Right Ventricular Hemodynamics in the Acute Respiratory Distress Syndrome: Monitoring and Implications for Clinical Management

Right ventricular injury (including right ventricular dilatation/dysfunction/limitation/failure) and pulmonary vascular dysfunction are common in patients with acute respiratory distress syndrome. Despite increasing recognition, right ventricular injury is associated with increased mortality in patients with the acute respiratory distress syndrome and implementation of multi-modal monitoring and timely right ventricle-targeted interventions may therefore confer outcome benefit. The aim of this narrative review is to explore the clinical applications of diagnostic modalities for the right ventricle and pulmonary circulation in invasively ventilated patients with the acute respiratory distress syndrome, including the complementary roles of invasive hemodynamics, echocardiography, and pulmonary monitoring. Then, we discuss the physiologic basis and utility of right ventricle and pulmonary monitoring to guide the bedside intensivist in personalizing therapies aimed at protecting the right ventricle. Building upon previous work which focused on the principles and terminology of abnormal right ventriclular biomechanics in critical illness, this review is centred on monitoring of right ventricular pathophysiology in the acute respiratory distress syndrome and implications for bedside management.