Intensive care management of right ventricular failure and pulmonary hypertension crises

Pediatr Pulmonol. 2021 Mar;56(3):636-648. doi: 10.1002/ppul.24776.


Pulmonary hypertension (PH), an often unrelenting disease that carries with it significant morbidity and mortality, affects not only the pulmonary vasculature but, in turn, the right ventricle as well. The survival of patients with PH is closely related to the right ventricular function. Therefore, having an understanding of how to manage right ventricular failure (RVF) and acute pulmonary hypertensive crises is imperative for clinicians who encounter these patients. This review addresses the management of these patients in detail, addressing: (a) the pathophysiology of RVF, (b) intensive care monitoring of these patients in the intensive care unit, (c) imaging of the right ventricle, (d) intubation and mechanical ventilation, (e) inotrope and vasopressor selection, (f) pulmonary vasodilator use, (g) interventional and surgical procedures for the acutely failing right ventricle, and (h) mechanical support for RVF.

Keywords: critical care; mechanical ventilation; pharmacology; pulmonary hypertension; pulmonary physiology; right ventricular failure.

Publication types

  • Review

MeSH terms

  • Biomarkers / metabolism
  • Capnography
  • Central Venous Pressure
  • Critical Care / methods*
  • Echocardiography
  • Epinephrine / therapeutic use
  • Epoprostenol / administration & dosage
  • Extracorporeal Membrane Oxygenation
  • Heart Failure
  • Heart Ventricles / physiopathology*
  • Humans
  • Hypertension, Pulmonary / therapy*
  • Iloprost / administration & dosage
  • Intensive Care Units
  • Milrinone / pharmacology
  • Nitric Oxide / administration & dosage
  • Radiography, Thoracic
  • Respiration, Artificial
  • Spectroscopy, Near-Infrared / methods
  • Vasodilator Agents / therapeutic use
  • Vasopressins / therapeutic use
  • Ventricular Dysfunction, Right / therapy*
  • Ventricular Function, Right / physiology*


  • Biomarkers
  • Vasodilator Agents
  • Vasopressins
  • Nitric Oxide
  • Epoprostenol
  • Iloprost
  • Milrinone
  • Epinephrine