Right heart failure in the intensive care unit

Area of Science:

• Critical Care Medicine
• Cardiology
• Pulmonary Hypertension

Background:

• Acute right heart failure (RV failure) is a common ICU complication.
• It stems from increased RV afterload and/or RV contractile dysfunction.
• RV failure leads to venous congestion and systemic hypoperfusion.

Purpose of the Study:

• To review current approaches to evaluating and treating acute RV failure in the ICU.
• To highlight recent advancements in understanding RV failure pathophysiology.
• To discuss emerging therapeutic strategies for RV failure.

Main Methods:

• Literature review of recent research on RV failure.
• Analysis of current clinical management strategies.
• Evaluation of novel treatment options, including mechanical support.

Main Results:

• RV failure management remains challenging due to limited understanding and guidelines.
• Recent research has improved understanding of RV failure mechanisms.
• Right-ventricular assist devices (RVADs) show promise for refractory cases.

Conclusions:

• Primary goal is to address reversible causes of RV afterload or dysfunction.
• Diuretic, vasodilator, and inotropic therapies may be necessary.
• RVADs represent a potential treatment for medically refractory RV failure.