Right ventricular failure in the intensive care unit: Mechanisms and medical therapy

Right ventricular (RV) failure is frequently encountered in the intensive care unit. This clinical syndrome may be difficult to diagnose and treat. RV failure is commonly characterised by oedema, elevated jugular venous pressure, hypotension and in worse cases shock or multi-organ failure. High-risk patients include those with cardiac surgery, ARDS, ischaemia (inferior infarction, RV involvement), recent myocardial infarction, pulmonary hypertension and patients with congenital heart disease. Besides supportive treatment, medical therapies are available that are targeted to RV failure including inotropic and vasodilatory agents. Mechanical and surgical therapy of RV failure is beyond the scope of this article. Larger prospective studies are needed to determine optimal diagnostic and medical therapy for patients with RV failure in the intensive care unit.