دانلود رایگان مقاله انگلیسی اختلال حاد در بطن راست در بخش مراقبت های ویژه - هینداوی 2017

The role of the left ventricle in ICU patients with circulatory shock has long been considered. However, acute right ventricle (RV) dysfunction causes and aggravates many common critical diseases (acute respiratory distress syndrome, pulmonary embolism, acute myocardial infarction, and postoperative cardiac surgery). Several supportive therapies, including mechanical ventilation and fluid management, can make RV dysfunction worse, potentially exacerbating shock. We briefly review the epidemiology, pathophysiology, diagnosis, and recommendations to guide management of acute RV dysfunction in ICU patients. Our aim is to clarify the complex effects of mechanical ventilation, fluid therapy, vasoactive drug infusions, and other therapies to resuscitate the critical patient optimally.

6. Conclusions

Acute RVD/RVF is seen with increasing frequency in the intensive care unit and causes or aggravates many common critical diseases.

Bedside echocardiography assessment and invasive hemodynamic monitoring remain the most valuable methods to diagnose and to guide a rationale therapy of acute RVD/ RVF in critically ill patients.

General precautionary measures, early diagnosis of RVD, and etiology-specific therapy may reduce the appearance of RVF. Supportive therapies focused on improving RV function via optimization of preload, enhancing contractility, and reducing afterload are the key principles in the management of acute RVF.

Future research should focus on better understanding the cellular and molecular mechanisms of acute RV cardiac dysfunction to develop novel therapies that directly target the injured myocardium.