Acute Right Ventricular Dysfunction in Intensive Care Unit

Table 5

Mechanisms and targeted management in specific clinical scenarios of acute RV failure.

Clinical scenario	Mechanism	Treatment
Right ventricular infarct	Decreased RV contractility	Early myocardial reperfusion (percutaneous coronary intervention, systemic thrombolysis)
Pulmonary embolism	Increase RV afterload (mechanical obstruction & vasoconstriction)	Systemic anticoagulation, systemic or catheter-directed thrombolysis, embolectomy
Decompensated PAH	Increase RV afterload	Parenteral prostanoids (with or without inhaled pulmonary vasodilators
ARDS	Increasing RV afterload/decreasing RV contractility	Limiting VT and PEEP, avoiding hypoxia, hypercapnia, and acidosis
Noncardiac surgery	Acute PH, decreasing RV contractility (RV infarct)	Pulmonary vasodilators, myocardial reperfusion, inotropic drugs
Cardiac surgery	Volume overload, myocardial ischaemia, preexisting RVD, arrhythmias	Diuretics, inotropic drugs, cardioversion, antiarrhythmic drugs

ARDS: acute respiratory distress syndrome; PAH: pulmonary arterial hypertension; RVD: right ventricular dysfunction.