scholarly journals Effect of volume status on the estimation of mean systemic filling pressure

2019 ◽  
Vol 126 (6) ◽  
pp. 1503-1513 ◽  
Author(s):  
Per Werner-Moller ◽  
Soren Sondergaard ◽  
Stephan M. Jakob ◽  
Jukka Takala ◽  
David Berger
Keyword(s):  
Dynamic Model ◽  
Venous Return ◽  
Filling Pressure ◽  
Right Atrial ◽  
Volume Status ◽  
Mean Systemic Filling Pressure ◽  
Volume State ◽  
Systemic Filling ◽  
The Difference ◽  
Systemic Filling Pressure

Various methods for indirect assessment of mean systemic filling pressure (MSFP) produce controversial results compared with MSFP at zero blood flow. We recently reported that the difference between MSFP at zero flow measured by right atrial balloon occlusion (MSFPRAO) and MSFP estimated using inspiratory holds depends on the volume status. We now compare three indirect estimates of MSFP with MSFPRAO in euvolemia, bleeding, and hypervolemia in a model of anesthetized pigs ( n = 9) with intact circulation. MSFP was estimated using instantaneous beat-to-beat venous return during tidal ventilation (MSFPinst_VR), right atrial pressure-flow data pairs at flow nadir during inspiratory holds (MSFPnadir_hold), and a dynamic model analog adapted to pigs (MSFPa). MSFPRAO was underestimated by MSFPnadir_hold and MSFPa in all volume states. Volume status modified the difference between MSFPRAO and all indirect methods (method × volume state interaction, P ≤ 0.020). All methods tracked changes in MSFPRAO concordantly, with the lowest bias seen for MSFPa [bias (confidence interval): −0.4 (−0.7 to −0.0) mmHg]. We conclude that indirect estimates of MSFP are unreliable in this experimental setup. NEW & NOTEWORTHY For indirect estimations of MSFP using inspiratory hold maneuvers, instantaneous beat-to-beat venous return, or a dynamic model analog, the accuracy was affected by the underlying volume state. All methods investigated tracked changes in MSFPRAO concordantly.

scholarly journals Right atrial pressure and venous return during cardiopulmonary bypass

2017 ◽  
Vol 313 (2) ◽  
pp. H408-H420 ◽  
Author(s):  
Per W. Moller ◽  
Bernhard Winkler ◽  
Samuel Hurni ◽  
Paul Philipp Heinisch ◽  
Andreas Bloch ◽  
...  
Keyword(s):  
Venous Return ◽  
Filling Pressure ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Pump Speed ◽  
Mean Systemic Filling Pressure ◽  
Upstream Pressure ◽  
Systemic Filling ◽  
Systemic Filling Pressure

The relevance of right atrial pressure (RAP) as the backpressure for venous return (QVR) and mean systemic filling pressure as upstream pressure is controversial during dynamic changes of circulation. To examine the immediate response of QVR (sum of caval vein flows) to changes in RAP and pump function, we used a closed-chest, central cannulation, heart bypass porcine preparation ( n = 10) with venoarterial extracorporeal membrane oxygenation. Mean systemic filling pressure was determined by clamping extracorporeal membrane oxygenation tubing with open or closed arteriovenous shunt at euvolemia, volume expansion (9.75 ml/kg hydroxyethyl starch), and hypovolemia (bleeding 19.5 ml/kg after volume expansion). The responses of RAP and QVR were studied using variable pump speed at constant airway pressure (PAW) and constant pump speed at variable PAW. Within each volume state, the immediate changes in QVR and RAP could be described with a single linear regression, regardless of whether RAP was altered by pump speed or PAW ( r2 = 0.586–0.984). RAP was inversely proportional to pump speed from zero to maximum flow ( r2 = 0.859–0.999). Changing PAW caused immediate, transient, directionally opposite changes in RAP and QVR (RAP: P ≤ 0.002 and QVR: P ≤ 0.001), where the initial response was proportional to the change in QVR driving pressure. Changes in PAW generated volume shifts into and out of the right atrium, but their effect on upstream pressure was negligible. Our findings support the concept that RAP acts as backpressure to QVR and that Guyton’s model of circulatory equilibrium qualitatively predicts the dynamic response from changing RAP. NEW & NOTEWORTHY Venous return responds immediately to changes in right atrial pressure. Concomitant volume shifts within the systemic circulation due to an imbalance between cardiac output and venous return have negligible effects on mean systemic filling pressure. Guyton’s model of circulatory equilibrium can qualitatively predict the resulting changes in dynamic conditions with right atrial pressure as backpressure to venous return.

