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Management of Pulmonary Hypertension and Right Heart Failure in the Intensive Care Unit

  • Pulmonary Hypertension (JR Klinger, Section Editor)
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Abstract

Management of acute right ventricular failure, both with and without coexisting pulmonary hypertension, is a common challenge encountered in the intensive care setting. Both right ventricular dysfunction and pulmonary hypertension portend a poor prognosis, regardless of the underlying cause and are associated with significant morbidity and mortality. The right ventricle is embryologically distinct from the left ventricle and has unique morphologic and functional properties. Management of right ventricular failure and pulmonary hypertension in the intensive care setting requires tailored hemodynamic management, pharmacotherapy, and often mechanical circulatory support. Unfortunately, our understanding of the management of right ventricular failure lags behind that of the left ventricle. In this review, we will explore the underlying pathophysiology of the failing right ventricle and pulmonary vasculature in patients with and without pulmonary hypertension and discuss management strategies based on evidence-based studies as well as our current understanding of the underlying physiology.

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Abbreviations

RV:

Right ventricle

LV:

Left ventricle

PH:

Pulmonary hypertension

ICU:

Intensive care unit

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Authors and Affiliations

  1. Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA

    Jonathan Grinstein & Mardi Gomberg-Maitland

  2. Section of Cardiology, University of Chicago Medical Center, 5841 S. Maryland Ave, MC 5403- L08, Chicago, IL, 60637, USA

    Mardi Gomberg-Maitland

  3. Section of Cardiology, University of Chicago Medical Center, 5841 S. Maryland Ave, MC 6080, Chicago, IL, 60637, USA

    Jonathan Grinstein

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Correspondence to Mardi Gomberg-Maitland.

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Conflict of Interest The University of Chicago receives research grant support from Actelion, Gilead, Novartis, Medtronic, Lung Biotechnology, and Reata for Dr. Gomberg-Maitland to be a principal investigator on research grants. Dr. Gomberg-Maitland has served as a consultant for Actelion, Bayer, Gilead, Medtronic, Merck, Bellerophon (formerly known as Ikaria), and United Therapeutics as a member of steering committees and DSMB/event committees. Jonathan Grinstein declares no conflict of interest.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

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Grinstein, J., Gomberg-Maitland, M. Management of Pulmonary Hypertension and Right Heart Failure in the Intensive Care Unit. Curr Hypertens Rep 17, 32 (2015). https://doi.org/10.1007/s11906-015-0547-z

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