Letter to the editor: Comments on “Value and determinants of the mean systemic filling pressure in critically ill patients”

2015 ◽  
Vol 309 (8) ◽  
pp. H1370-H1371 ◽  
Author(s):  
George L. Brengelmann
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Filling Pressure ◽  
Mean Systemic Filling Pressure ◽  
Letter To The Editor ◽  
Systemic Filling ◽  
The Mean ◽  
Systemic Filling Pressure

Value and determinants of the mean systemic filling pressure in critically ill patients

2015 ◽  
Vol 309 (5) ◽  
pp. H1003-H1007 ◽  
Author(s):  
Xavier Repessé ◽  
Cyril Charron ◽  
Julia Fink ◽  
Alain Beauchet ◽  
Florian Deleu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Filling Pressure ◽  
Time Of Death ◽  
Large Variability ◽  
Mean Systemic Filling Pressure ◽  
Systemic Filling ◽  
A Prospective Study ◽  
Systemic Filling Pressure

Mean systemic filling pressure (Pmsf) is a major determinant of venous return. Its value is unknown in critically ill patients (ICU). Our objectives were to report Pmsf in critically ill patients and to look for its clinical determinants, if any. We performed a prospective study in 202 patients who died in the ICU with a central venous and/or arterial catheter. One minute after the heart stopped beating, intravascular pressures were recorded in the supine position after ventilator disconnection. Parameters at admission, during the ICU stay, and at the time of death were prospectively collected. One-minute Pmsf was 12.8 ± 5.6 mmHg. It did not differ according to gender, severity score, diagnosis at admission, fluid balance, need for and duration of mechanical ventilation, or length of stay. Nor was there any difference according to suspected cause of death, classified as shock (cardiogenic, septic, and hemorrhagic) and nonshock, although a large variability of values was observed. The presence of norepinephrine at the time of death (102 patients) was associated with a higher 1-min Pmsf (14 ± 6 vs. 11.4 ± 4.5 mmHg), whereas the decision to forgo life-sustaining therapy (34 patients) was associated with a lower 1-min Pmsf (10.9 ± 3.8 vs. 13.1 ± 5.3 mmHg). In a multiple-regression analysis, norepinephrine (β = 2.67, P = 0.0004) and age (β = −0.061, P = 0.022) were associated with 1-min Pmsf. One-minute Pmsf appeared highly variable without any difference according to the kind of shock and fluid balance, but was higher with norepinephrine.

Systemic filling pressure in intact circulation determined on basis of aortic vs. central venous pressure relationships

1994 ◽  
Vol 267 (6) ◽  
pp. H2255-H2258 ◽  
Author(s):  
E. A. Den Hartog ◽  
A. Versprille ◽  
J. R. Jansen
Keyword(s):  
Central Venous Pressure ◽  
Flow Resistance ◽  
Venous Pressure ◽  
Aortic Pressure ◽  
Filling Pressure ◽  
Central Venous ◽  
Mean Systemic Filling Pressure ◽  
Systemic Filling ◽  
The Mean ◽  
Systemic Filling Pressure

In the intact circulation, mean systemic filling pressure (Psf) is determined by applying a series of inspiratory pause procedures (IPPs) and using Guyton's equation of venous return (Qv) and central venous pressure (Pcv): Qv = a - b x Pcv. During an IPP series, different tidal volumes are applied to set Pcv at different values. From the linear regression between Qv and Pcv, Psf can be calculated as Psf = a/b. Guyton's equation can also be written as Qv = (Psf - Pcv)/Rsd, where Rsd is the flow resistance downstream of the places where blood pressure is equal to Psf. During an IPP, a steady state is observed. Therefore, we can also formulate the following equation for flow: Qs = (Pao - Psf)/Rsu, where Qs is systemic flow, Rsu is the systemic flow resistance upstream to Psf, and Pao is aortic pressure. Because both flows (Qs and Qv) are equal, it follows that Pao = Psf(1 + Rsu/Rsd) - Rsu/Rsd x Pcv. This equation implies a method to determine mean systemic filling pressure on the basis of Pao measurements instead of flow determinations. Using 22 IPPs in 10 piglets, we determined the mean systemic filling pressure, and we compared the values obtained from the flow curves with those obtained from the aortic pressure curves. The mean difference between the two methods was 0.03 +/- 1.16 mmHg. With the use of Pao measurements, the Psf can be estimated as accurately as in using flow determinations. The advantage of the new method is that estimation of cardiac output is not required.

