Key result
Stepwise, physiology-driven care using ultrasound, hemodynamics, and mechanical support guides acute RV failure management.
Provides intensivists with a practical, physiology-driven bedside framework for diagnosing and managing acute right ventricular failure, including timely escalation to mechanical circulatory support.
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May guide ICU management of acute right ventricular failure; leaves open the need for prospective validation.
Right ventricular failure (RVF) is a high-mortality form of cardiogenic shock frequently encountered in critical illness and is often underrecognized due to its heterogeneous presentation. This article presents a physiology-driven, stepwise approach to the diagnosis and management of acute RVF using a longitudinal case in the intensive care unit. We highlight practical bedside tools for recognition, including point-of-care ultrasound and invasive hemodynamics, and review targeted strategies for preload optimization, afterload reduction, and contractility support. Special emphasis is placed on airway management, vasoactive medications, and timely escalation to mechanical circulatory support (MCS) in appropriately selected patients. This bedside "How I Do It" guide is written for intensivists and pulmonary/critical care clinicians and translates advanced hemodynamic and device concepts into practical decision points for acute care management.
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SRIDHAR et al. (2026) conducted a review in Acute right ventricular failure (RVF). Physiology-driven, stepwise management including preload optimization, afterload reduction, contractility support, and mechanical circulatory support (MCS) was evaluated. A physiology-driven, stepwise approach using bedside ultrasound, invasive hemodynamics, and timely mechanical circulatory support guides acute right ventricular failure management in the ICU.
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