Abstract
In critically ill patients, acute right ventricular dysfunction can be secondary to either structural (pulmonary embolism, severe acute respiratory distress syndrome) or functional (mechanical ventilation) causes. In the presence of shock, the decision whether to administer fluids is tricky and depends on the mechanism of the right ventricular dysfunction. In cases of structural causes of right ventricular dysfunction, administration of fluids is potentially harmful. In the case of acute right ventricular dysfunction due to mechanical ventilation with positive end-expiratory pressure, administration of fluids might be beneficial, by reopening intra-alveolar microvessels, which were previously closed due to the effects of positive end-expiratory pressure. However, this fluid strategy is suitable only in the case of mechanical ventilation-induced right ventricular dysfunction. In patients with acute respiratory distress syndrome, structural and functional causes may coexist. In this context, it can be helpful to measure the changes in right ventricular function echocardiographic variables during passive leg raising, a maneuver that simulates in a reversible manner the effect of a fluid challenge.
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Gavelli, F., Monnet, X., Teboul, JL. (2020). Right Ventricular Dysfunction and Fluid Administration in Critically Ill Patients. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2020. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-37323-8_12
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DOI: https://doi.org/10.1007/978-3-030-37323-8_12
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