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Optimizing Mechanical Ventilation in Right Heart Failure
Angela Phillips1, Gustavo A Cortes-Puentes1
1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
Clinics in Chest Medicine
|July 22, 2026
Summary
Right ventricular dysfunction (RVD) affects up to 30% of acute respiratory distress syndrome patients. This review details mechanical ventilation strategies to protect both lungs and the heart in these critically ill individuals.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Cardiology
Background:
- Right ventricular dysfunction (RVD) is a significant complication in acute respiratory distress syndrome (ARDS), with reported prevalence varying from 20% to 60%.
- Lung-protective ventilation strategies may be associated with a lower incidence of RVD.
- Understanding the interplay between mechanical ventilation and RVD is crucial for optimizing patient outcomes.
Purpose of the Study:
- To review the physiological principles of mechanical ventilation in the context of RVD.
- To provide a practical bedside approach for managing mechanical ventilation in ARDS patients with RVD.
- To emphasize the importance of dual lung and heart protection during mechanical ventilation.
Main Methods:
- Literature review focusing on physiological principles of mechanical ventilation and RVD.
- Synthesis of current evidence regarding ventilator strategies in ARDS with RVD.
- Development of a practical bedside management approach.
Main Results:
- Mechanical ventilation presents unique challenges in patients with RVD.
- Optimizing ventilatory support requires consideration of both pulmonary and cardiac function.
- Strategies should aim to minimize right ventricular afterload and optimize preload.
Conclusions:
- Mechanical ventilation in ARDS patients with RVD necessitates a tailored approach.
- Protecting both the lungs and the heart is paramount.
- A practical bedside strategy can guide optimal ventilatory support in this complex patient group.
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