Links To And Excerpts From The IBCC Chapter, Right Ventricular failure due to pulmonary hypertension

In this post I link to and excerpt from The Internet Book Of Critical Care‘s [Link is to the IBCC Table of Contents] Chapter, IBCC – Right Ventricular failure due to pulmonary hypertension. September 4, 2021 by Dr. Josh Farkas:

Right ventricular failure is extremely common among critically ill patients (e.g., affecting a quarter of patients with ARDS).  Unfortunately, this is often overlooked in critical care curricula.  We tend to spend lots of time focusing on pulmonary arterial hypertension (which is far more rare), thereby overlooking the everyday conundrum of right ventricular failure.  It’s called “the forgotten ventricle” for a reason.

The good news is that you often don’t need to do anything exceedingly crazy for most of these patients (e.g., you don’t need to float a Swan in a quarter of all ARDS patients).  Some basic techniques to identify right ventricular failure and institute physiologically-based treatments will go a long way.  Recognition and management of this problem can transform may failed resuscitations into success stories.

All that follows is from the above IBCC chapter:

CONTENTS

• Rapid Reference 
• Caveat:  Lack of evidentiary support
• Background
  • RV failure & pulmonary hypertension:  Relationships & definitions
  • Pathophysiology of RV failure
• Causes of pulmonary hypertension
• Diagnosis
  • Diagnosis of RV failure
  • Echocardiography
  • Pulmonary artery catheterization
• Treatment
  • 1st Tier:  Core treatments for all RV failure patients:
    • Correct any precipitating factors
    • Optimize the lungs
    • Volume management
    • Establish an adequate MAP
  • 2nd Tier:  Often needed:  
    • Inhaled pulmonary vasodilators
    • Inotrope
  • 3rd Tier:
    • Additional therapies
    • Intubation
• Podcast
• Questions & discussion
• Pitfalls
• Supplemental media