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

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