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RV dysfunction (therapies) (Volume (Advantages - effective as RV needs a…
RV dysfunction (therapies)
Volume
Advantages - effective as RV needs a higher filling pressure. A PA catheter may be useful in guiding volume therapy
Disadvantages - Determination of preload is problematic, RA pressure may be high in CRHF and may not be a predictor in volume response. Functional parameters of volume responsiveness not useful in RHF.
Inotropes and vasopressors
Advantages - may be of benefit in RV infarction where they may increase coronary perfusion pressure - some suggestion that levosimendan may improve RV afterload in ARDS
Disadvantage - no large scale published data on any specific inotrope or pressor in isolated RV failure
Afterload manipulation (control of hypoxia, hypercapnia and acidosis)
Advantage - reduce PA pressures
Disadvantage - optimal target levels unclear
Prostaglandins
Advantages - reduce pulmonary pressures
Disadvantages - May cause systemic hypotension, flushing
NO
Advantages - improves VQ matching and improves oxygenatin
Disadvantages - metHb, platelet dysfunction, requires special delivery systems, not shown to improve mortality
Bosentan
Advantages - reduce pulmonary pressures
Disadvantages - no large scale study
Phosphodiesterase inhibitor (sildenafil)
Advantages - reduce pulmonary pressures
Disadvantages - No large scale data
Pacing to improve A-V synchrony
Advantages - improves preload
Mechanical ventilation
Advantages - may improve oxygenation and C02 transfer and may reduce pulmonary HTN
Disadvantages - deleterious effects of IPPV