Acute Right Heart Failure in the ICU - Critical Care Canada

Acute Right Heart Failure in the ICU

Nicholas S. Hill MD Tufts Medical Center Boston, MA

Disclosures

Research Grants Actelion Bayer Genzyme Gilead National Institutes of Health Novartis Pfizer United Therapeutics

AcuteRightHeart Syndrome

IncreaseinRVafterload(orimpedance) precipitatingRVfailure RVdilates,contractilefunction deteriorates RightatrialandRVenddiastolic pressuresrise(>8mmHg) Cardiacoutputandsystemicblood pressurefall

Acute Right Heart Syndrome

in ICU: Precipitating events

Acute or acute on chronic pulmonary

embolism

Acute lung injury/ARDS/sepsis Heart, Lung, Liver Transplantation LV Failure, LV assist device Cardiac Surgery (valve replacement) Lung Resection Deteriorating Chronic Pulmonary Arterial

Hypertension

ARHSinALI/ARDS

Of502ptsinFACCT(FluidandCatheter Trial)ofARDSnet,73%hadtrans-pulmonary gradient(mPAP-PAW)>12mmHg

? BullTetal,AJRCCM2010

DecreaseinARDS-relatedcorpulmonalefrom 60%in1985to20%in2001associatedwith useoflowVT

? Vieillard-BaronAetal,CCM2001

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