Kermanian R, Dosanjh H, Lewis MI, Matusov Y. Pathophysiology and management of right ventricular failure in critically ill patients: A narrative review. World J Crit Care Med 2025; 14(4): 111434 [DOI: 10.5492/wjccm.v14.i4.111434]
Corresponding Author of This Article
Yuri Matusov, MD, FACP, ATSF, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States. yuri.matusov@cshs.org
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Critical Care Medicine
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Review
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Dec 9, 2025
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World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Kermanian R, Dosanjh H, Lewis MI, Matusov Y. Pathophysiology and management of right ventricular failure in critically ill patients: A narrative review. World J Crit Care Med 2025; 14(4): 111434 [DOI: 10.5492/wjccm.v14.i4.111434]
World J Crit Care Med. Dec 9, 2025; 14(4): 111434 Published online Dec 9, 2025. doi: 10.5492/wjccm.v14.i4.111434
Pathophysiology and management of right ventricular failure in critically ill patients: A narrative review
Riley Kermanian, Harpreet Dosanjh, Michael I Lewis, Yuri Matusov
Riley Kermanian, Michael I Lewis, Yuri Matusov, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Harpreet Dosanjh, Department of Internal Medicine, Los Robles Regional Medical Center, Thousand Oaks, CA 91360, United States
Author contributions: Kermanian R and Dosanjh H performed the literature review and wrote the initial draft of the manuscript; Lewis MI provided expert review of the manuscript and contributed to manuscript revisions; Matusov Y conceptualized and oversaw the project and contributed to manuscript revisions.
Conflict-of-interest statement: Kermanian R, Dosanjh H, and Lewis MI have no conflicts of interest or disclosures. Matusov Y has no conflicts of interest, has received research funding to the institution from Mallickrodt, Tenax, Penumbra, and Aerovate. The present work is unfunded.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuri Matusov, MD, FACP, ATSF, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States. yuri.matusov@cshs.org
Received: July 1, 2025 Revised: August 5, 2025 Accepted: November 6, 2025 Published online: December 9, 2025 Processing time: 150 Days and 15.4 Hours
Abstract
Right ventricular (RV) failure accounts for significant morbidity and mortality in critically ill patients. The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload, which are commonly encountered in the intensive care unit (ICU). Conditions such as acute respiratory distress syndrome, pulmonary embolism, and decompensated pulmonary arterial hypertension are associated with acute and acute-on-chronic RV failure. In the ICU, RV failure may develop or worsen in patients with parenchymal pulmonary disease who acutely experience fluctuations in preload, excessive afterload, and/or insufficient myocardial contractility, often in addition to mechanical ventilation and circulatory compromise. This dynamic clinical scenario demands early recognition and intervention tailored to an individual patient’s physiology. Distinguishing between acute and chronic RV failure in critical illness informs diagnostic workup, hemodynamic monitoring, and resuscitative efforts. This narrative review will provide an overview of common conditions associated with RV failure in critical illness, highlighting a practical, physiology-oriented approach to diagnosis and optimization of ventilator support, fluid resuscitation, vasopressor and inotrope use, and mechanical circulatory support. RV failure due to RV infarction or severe LV failure and decompensated congenital heart disease are distinct pathophysiologic entities. These conditions require distinct treatment approaches and are beyond the scope of this review.
Core Tip: Right ventricular (RV) failure is a common and complex problem among critically ill patients. The management of RV failure is highly dependent on its underlying etiology, chronicity, and resource availability. General principles of RV failure include maintenance of adequate systemic blood pressure, reduction of RV afterload, provision of inotropic support, correction of acidosis and hypoxemia, and management of the underlying precipitating condition. This review provides a comprehensive and practical approach to RV failure in critical illness, highlighting common scenarios and summarizing the available evidence.
