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Right Ventricular Dysfunction in the Intensive Care Unit

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Acute Heart Failure

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Abstract

Assessing right ventricular (RV) function in acute conditions, such as circulatory and respiratory failure, is of great importance for hemodynamic monitoring and therapeutic adaptation (1, 2). Right ventricular function is responsible for the back-pressure of systemic venous return (3), and for the amount of blood that reaches the pulmonary circulation, which is one of the main determinants of left ventricular (LV) stroke volume (4). Right ventricular failure in septic shock may explain why blood volume expansion is unable to increase cardiac output (5). In certain conditions, such as massive pulmonary embolism (PE) and acute respiratory distress syndrome (ARDS), RV failure may be the main cause of shock, leading to specific therapeutic interventions such as thrombolysis or limitation of airway pressures. Before considering the main causes of RV dysfunction, it is essential to understand the specific features of RV physiology.

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References

  1. Vieillard-Baron A, Prin S, Chergui K, et al. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med 2002;166:1310–1319.

    Article  PubMed  Google Scholar 

  2. Vieillard-Baron A, Prin S, Chergui K, et al. Hemodynamic instability in sepsis: bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med 2003;168:1270–1276.

    Article  PubMed  Google Scholar 

  3. Guyton A, Lindsey A, Abernathy B, et al. Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol 1957;189:609–615.

    CAS  PubMed  Google Scholar 

  4. Milnor W, Jose A, McGaff C. Pulmonary vascular volume, resistance and compliance in man. Circulation 1960;22:130.

    CAS  PubMed  Google Scholar 

  5. Schneider A, Teule G, Groeneveld A, et al. Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study. Am Heart J 1988;116:103–112.

    Article  CAS  PubMed  Google Scholar 

  6. Laks M, Garner D, Swan H. Volumes and compliances measured simultaneously in the right and left ventricles of the dog. Circ Res 1967;20:565–569.

    CAS  PubMed  Google Scholar 

  7. Jardin F, Vieillard-Baron A. Right ventricular function and positive pressure ventilation in clinical practice: from hemodynamic subsets to respirator settings. Intensive Care Med 2003;29:1426–1434.

    Article  PubMed  Google Scholar 

  8. Jardin F, Brun-Ney D, Cazaux P, et al. Relation between transpulmonary isovolumetric pressure change during respiratory support. Cathet Cardiovasc Diagn 1989;16:215–220.

    Article  CAS  PubMed  Google Scholar 

  9. Morgan B, Guntherot W, Dillard D. Relationship of pericardial to pleural pressure during quiet respiration and cardiac tamponade. Circ Res 1965;16:493–498.

    CAS  PubMed  Google Scholar 

  10. Fessler H, Brower R, Wise R, Permutt S. Effects of positive end-expiratory pressure on the canine venous return curve. Am Rev Respir Dis 1992;146:4–10.

    CAS  PubMed  Google Scholar 

  11. Vieillard-Baron A, Augarde R, Prin S, et al. Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support. Anesthesiology 2001;95:1083–1088.

    Article  CAS  PubMed  Google Scholar 

  12. Whittenberger J, McGregor M, Berglund E, et al. Influence of state of inflation of the lung on pulmonary vascular resistance. J Appl Physiol 1960;15:878–882.

    CAS  PubMed  Google Scholar 

  13. West J, Dollery C, Naimark A. Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures. J Appl Physiol 1964;19:713–724.

    CAS  PubMed  Google Scholar 

  14. Vieillard-Baron A, Loubières A, Schmitt JM, et al. Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol 1999;87:1644–1650.

    CAS  PubMed  Google Scholar 

  15. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients. A critical analysis of the evidence. Chest 2002;121:2000–2008.

    Article  PubMed  Google Scholar 

  16. Barbier C, Loubières Y, Jardin F, et al. Author’s reply to the comment by Dr. Bendjelid. Intensive Care Med 2004;30:1848.

    Google Scholar 

  17. Vieillard-Baron A, Chergui K, Augarde R, et al. Cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography. Am J Respir Crit Care Med 2003;168:671–676.

    Article  PubMed  Google Scholar 

  18. Vieillard-Baron A, Chergui K, Rabiller A, et al. Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med 2004;30:1734–1739.

    PubMed  Google Scholar 

  19. Feissel M, Michard F, Faller JP, et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 2004;30:1834–1837.

    Article  PubMed  Google Scholar 

  20. Barbier C, Loubières Y, Schmit C, et al. Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 2004;30:1740–1746.

    PubMed  Google Scholar 

  21. Testa AG: Delle malattie del cuore: loro cagioni, specie, segni e cura. Nuova edition. Schieppati, Truffie Fusi, ed. Milano: 1831.

    Google Scholar 

  22. Vieillard-Baron A, Page B, Augarde R, et al. Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic pattern, clinical implications and recovery rate. Intensive Care Med 2001;27:1481–1486.

    Article  CAS  PubMed  Google Scholar 

  23. Vieillard-Baron A, Schmitt JM, Augarde R, et al. Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. Crit Care Med 2001;29:1551–1555.

