RT Book, Section A1 Filippatos, Gerasimos S. A1 Baltopoulos, George A1 Karambatsos, Elias A1 Nieminen, Markku S. A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Wood, Lawrence D.H. SR Print(0) ID 2284740 T1 Chapter 23. Diagnostic and Management Strategies for Acute Heart Failure in the Intensive Care Unit T2 Principles of Critical Care, 3e YR 2005 FD 2005 PB The McGraw-Hill Companies PP New York, NY SN 9780071416405 LK accessanesthesiology.mhmedical.com/content.aspx?aid=2284740 RD 2021/03/07 AB Patients are admitted to the intensive care unit (ICU) with manifestations of acute heart failure (AHF) that arise in three general contexts: decompensation of chronic heart failure, as a complication of a cardiac process such as ischemia or valve incompetence, and when cardiomyopathy complicates other critical illness.Determining which of the contexts of AHF is present is invaluable to guide therapy.Predominant signs and symptoms arise from venous congestion after elevation of ventricular end-diastolic pressure and hypoperfusion; in a given patient, different contributions of these processes may be present.Measurement of brain natriuretic peptide has been a useful addition to the diagnostic armamentarium to determine whether heart failure is a cause of acute dyspnea; this measurement is most useful when obtained acutely and before initiation of therapies and, hence, has a limited role for assessing patients after admission to the ICU.Echocardiography is an extremely useful tool to assess ventricular function and define cardiac anatomy; on occasion, information from invasive measurement of intravascular pressure or venous oxygen saturation is also required to guide therapy.Many patients will exhibit respiratory distress and different degrees of impaired oxygenation; whereas many, if not most, patients can be managed with oxygen for this component of AHF, ventilatory support in the form of continuous positive airway pressure or bilevel airway support (BiPAP) should be considered for patients not responding adequately to oxygen therapy alone or whose respiratory symptoms and findings are severe from the onset.Diuretics are useful for treating venous congestion and inotropes for inadequate perfusion, but each carry risk of excessive dosing; the mainstay of therapy for most patients should be afterload reduction and search for the underlying causes of ventricular dysfunction and decompensation.Vasoconstrictive agents should be used only when and as long as truly life-threatening hypotension is present