Intraoperative approach to a hypotensive patient with presumed RV failure*^¶

RV: right ventricular; FiO₂: fraction of inspired oxygen; PEEP: positive end-expiratory pressure; ZEEP: zero end-expiratory pressure; SpO₂: peripheral arterial saturation; SPV or PPV: systolic pressure variations or pulse pressure variations with respiration noted on the intra-arterial pressure waveform; CVP: central venous pressure; TEE: transesophageal echocardiography; TTE: transthoracic echocardiography; ICU: intensive care unit; PVR: pulmonary vascular resistance; IABP: intraaortic balloon pump; RVAD: right ventricular assist device; ECMO: extracorporeal membrane oxygenation; LV: left ventricle.

* Refer to to UpToDate's content on management of shock.

¶ Refer to UpToDate content on management of right heart failure.

Δ Refer to UpToDate content regarding dynamic hemodynamic parameters, rescue echocardiography, and focused cardiac ultrasound.

◊ Hypovolemia is likely (ie, inadequately filled LV); evidence may include: TEE or TTE evidence of LV underfilling;

OR

Hypovolemia is unlikely (ie, adequately filled LV); evidence may include: TEE or TTE evidence of adequately filled LV.

§ Refer to UpToDate content regarding intraoperative fluid management and transfusion.

¥ Refer to UpToDate content regarding vasoactive agents.