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Diagnostic workup, etiologies and management of acute right ventricle failure:A state-of-the-art paper
- Source :
- Vieillard-Baron, A, Naeije, R, Haddad, F, Bogaard, H J, Bull, T M, Fletcher, N, Lahm, T, Magder, S, Orde, S, Schmidt, G & Pinsky, M R 2018, ' Diagnostic workup, etiologies and management of acute right ventricle failure : A state-of-the-art paper ', Intensive Care Medicine, vol. 44, no. 6, pp. 774-790 . https://doi.org/10.1007/s00134-018-5172-2
- Publication Year :
- 2018
-
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.
- Subjects :
- Adult
Male
Inotrope
Cardiac output
medicine.medical_specialty
Critical Illness
Heart Ventricles
Ventricular Dysfunction, Right
Hemodynamics
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
03 medical and health sciences
0302 clinical medicine
Anesthesiology
Internal medicine
medicine
Humans
Aged
Aged, 80 and over
business.industry
030208 emergency & critical care medicine
Stroke volume
Middle Aged
medicine.disease
Pulmonary hypertension
Preload
Shock (circulatory)
Cardiology
Female
medicine.symptom
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Vieillard-Baron, A, Naeije, R, Haddad, F, Bogaard, H J, Bull, T M, Fletcher, N, Lahm, T, Magder, S, Orde, S, Schmidt, G & Pinsky, M R 2018, ' Diagnostic workup, etiologies and management of acute right ventricle failure : A state-of-the-art paper ', Intensive Care Medicine, vol. 44, no. 6, pp. 774-790 . https://doi.org/10.1007/s00134-018-5172-2
- Accession number :
- edsair.doi.dedup.....52fb1cad3d94e9ca7a6d4132683761d5