Changes in the mean systemic filling pressure during a fluid challenge in postsurgical intensive care patients

2013 ◽  
Vol 39 (7) ◽  
pp. 1299-1305 ◽  
Author(s):  
Maurizio Cecconi ◽  
Hollmann D. Aya ◽  
Martin Geisen ◽  
Claudia Ebm ◽  
Nick Fletcher ◽  
...  
Keyword(s):  
Intensive Care ◽  
Fluid Challenge ◽  
Filling Pressure ◽  
Intensive Care Patients ◽  
Mean Systemic Filling Pressure ◽  
Systemic Filling ◽  
The Mean ◽  
Systemic Filling Pressure

scholarly journals Impact of positive pressure ventilation on mean systemic filling pressure in critically ill patients after death

2017 ◽  
Vol 122 (6) ◽  
pp. 1373-1378 ◽  
Author(s):  
Xavier Repessé ◽  
Cyril Charron ◽  
Guillaume Geri ◽  
Alix Aubry ◽  
Alexis Paternot ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Venous Return ◽  
Filling Pressure ◽  
Positive End Expiratory Pressure ◽  
Mean Systemic Filling Pressure ◽  
Tidal Ventilation ◽  
Heart Beating ◽  
Systemic Filling ◽  
Systemic Filling Pressure

Mean systemic filling pressure (Pms) defines the pressure measured in the venous-arterial system when the cardiac output is nil. Its estimation has been proposed in patients with beating hearts by building the venous return curve, using different pairs of right atrial pressure/cardiac output during mechanical ventilation. We raised the hypothesis according to which the Pms is altered by tidal ventilation and positive end-expiratory pressure (PEEP), which would challenge this extrapolation method based on cardiopulmonary interactions. We conducted a two-center, noninterventional, observational, and prospective study, using an arterial and a venous catheter to measure the pressure in the circulatory system at the time of death in critically ill, mechanically ventilated patients with a PEEP. Arterial (Part) and venous pressures (Pra) were recorded in five conditions: at end expiration and end inspiration with and without PEEP and finally once the ventilator was disconnected. Part and Pra did not differ in any experimental conditions. Tidal ventilation increased Pra and Part by 2.4 and 1.9 mmHg, respectively, whereas PEEP increased both values by 1.2 and 1 mmHg, respectively. After disconnection of the ventilator, Pra and Part were 10.0 ± 4.2 and 9.9 ± 4.2 mmHg, respectively. Pms increases during mechanical ventilation, with an effect of tidal ventilation and PEEP. This calls into question the validity of its evaluation in heart-beating patients using cardiopulmonary interactions during mechanical ventilation. NEW & NOTEWORTHY The physiology of the mean systemic filling pressure (Pms) is not well understood in human beings. This study is the first report of a tidal ventilation- and positive end-expiratory pressure-related increase in Pms in critically ill patients. The results challenge the utility and the value estimating Pms in heart-beating patients by reconstruction of the venous return curve using varying inflation pressures.

scholarly journals Validation of the mean systemic filling pressure assessment with preserved arterial blood flow by comparing two methods of calculation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Roberto Alberto De Blasi ◽  
Stefano Finazzi
Keyword(s):  
Filling Pressure ◽  
Arterial Blood Flow ◽  
Venous Compliance ◽  
Mean Systemic Filling Pressure ◽  
Model Method ◽  
Arterial Blood ◽  
Methods Of Calculation ◽  
Systemic Filling ◽  
The Mean ◽  
Systemic Filling Pressure

AbstractWe developed a method for measuring in vivo venular volumes and the mean systemic filling pressure in the limbs using near-infrared spectroscopy (NIRS). We aimed to validate the NIRS methodology by comparing two independent methods of calculation based on different physiological approaches. Pressure–volumes (P–V) curves were recorded following graded venous occlusion on the forearm. Values from a P–V curves analysis model (method 1) were compared with data derived from a resistor-capacitance calculation model (method 2) based on arterial pressure and venous compliance. We tested these methods on 10 healthy participants at rest and during exercise and on 6 severely ill patients. Results from method 1 were comparable with those calculated by method 2. Venular volumes calculated using method 1 correlated linearly with those calculated using method 2 both in participants (R2 = 0.98) and in patients (R2 = 0.94). A good agreement between methods was shown with few values out of the range of ± 1.96 standard deviation. Our findings added mathematical consistency for the NIRS methodology validation in the venular P–V assessment with no flow interruption. Further research will be required to confirm the relevance of the methodology in the clinical setting.

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