about 85 y old patient with known chronic RV-failure; actually the patient was admitted to our ICU from another ER with syncope and dyspnoea. NIV wasn´t effective, so we had to intubate and mechanically ventilate the patient. In bronchoscopy we found a severe pulmonary infection in lower left lung (gram-stain: gram-negative rod cell and gram-positive coccal).
The patient needed high-dose catecholamines (norepinephrin, dobutamine, milrinon, amiodarone,pitressin, hydrocortisone); CVP of 13 > after volume CVP of 17 without profit of haemodynamic.
In TTE and TEE we saw a RV-overpressure with systolic septum-shift and no undulation of VCI: in TEE: no sign of thrombus in LAA, RAA or PA. besides we could see the pulmonary consolidation lower left lung despite of former bronchoscopy.
volume-challenge wasn´t effective; over the course of time the patient was catecholamine-refraktory.
What do you think? Any other options in therapeutical treatment of RV-failure?