Pilarczyk Kevin, Renner Jochen, Haake Nils
Klinik für Intensivmedizin, imland Klinik Rendsburg, Lilienstr. 22-28, 24768, Rendsburg, Deutschland.
Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
Med Klin Intensivmed Notfmed. 2019 Sep;114(6):567-588. doi: 10.1007/s00063-019-0603-6. Epub 2019 Aug 27.
Right ventricular heart failure is a frequent and serious but often undetected and complex clinical challenge on the intensive care unit. The commonest causes include acute decompensation of pulmonary hypertension, pulmonary embolism, sepsis, acute respiratory distress, and cardiothoracic surgery. The gold standard of bedside diagnosis is a combination of clinical symptoms, biochemical markers (NT-proBNP) and echocardiography. For the purposes of hemodynamic monitoring and treatment management, the indication to place a pulmonary artery catheter should be made generously. The major components of management include treating the underlying disease and triggering factors, reducing pulmonary vascular resistance, increasing contractility, volume optimization, and maintenance of adequate perfusion. Mechanical circulatory support should be considered before irreversible end-organ failure develops.
右心室心力衰竭是重症监护病房中常见且严重但常未被察觉且复杂的临床挑战。最常见的病因包括肺动脉高压急性失代偿、肺栓塞、脓毒症、急性呼吸窘迫和心胸外科手术。床旁诊断的金标准是临床症状、生化标志物（NT-proBNP）和超声心动图的综合。为了进行血流动力学监测和治疗管理，放置肺动脉导管的指征应放宽。治疗的主要内容包括治疗基础疾病和触发因素、降低肺血管阻力、增强心肌收缩力、优化血容量以及维持充足灌注。在不可逆的终末器官衰竭发生之前，应考虑机械循环支持。
