Management of acute right ventricular failure in the intensive care unit

Acute failure of the right ventricle is a common challenge in the intensive care unit that is associated with significant morbidity and mortality. Although often a complication of left ventricular failure, right ventricular failure is a distinct clinical entity, both in terms of its hemodynamic abnormalities and response to treatment. Effective management of right ventricular failure must consider the unique properties of the right ventricle and the pulmonary circulation, and their response to common pharmacologic and mechanical interventions. In this review, we present a contemporary approach to patients with acute failure of the right ventricle including strategies for mechanical ventilation, hemodynamic management, and mechanical circulatory support.