Assessment of fluid status and responsiveness in acute right ventricular failure – a narrative review
DOI:
https://doi.org/10.12775/QS.2026.65.73976Keywords
acute right ventricular failure, fluid responsiveness, VExUS, POCUS, CVPAbstract
Background. Acute right ventricular failure (ARVF) is a life-threatening syndrome causing systemic congestion, low cardiac output, and possible hemodynamic collapse. Fluid therapy is a key intervention, but the failing right ventricle is highly sensitive to both insufficient preload and fluid overload, making accurate assessment of volume status and fluid responsiveness crucial.
Aim. To review the evidence on fluid therapy assessment in ARVF, focusing on central venous pressure (CVP), point-of-care ultrasonography (POCUS), and venous excess ultrasound (VExUS).
Material and methods. A narrative review of publications from 2016–2026 (with selected fundamental older studies) covering ARVF, fluid therapy, fluid responsiveness, CVP, POCUS, IVC assessment, and VExUS. Guidelines, RCTs, meta-analyses, observational studies, and reviews in English or Polish were considered.
Results. Fluid administration in ARVF should be cautious, as excessive preload may worsen RV performance, tricuspid regurgitation, venous congestion, and instability. Guidelines emphasize clinical assessment, CVP, and invasive monitoring but offer limited guidance on fluid responsiveness. CVP is widely used yet limited and should not guide therapy alone. POCUS and VExUS are promising adjuncts for assessing congestion and right-sided hemodynamics, but current evidence does not support them as standalone methods; their value is greatest when integrated with clinical and hemodynamic findings and RV function. Evidence on optimal fluid type is scarce, though indirect data suggest possible benefit of balanced crystalloids over normal saline.
Conclusions. Fluid therapy in ARVF requires individualized, closely monitored decisions. No single method reliably guides it. CVP, POCUS, and VExUS provide complementary information interpreted within the clinical context. In uncertain cases, a cautious fluid challenge under close monitoring may be preferable to empiric liberal fluid administration.
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Copyright (c) 2026 Aleksander Urbaś, Michał Kawa, Kamil Robert Idzik, Agnieszka Anna Gaczoł, Paulina Kopcińska, Gabriela Piotrowska, Dominika Grzybowska, Tomasz Bartłomiej Kilian, Michał Kurnik, Weronika Grzyb-Kurnik, Magdalena Mortka, Hubert Marcin Bednarz
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