Marina Laura Grazia Pieri, MD, a cardiac anesthesiologist and intensivist at San Raffaele Hospital in Milan, Italy, discusses heart insufficiency management in the ICU. With regard to hemodynamic monitoring, she explains that right heart catheterization (RHC) “provides unique information that is useful in every step of care from cardiogenic shock profiling, to identification of the appropriate treatment, assesment of the initial treatment efforts, and identificaiton of complications.” She emphasizes an MCS approach specifically tailored to each patient by choosing the appropriate type and degree of support and following appropriate timing for initiation, escalation, de-escalation of support. She also highlights ICU care strategies including monitoring lab parameters (eg, lactate) and managing mechanical ventilation, renal replacement therapy, blood transfusions, nutrition therapy, blood purification, as well as preventing critical illness associated weakness (CIAW).