Right Ventricular Failure in ICU
Summary
In 1616, Sir William Harvey was the first physician to realise the importance of the right ventricle (RV) and its interactions with the pulmonary circulation, yet up until the mid-20th century little emphasis had been placed on the RV. In recent times however there has been increased recognition of the role of RV function in many disease states. This has followed an increased understanding of the interactions of the pulmonary and systemic circulations, particularly in pathophysiological conditions. Additionally, the widespread treatment of patients with pulmonary hypertension and associated RV dysfunction, along with advances in management strategies with newer pulmonary vasodilators and the increasing role of extra-corporeal life support mean a new focus on the role of RV function in critically ill patients.
In this overview of the RV and intensive care, we will discuss the underlying normal anatomy and physiology of the RV, conditions associated with right ventricular failure (RVF), diagnosis and provide a systematic approach to managing the critically-ill patient with RVF.
General Information
Enrolled trainees 2345
Open 13.01.2020
Available for ESICM members
Student effort 3
Last Updated September 28, 2022
Intended Learning Outcomes
At the end of this course the student should be able to:
- Describe the epidemiology and importance of right ventricular failure in intensive care medicine
- Understand the normal anatomy and physiology of the right ventricle
- Understand the concepts of preload, afterload, coupling and ventricular interdependence in relation to the right ventricle.
- Describe the pathophysiology of the failing right ventricle
- Describe the variety of clinical conditions related to right ventricular failure in intensive care.
- Demonstrate the work up of a patient with right ventricular failure including clinical assessment and key investigations
- Describe a structured approach to management including attention to rate/rhythm, coronary perfusion, preload, contractility and afterload.
- Describe the indications and timings for short term mechanical circulatory support in acute right ventricular failure
- Describe the key features of mechanical circulatory support including TandemHeart, ImpellaRP and veno-arterial extracorporeal membrane oxygenation.
- Understand the role of long term mechanical support and heart transplantation
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilization of the acutely ill patient with disordered physiology
- 1.3 Manages the patient post-resuscitation
- 2.2 Undertakes timely and appropriate investigations
- 2.3a Performs and interprets focused transthoracic echocardiography
- 2.4 Performs electrocardiography (ECG / EKG) and interprets the results
- 2.9 Monitors and responds to trends in physiological variables
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions
- 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient
- 3.3 Recognises and manages the patient with circulatory failure
- 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
- 4.5 Describes the use of devices for circulatory or respiratory assist
- 5.17 Demonstrates a method for measuring cardiac output and derived haemodynamic variables
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