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Right Atrial Pressure Assessment

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Elevations in right atrial pressure (RAP) can cause venous congestion resulting in tissue edema. Ongoing fluid boluses will further elevate RAP leading to organ dysfunction impacting hepatic, bowel, and renal perfusion by inhibiting venous drainage. Increased RAP is difficult to detect clinically, especially in mechanically ventilated patients. Central venous pressure (CVP) and pulmonary artery catheters are affected by mean airway pressure rendering them unreliable. Echo is an exciting alternative. We use evidence of elevated RAP and venous congestion as an indication that fluid is becoming harmful and often limit administration when it is present. How to obtain these measurements is discussed in their respective chapters. In this section, we discuss how to use them together to assess RAP and determine if venous congestion is present.


  • Right atrial pressure
  • RAP
  • Central venous pressure
  • CVP
  • Portal venous flow
  • Hepatic venous flow
  • Renal venous flow
  • Acute renal injury

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Fig. 1
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Fig. 4



Cardiac output


Central venous pressure






Inferior vena cava


Mean arterial blood pressure


Pulmonary artery systolic pressure

RA :

Right atrial pressure


Right atrial pressure




Systemic vascular resistance

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Correspondence to Sarah B. Murthi .

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Dave, S.B., Murthi, S.B. (2021). Right Atrial Pressure Assessment. In: Salerno, A., Haase, D.J., Murthi, S.B. (eds) Atlas of Critical Care Echocardiography. Springer, Cham.

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