Assessment of right ventricular function.

PURPOSE OF REVIEW

To emphasize the importance and clinical implications of right ventricular function assessment in many situations encountered by intensivists and to explain in practical terms how to perform such an assessment at the bedside.

RECENT FINDINGS

Assessment of right ventricular function requires a full understanding of the physiology of the right ventricle. The right ventricle, unlike the left ventricle, is sensitive to acute increases in its afterload. The right ventricle is usually dilated when its failure is the cause of shock. Three possible causes of right ventricular failure must be evaluated: decrease in contractility, pressure overload and volume overload. Many devices are available to assess right ventricular performance, but they are not equal in terms of accuracy and invasiveness. Although noncontinuous, echocardiography is probably the best device and this technique can also be employed by nonexpert intensivists. Two main signs must be sought: right ventricular dilatation and paradoxical septal motion.

SUMMARY

Assessment of right ventricular function in the ICU is crucial in many situations because right ventricular failure may be responsible for, or participate in, shock in pulmonary embolism, acute respiratory distress syndrome and septic shock. The best method is echocardiography, which is noninvasive and accurate.