Right ventricular function in the ICU 

Under normal conditions, the right ventricle (RV) virtually acts as a passive conduit. In critically-ill patients many situations induce uncoupling between the right ventricle and pulmonary circulation, leading to RV systolic dysfunction, then failure. Mechanical ventilation has a major impact by decreasing RV preload, but also significantly increasing RV afterload. RV function should thus always be interpreted and re-evaluated in the light of respiratory mechanics and ventilator settings. RV systolic function is key to the patient’s haemodynamic profile and must be monitored to achieve optimal haemodynamic management. Echocardiography is the best compromise between clinical effectiveness and invasiveness to monitor RV function. A limitation is its inability to monitor haemodynamics continuously. Acute cor pulmonale is defined by the combination of RV dilatation with paradoxical septal motion during systole. In conclusion, RV function monitoring is strongly recommended in many situations encountered in the intensive care unit, such as ARDS, septic shock, and pulmonary embolism. Many devices are available, but echocardiography constitutes the best compromise between accuracy and invasiveness.