Monitoring of right-sided heart function

Abstract

Because the right side of the heart supplies blood to the pulmonary circulation, its integrity is required for both adequate respiratory and circulatory function. By reducing pulmonary perfusion, right-sided heart failure may compromise arterial oxygenation and left ventricular filling, and monitoring of right-sided heart function at the bedside in critically ill patients is fundamental. Two recent clinical commentaries have focused on the invaluable help provided by echocardiography for this purpose. Bedside echocardiography has supplanted invasive procedures as the best tool to evaluate right-sided heart function. Although not recent, this technique, previously reserved for cardiologists, has recently gained a larger acceptance in respiratory intensive care units. Echocardiographic examination detects excessive right ventricular afterload, visualized by septal dyskinesia, and its usual consequence, right ventricular enlargement, which impairs left ventricular filling. Monitoring of right-sided heart function is essential in a clinical setting associated with hemodynamic instability, such as severe sepsis or acute coronary artery obstruction, and also in that it is associated with increased pulmonary vascular resistance, as in massive pulmonary embolism or acute respiratory failure. Moreover, use of mechanical ventilation requires regular evaluation of its effects on the right side of the heart.