重症监护病房右心室功能评估.pdfVIP

33 Evaluation of Right Ventricular Function in the Intensive Care Unit by Echocardiography MICHEL SLAMA | JULIEN MAIZEL | YAZINE MAHJOUB | SHARI EL-DASH (CONSULTANT-LEVEL EXAMINATION) normally contributes 25% of RV contraction, whi ay Overview be reased up to 35% in patients with pulmonary hyper- Assessment of right ventricular (RV) function is a key ele- tension.7,8 The right ventricle is very sensitive to coronary ment in the hemodynamic evaluation of patients in the in- flow and is perfused, unlike the LV, during both systole and tensive care unit (ICU) with shock or respiratory failure.1,2 diastole.9 For several decades the former was considered to y a mi- nor role in hemodynamic failure. However, RV dysfunction may be a crucial element in the hemodynamic compromise that intensivists encounter in various clinical scenarios such as pulmonary embolism (PE), sepsis and septic shock, myo- cardial infarction, and acute respiratory distress syndrome (ARDS).3-5 The right ventricle is highly sensitive to changes in preload and afterload and, unlike the left ventricle (LV), may become acu y enlarged. A pulmonary artery catheter can be used to estimate right atrial pressure (RAP), pulmo- nary arterial pressure (PAP) and , and cardiac out- put. In recent years, echocardiography has progressively re ced the former in the ICU. Ech