Optimizing Mechanical Ventilation in Right Heart Failure.

In patients with acute respiratory distress syndrome, the prevalence of right ventricular dysfunction (RVD) has been documented as high as 60%, though more recent estimates suggest a lower incidence of 20% to 30%, potentially reflecting the broader implementation of lung-protective ventilation strategies. The objective of this article is to review the physiologic principles of mechanical ventilation considering the unique challenges posed by RVD, and to offer a practical bedside approach to optimizing ventilatory support in this patient population. Importantly, mechanical ventilation strategies should aim to protect both the lungs and the heart-in all critically ill patients requiring ventilatory support.