title: Acute Right Ventricle Failure in the Intensive Care Unit: Assessment and Management.
abstract: Caring for the critically ill patient with acute right ventricle (RV) failure is a diagnostic and management challenge. A thorough understanding of normal RV anatomy and physiology is essential to manage RV failure. Despite the fact that the RV is essentially a volume chamber that ejects into a low-pressure system, the left ventricle contributes significantly to RV function through maintenance of the transseptal gradient (TSG). Preserving systemic mean arterial pressure maintains the TSG and RV perfusion. Various pathological states cause acute RV failure by decreasing the TSG and RV perfusion and/or increasing pulmonary vascular resistance. Early diagnosis prevents rapid progression of RV failure due to the "double hit phenomenon," which is acute intra-abdominal multiple organ system failure as a result of a reduced blood pressure and elevated central venous pressure. Management includes hemodynamic support and reversal of the precipitating cause through optimizing RV rate and rhythm, determining ideal RV filling pressure, reducing RV afterload through nonpharmacologic and pharmacological means, and selecting the appropriate RV inotrope or mechanical support.
authors.affiliation: Department of Internal Medicine, Section of Critical Care, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Carmen
authors.initials: C
authors.lastname: Hrymak
authors.affiliation: Department of Anesthesia and Perioperative Medicine, and Department of Internal Medicine, Section of Critical Care, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Johann
authors.initials: J
authors.lastname: Strumpher
authors.affiliation: Department of Anesthesia and Perioperative Medicine, and Department of Internal Medicine, Section of Critical Care, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: ejacobsohn@hsc.mb.ca.
authors.forename: Eric
authors.initials: E
authors.lastname: Jacobsohn
mesh_terms: D000208:Acute Disease; D019468:Disease Management; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D018570:Risk Assessment; D018497:Ventricular Dysfunction, Right / Q000628:therapy*