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.