Assessment of venous return curve and mean systemic filling pressure in postoperative cardiac surgery patients*

2009 ◽  
Vol 37 (3) ◽  
pp. 912-918 ◽  
Author(s):  
Jacinta J. Maas ◽  
Bart F. Geerts ◽  
Paul C. M. van den Berg ◽  
Michael R. Pinsky ◽  
Jos R. C. Jansen
Keyword(s):  
Cardiac Surgery ◽  
Venous Return ◽  
Filling Pressure ◽  
Mean Systemic Filling Pressure ◽  
Systemic Filling ◽  
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 Clinical validation of a computerized algorithm to determine mean systemic filling pressure

2021 ◽  
Author(s):  
Loek P.B. Meijs ◽  
Joris van Houte ◽  
Bente C. M. Conjaerts ◽  
Alexander J. G. H. Bindels ◽  
Arthur Bouwman ◽  
...  
Keyword(s):  
Conversion Coefficient ◽  
Intraclass Correlation ◽  
Filling Pressure ◽  
Right Atrial ◽  
Release Date ◽  
Clinical Trial Registration ◽  
Mean Systemic Filling Pressure ◽  
Link Type ◽  
Systemic Filling ◽  
Systemic Filling Pressure

AbstractMean systemic filling pressure (Pms) is a promising parameter in determining intravascular fluid status. Pms derived from venous return curves during inspiratory holds with incremental airway pressures (Pms-Insp) estimates Pms reliably but is labor-intensive. A computerized algorithm to calculate Pms (Pmsa) at the bedside has been proposed. In previous studies Pmsa and Pms-Insp correlated well but with considerable bias. This observational study was performed to validate Pmsa with Pms-Insp in cardiac surgery patients. Cardiac output, right atrial pressure and mean arterial pressure were prospectively recorded to calculate Pmsa using a bedside monitor. Pms-Insp was calculated offline after performing inspiratory holds. Intraclass-correlation coefficient (ICC) and assessment of agreement were used to compare Pmsa with Pms-Insp. Bias, coefficient of variance (COV), precision and limits of agreement (LOA) were calculated. Proportional bias was assessed with linear regression. A high degree of inter-method reliability was found between Pmsa and Pms-Insp (ICC 0.89; 95%CI 0.72–0.96, p = 0.01) in 18 patients. Pmsa and Pms-Insp differed not significantly (11.9 mmHg, IQR 9.8–13.4 vs. 12.7 mmHg, IQR 10.5–14.4, p = 0.38). Bias was −0.502 ± 1.90 mmHg (p = 0.277). COV was 4% with LOA –4.22 − 3.22 mmHg without proportional bias. Conversion coefficient Pmsa ➔ Pms-Insp was 0.94. This assessment of agreement demonstrates that the measures Pms-Insp and the computerized Pmsa-algorithm are interchangeable (bias −0.502 ± 1.90 mmHg with conversion coefficient 0.94). The choice of Pmsa is straightforward, it is non-interventional and available continuously at the bedside in contrast to Pms-Insp which is interventional and calculated off-line. Further studies should be performed to determine the place of Pmsa in the circulatory management of critically ill patients. (www.clinicaltrials.gov; TRN NCT04202432, release date 16-12-2019; retrospectively registered).Clinical Trial Registrationwww.ClinicalTrials.gov, TRN: NCT04202432, initial release date 16-12-2019 (retrospectively registered).

scholarly journals Hubungan Volume Cairan dengan Cardiac Output dan Venous Return pada Pasien Kritis

2019 ◽  
Vol 11 (3) ◽  
pp. 164-177
Author(s):  
Listiana Dewi Sartika ◽  
Erwin Pradian ◽  
Nurita Dian ◽  
Reza W Sudjud ◽  
Ricky Aditya
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Venous Return ◽  
Filling Pressure ◽  
Mean Systemic Filling Pressure ◽  
Systemic Filling ◽  
Systemic Filling Pressure

Pemberian cairan merupakan salah satu intervensi medis yang sering dilakukan pada pasien kritis di intensif care unit (ICU). Perkembangan ilmu mengenai cairan tubuh dulu lebih menitikberatkan pada fisiologi jantung kiri. Cardiac output, pada mulanya lebih dikenal sebagai fungsi jantung kiri dimana cardiac output ditentukan oleh jumlah darah yang dipompa dari ventrikel kiri dalam semenit (stroke volume) dan heart rate. Namun demikian, ternyata pemahaman fisiologi kardiovaskular tidak sesederhana itu. Menurut Starling, jantung hanya akan memompa darah yang masuk ke dalam jantung kanan. Dengan demikian, jumlah darah yang masuk ke jantung kanan harus sama dengan jumlah darah yang dipompa oleh jantung kiri, dimana keduanya adalah cardiac output. Ini kemudian diteliti lagi oleh Guyton. Guyton mencoba memandang cardiac output sebagai darah yang masuk ke jantung kanan (venous return). Terdapat banyak faktor yang menentukan kembalinya cairan ke jantung kanan. Faktor perbedaan tekanan antara mean systemic filling pressure (MSFP) dengan tekanan atrium kanan, serta faktor resistensi vena merupakan faktor penentu dalam fungsi venous return. Guyton juga mencari hubungan antara fungsi jantung dengan fungsi venous return. Pemahaman cardiac output secara utuh baik sebagai fungsi jantung dan sebagai venous return ini dapat menjelaskan banyak hal yang berhubungan dengan disfungsi kardiovaskular maupun gangguan ekstra kardiak pada pasien kritis dengan kondisi syok. Oleh karena itu, sangat penting bagi klinisi untuk memahami hubungan antara cairan tubuh dengan cardiac output dan venous return.

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