Right Ventricular Hemodynamics in Acute Respiratory Distress Syndrome: Monitoring and Implications for Clinical Management

Overview

Right ventricular (RV) injury (including RV dilatation/ dysfunction/limitation/failure) and pulmonary vascular dysfunction are common in patients with acute respiratory distress syndrome (ARDS). Despite increasing recognition, RV injury is associated with increased mortality in patients with ARDS, and implementation of multimodal monitoring and timely RV–targeted interventions may therefore confer outcome benefit. The aim of this narrative review is to explore the clinical applications of diagnostic modalities for the RV and pulmonary circulation in invasively ventilated patients with ARDS, including the complementary roles of invasive hemodynamics, echocardiography, and pulmonary monitoring. We discuss the physiologic basis and utility of RV and pulmonary monitoring to guide the bedside intensivist in personalizing therapies aimed at protecting the RV. Building on previous work that focused on the principles and terminology of abnormal RV biomechanics in critical illness, this review is centered on monitoring of RV pathophysiology in ARDS and implications for bedside management.

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Target Audience

Pulmonologists, critical care specialists, translational researchers, and clinicians

Learning Objectives

At the conclusion of this activity, learners should be able to:

  • Differentiate between the different right ventricular injury subtypes encountered in patients with acute respiratory distress syndrome 
  • Develop strategies to provide right ventricle–protective mechanical ventilation in patients with acute respiratory distress syndrome 
  • Describe therapeutic interventions that can lower right ventricular afterload in patients with acute respiratory distress syndrome 
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit(s)™
    The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Participation
Publication Date: 
11/21/2025
Credit Expires: 
01/01/2028
Cost:
$25.00
Rating: 
0

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Accreditation Statement

The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Disclosure Declaration

Article Authorship Disclosures (as submitted to the ATS prior to article publication date)

Douglas Slobod, M.D. (McGill University, Montreal, Canada) has received an educational grant from Fisher & Paykel Healthcare Ltd and a CIHR doctoral award. 

Vasileios Zochios, M.D. (University of Leicester, Leicester, United Kingdom) reports honoraria for education from Mitsubishi Tanabe Pharma Europe, outside the submitted work. Payments were made directly to him. He is the chair of the Protecting the Right Ventricle Network (PRORVNet). 

Hakeem Yusuff, M.D. (University of Leicester, Leicester, United Kingdom) has received funding from Jafron Biomedical Limited, which was paid to a hospital research account and supported a pilot study on the use of a cytokine filter (HA 380) in critically ill patients. He has received honoraria from AOP Orphan Limited for presentations. He has received payment from West Sussex, Brighton and Hove Coroner Service for preparing an expert witness statement and attending the coroner’s court. He has received payment from AOP Orphan Limited for membership on an advisory board. 

Mads Dam Lyhne, M.D., Ph.D. (Aarhus University, Aarhus, Denmark) has received a subaward from the NIH (1R01HL168040-01) directed to his institution (not for the present manuscript). He has received a grant from the Independent Research Fund Denmark (4360-00006B) (not for the present manuscript). 

André Y. Denault, M.D., Ph.D. (University of Montreal, Montreal, Quebec, Canada) is a consultant for Elevate Healthcare and for Becton and Dickinson and Company. 

AJRCCM CME Planners 

Edward Schenck, M.D. 
Associate Editor, AJRCCM 

Dr. Schenck reported no relevant financial relationships with ineligible companies. 

Off-Label Usage Disclosure

None

All relevant financial relationships have been reviewed and mitigated.

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Available Credit

  • 1.00 AMA PRA Category 1 Credit(s)™
    The American Thoracic Society designates this for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Participation

Price

Cost:
$25.00
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