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LVADs and RV Failure
- Acute RV failure can be seen in up to 10% of patients after LVAD implantation.
- The treatment of RV failure in the LVAD patient consists of the following:
- Fluids: avoid aggressive fluid administration, as this can displace the septum and impair LVAD function
- Inotropes: consider early initiation of dobutamine, milrinone, or epinephrine to augment RV function
- Vasopressors: target a MAP higher than 60 to 70 mmHg to maintain RV perfusion pressure
- If intubated, avoid hypoxia, hypercarbia, high PEEP, and high ventilator pressures. These can increase pulmonary vascular resistance and further worsen RV function.
References
Sen A, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care 2016; 20:153.