Table 1 POQI 9 RV Risk Score and clinical activity

Level 1 (1 point)

-No RVD risk (1 point) undergoing low-stress surgery (0 points)

-Best anesthetic practice

-ASA standard monitoring

Level 2 (2 points)

-Overall, low-risk patients

-May have RVD risk factors (2 points) undergoing lower-risk surgery (0 points)

-Patient with risk factors for RVD (1 point) undergoing moderate-risk surgery (1 point)

-Preventative measures

-Avoid hypoxia, hypotension, hypervolemia, hypercapnia, acidosis, and dysrhythmias

-Lung protective ventilation

-Consider arterial line

Level 3 (3 points)

-Require increased monitoring capabilities and require planning for higher levels of treatments for potential RV decompensation

-Patient without risk factors (1 point) undergoing a liver transplant (2 points)

-Known RVD risk factors (2 points) undergoing lobectomy (1 points)

-Preventative measures described for level 2 patients

-Diuretics

-Low-dose inodilators

-Consider arterial line

-Consider CVC

-Consider post-op care in a unit capable of higher monitoring

Level 4 (4 points)

-Moderate to high risk of RV decompensation

-Anticipate the need for RV support

-Known RVD (3 points) undergoing laparoscopic cholecystectomy (1 point)

-Known risk factors (2 points) undergoing major cardiac surgery (2 points)

-Inotropes

-Vasopressor

-Inhaled pulmonary vasodilators

-Continuous renal replacement therapy (CRRT)

-Arterial line

-CVC

-Consider other advanced hemodynamic monitoring

-Consider transesophageal echocardiography (TEE)

-ICU

-Possible ECMO initiation capability

Level 5 (5–7 points)

-Either in refractory shock or high risk of RV

-Left ventricular assist device (LVAD) patients with known RVF (4 points) needing hemicolectomy (1 point)

-Acute PE with RV strain (4 points) undergoing pulmonary embolectomy (2 points)

-ECMO

-RVAD

-Arterial line

-CVC

-Consider other advanced hemodynamic monitoring (PAC)

-Transesophageal echocardiography (TEE)

-Specialized advanced heart failure team and resources