Outline the key issues in the management of acute right ventricular failure in an ICU patient with moderate to severe pulmonary hypertension.
|Goal / Principle||Additional detail to be provided|
|Treat triggering factors||Infection, anaemia, arrhythmias, comorbidities, PE,
|Maintain oxygenation||Supplemental Oxygen to maintain sats >90%
Avoid Intubation if possible.
Consider Echo +/ - PA Catheter risks
|ECG, Arterial line, Oxygen Sats, CVP,
Echocardiography vs PA Catheter
Kidney function: Urine Catheter, Serum Creatinine,
Liver congestion: AST, ALT, Bilirubin, Lactate
|Optimise fluid balance||Fluids if hypovolaemia is present , diuretics if excess fluid is
|Reduce RV afterload||IV Prostanoids: Epoprostinil, iloprost
IV or Oral PDE-5 inhibitors (sildenafil)
Inhaled vasodilators (nitric oxide)
Endothelin receptor antagonists (ERAs) eg bosantan
|Optimise Cardiac output||Milrinone, Levosimendan,|
|Norepinephrine or Vasopressin|
|Liaison with Pulmonary
|Surgical options: Pulmonary thrombendarterectomy /
balloon atrial septostomy / ECMO / Ventricular assist device /
Heart/lung transplant / Palliation
Candidates who scored well showed an in-depth understanding of the applied physiology and consequences of the various therapeutic options. Candidates who scored poorly omitted key points.