Document Detail


Management of Acute Right Ventricular Failure in the Intensive Care Unit.
MedLine Citation:
PMID:  24828526     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Right ventricular failure occurs when the right ventricle fails to maintain enough blood flow through the pulmonary circulation to achieve adequate left ventricular filling. This can occur suddenly in a previously healthy heart due to massive pulmonary embolism or right sided myocardial infarction, but many cases encountered in the intensive care unit involve worsening of compensated RV failure in the setting of chronic heart and lung disease. Management of right ventricular failure is directed at maximizing right sided filling pressures and reducing afterload. Due to a lower level of vascular tone, vasoactive medications have less salient effects on reducing vascular resistance in the pulmonary than in the systemic circulation. Successful management requires reversal of any conditions that heighten pulmonary vascular tone and the use of selective pulmonary vasodilators at doses that do not induce systemic hypotension or worsening of oxygenation. Systemic systolic arterial pressure should be kept close to right ventricular systolic pressure to maintain right ventricular perfusion. When these efforts fail, the judicious use of inotropic agents my help improve right ventricular contractility enough to maintain cardiac output. Extracorporeal life support is increasingly being used to support patients with acute right ventricular failure who fail to respond to medical management while the underlying cause of their right ventricular failure is addressed.
Authors:
Corey E Ventetuolo; James R Klinger
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-5-14
Journal Detail:
Title:  Annals of the American Thoracic Society     Volume:  -     ISSN:  2325-6621     ISO Abbreviation:  Ann Am Thorac Soc     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-5-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101600811     Medline TA:  Ann Am Thorac Soc     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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