655:Vascular Resistance
keywords: fluid therapy; intensive care; right heart failure