    Article  CAS  PubMed  Google Scholar 

  24. Jardin F, Dubourg O, Bourdarias JP. Echocardiographic pattern of acute cor pulmonale. Chest 1997;111:209–217.

    Article  CAS  PubMed  Google Scholar 

  25. Weyman AE. Cross-Sectionnal Echocardiography. In: Lea & Febiger, ed. Philadelphia, PA: 1982:501–502.

    Google Scholar 

  26. Ryan T, Petrovic O, Dillon J, et al. An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol 1985;5:918–924.

    CAS  PubMed  Google Scholar 

  27. Zapol W, Snider M. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 1977;296:476–480.

    Article  CAS  PubMed  Google Scholar 

  28. Monchi M, Bellenfant F, Cariou A, et al. Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med 1998;158:1076–1081.

    CAS  PubMed  Google Scholar 

  29. Her C, Mandy S, Bairamian M. Increased pulmonary venous resistance contributes to increased pulmonary artery diastolic-pulmonary wedge pressure gradient in acute respiratory distress syndrome. Anesthesiology 2005;102:574–580.

    Article  PubMed  Google Scholar 

  30. Vieillard-Baron A, Jardin F. Why protect the right ventricle in patients with acute respiratory distress syndrome? Curr Opin Crit Care 2003;9:15–21.

    Article  PubMed  Google Scholar 

  31. Jardin F, Gueret P, Dubourg O, et al. Two-dimensional echocardiographic evaluation of right ventricular size and contractility in acute respiratory failure. Crit Care Med 1985;13:952–956.

    Article  CAS  PubMed  Google Scholar 

  32. Kimchi A, Ellrodt G, Berman D, et al. Right ventricular performance in septic shock: a combined radionuclide and hemodynamic study. J Am Coll Cardiol 1984;4:945–951.

    CAS  PubMed  Google Scholar 

  33. Jardin F, Brun-Ney D, Auvert B, et al. Sepsis-related cardiogenic shock. Crit Care Med 1990;110:402–409.

    Google Scholar 

  34. Groeneveld J, Berendsen R, Schneider A, et al. Effect of the mechanical ventilatory cycle on thermodilution right ventricular volumes and cardiac output. J Appl Physiol 2000;89:89–96.

    CAS  PubMed  Google Scholar 

  35. Hoeper M, Tongers J, Leppert A, et al. Evaluation of right ventricular performance with right ventricular ejection fraction thermodilution catheter and MRI in patients with pulmonary hypertension. Chest 2001;120:502–507.

    Article  CAS  PubMed  Google Scholar 

  36. Vieillard-Baron A, Schmitt JM, Beauchet A, et al. Early preload adaptation in septic shock? A transesophageal echocardiographic study. Anesthesiology 2001;94:400–406.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Intensive Care Unit, Ambroise Pare Hospital, Boulogne, France

    Vincent Caille MD, Cyril Charron MD & François Jardin MD

  2. Department of Cardiology, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France

    Antoine Leenhardt MD

Authors
  1. Vincent Caille MD
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  2. Cyril Charron MD
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  3. François Jardin MD
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  4. Antoine Leenhardt MD
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France

    Alexandre Mebazaa MD, PhD (Professor of Medicine) (Professor of Medicine)

  2. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Mihai Gheorghiade MD, FACC (Professor of Medicine and Surgery, Associate Chief, Division of Cardiology and Chief, Cardiology Clinical Service) (Professor of Medicine and Surgery, Associate Chief, Division of Cardiology and Chief, Cardiology Clinical Service)

  3. Department of Cardiology Centre d’Investigation Clinique (CIC), INSERM U-684, Centre Hospitalier Universitaire, University Henri Poincaré, Nancy, France

    Faiez M. Zannad MD, PhD, FESC (Professor of Medicine) (Professor of Medicine)

  4. Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Camden, NJ, USA

    Joseph E. Parrillo MD (Professor of Medicine, Chief, Department of Medicine Edward D. Viner MD Chair, Department of Medicine and Director) (Professor of Medicine, Chief, Department of Medicine Edward D. Viner MD Chair, Department of Medicine and Director)

  5. Cooper Heart Institute, Cooper University Hospital, Camden, NJ, USA

    Joseph E. Parrillo MD (Professor of Medicine, Chief, Department of Medicine Edward D. Viner MD Chair, Department of Medicine and Director) (Professor of Medicine, Chief, Department of Medicine Edward D. Viner MD Chair, Department of Medicine and Director)

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© 2008 Springer-Verlag London Limited

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Caille, V., Charron, C., Jardin, F., Leenhardt, A. (2008). Right Ventricular Dysfunction in the Intensive Care Unit. In: Mebazaa, A., Gheorghiade, M., Zannad, F.M., Parrillo, J.E. (eds) Acute Heart Failure. Springer, London. https://doi.org/10.1007/978-1-84628-782-4_22

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  • DOI: https://doi.org/10.1007/978-1-84628-782-4_22

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-781-7

  • Online ISBN: 978-1-84628-782-4

  • eBook Packages: MedicineMedicine (R0)

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