Hospital and intensive care unit management of decompensated pulmonary hypertension and right ventricular failure

Abstract

Pulmonary hypertension and concomitant right ventricular failure present a diagnostic and therapeutic challenge in the intensive care unit and have been associated with a high mortality. Significant co-morbidities and hemodynamic instability are often present, and routine critical care unit resuscitation may worsen hemodynamics and limit the chances of survival in patients with an already underlying poor prognosis. Right ventricular failure results from structural or functional processes that limit the right ventricle's ability to maintain adequate cardiac output. It is commonly seen as the result of left heart failure, acute pulmonary embolism, progression or decompensation of pulmonary hypertension, sepsis, acute lung injury, or in the perioperative setting. Prompt recognition of the underlying cause and institution of treatment with a thorough understanding of the elements necessary to optimize preload, cardiac contractility, enhance systemic arterial perfusion, and reduce right ventricular afterload are of paramount importance. Moreover, the emergence of previously uncommon entities in patients with pulmonary hypertension (pregnancy, sepsis, liver disease, etc.) and the availability of modern devices to provide support pose additional challenges that must be addressed with an in-depth knowledge of this disease.

Cardiac disorders in burn injury

“…Через 2 сут после ожога развивается тахикардия с повышением сердечного выброса (СВ), а в миокарде -выраженное воспаление благодаря β-адренергическому воздействию [8]. Снижение фракции выброса правого желудочка [9], наблюдаемое после эндотоксемии, может нивелироваться за счет блокады тромбоксана. Изначально после наблюдаемого увеличения общего сосудистого сопротивления в катаболическую фазу при системном воспалении и сепсисе наступает вазоплегия, что усугубляет кардиогенный и перераспределительный шок, приводя к мультиорганной недостаточности.…”

The overlooked chamber in coronavirus disease 2019

“…The treatment modalities of RHF include trigger removal, volume optimization, ventilator parameter modification, vasopressor and inotrope treatment, and mechanical circulatory support 26,27 . One should keep in mind that systemic vascular resistance should be greater than that in pulmonary vessels by administering systemic vasopressor such as noradrenaline and that RV afterload be reduced by pulmonary vasodilators including epoprostenol and nitrous oxide inhalant 13,28 . For the severe COVID‐19 patients with ARDS, right heart catheterization should be performed to evaluate and monitor right heart functions and haemodynamics.…”

Right Ventricular Failure

“…16 Newer RV assist devices (Impella RP, Abiomed; TandemHeart pVAD with Protek Duo cannula, CardiacAssist) have been used successfully to manage RV failure after RV infarction, cardiac surgery, LVAD implantation, and cardiac transplantation. 17 Refer to Figure 2 for examples of RV assist devices.…”