The role of the right ventricle in determining cardiac output in the critically ill

Abstract

Assessment and management of cardiovascular homeostasis represent a cornerstone in the teaching and practice of critical care medicine. Indeed, most invasive hemodynamic monitoring is done in an attempt to understand cardiovascular status and its response to specific therapies. Bedside insert ion of a flow-directed balloon-tipped pulmonary arterial cha theter to measure pulmonary artery occlusion pressure (Ppao) (as an estimate of left ventricular filling pressure) and cardiac output (by the thermodilution technique) in the hemodynamically unstable patient is now routine [1]. Using these data and derived parameters of left ventricular (LV) function [2) has allowed the clinician to diagnose common causes of cardiovascular instability, such as acute myocard ial infarction, tamponade, and other causes of LV failure versus hypovolemia [3]. From the time o f its introduction onward, the flow-directed balloon-tipped pulmonary artery catheter has been within the domain of the intensivist.