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

Moller, Per Werner; Søndergaard, Søren; Jakob, Stephan M.; Takala, Jukka; Berger, David

doi:10.1152/japplphysiol.00897.2018

Cited by 23 publications

(23 citation statements)

References 42 publications

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“…This wide variation in MSFP values extends even further when alternative measurement techniques-right atrium occlusion (20), arm occlusion (33,34), a model analogue (30,(35)(36)(37) or cardiac arrest (38)-are considered. Comparing these measurement techniques revealed that they are not interchangeable (20,35), and their accuracy depends on the underlying volume state (39). In this experiment we indeed showed a significant influence of volume status on the MSFP_IH, without finding a cut-off value to discriminate euvolemia from hypervolemia.…”

mentioning

confidence: 66%

The inspiration hold maneuver is a reliable method to assess mean systemic filling pressure but its clinical value remains unclear

Loon¹,

Hoeven²,

Veltink³

et al. 2020

Ann Transl Med

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Background: The upstream pressure for venous return (VR) is considered to be a combined conceptual blood pressure of the systemic vessels: the mean systemic filling pressure (MSFP). The relevance of estimating the MSFP during dynamic changes of the circulation at the bedside is controversial. Herein, we studied the effect of high ventilatory pressures on the relationship between VR and central venous pressure (CVP).Methods: In 9 healthy pigs under anaesthesia and mechanically ventilated, MSFP was estimated from extrapolated VR versus CVP relationships during inspiratory hold maneuvers (IHMs) with different levels of ventilatory pressure (Pvent). MSFP was measure 3 times per animal during euvolemia and hypovolemia.Hypovolemia was induced by bleeding with 10 mL/kg. The estimated MSFP values were compared to the blood pressure recording after induced ventricle fibrillation (i.e., mean circulatory filling pressure).Results: Our results revealed a strong linear correlation between VR and CVP [R2 of 0.92 (range, 0.67-0.99)], during IHMs with different levels of Pvent. Volume status significantly alters the resulting MSFP, 20±1 and 16±2 mmHg for euvolemia and hypovolemia respectively. This estimation of the MSFP was strongly correlated-but not interchangeable-to the blood pressure recording after induced ventricle fibrillation (R2=0.8 and P=0.045). Conclusions:In conclusion, we showed a strong linear correlation between VR and CVP-when applying IHMs with high levels of Pvent-however the clinical applicability of this method to guide volume therapy in its current form is improbable.

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mentioning

confidence: 66%

The inspiration hold maneuver is a reliable method to assess mean systemic filling pressure but its clinical value remains unclear

Loon¹,

Hoeven²,

Veltink³

et al. 2020

Ann Transl Med

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“…Right ventricular afterload increases may therefore be a reason for left-sided stroke volume variation, even though averaged right and left stroke volumes must equal each other [8]. Measurements upstream of the lung may not be exposed to these issues, since the right heart directly handles venous return and therefore changes in volume state [19,20,34]. Stroke volume variation may then be of particular interest.…”

Section: Discussionmentioning

confidence: 99%

“…This analysis was an independent, post hoc sub-study of an experiment on respiratory maneuvers and venous return. Baseline characteristics have been published before [19,20]. The study was conducted in accordance with the Guide for the Care and Use of Laboratory Animals (National Academy of Sciences, 1996) and Swiss National Guidelines and was approved by the Commission of Animal Experimentation of Canton Bern, Switzerland (approval BE 71/14), and this manuscript adheres to the applicable ARRIVE guidelines.…”

Section: Methodsmentioning

confidence: 99%

Right ventricular stroke volume assessed by pulmonary artery pulse contour analysis

Berger

Hobi

Möller

et al. 2020

ICMx

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Background Stroke volume measurement should provide estimates of acute treatment responses. The current pulse contour method estimates left ventricle stroke volume. Heart-lung interactions change right ventricular stroke volume acutely. We investigated the accuracy, precision, and trending abilities of four calibrated stroke volume estimates based on pulmonary artery pulse contour analysis. Results Stroke volume was measured in 9 pigs with a pulmonary artery ultrasound flow probe at 5 and 10 cmH2O of PEEP and three volume states (baseline, bleeding, and retransfusion) and compared against stroke volume estimates of four calibrated pulmonary pulse contour algorithms based on pulse pressure or pressure integration. Bland-Altman comparison with correction for multiple measurements and trend analysis were performed. Heart rate and stroke volumes were 104 ± 24 bpm and 30 ± 12 mL, respectively. The stroke volume estimates had a minimal bias: − 0.11 mL (95% CI − 0.55 to 0.33) to 0.32 mL (95% CI − 0.06 to 0.70). The limits of agreement were − 8.0 to 7.8 mL for calibrated pulse pressure to − 10.4 to 11.5 mL for time corrected pressure integration, resulting in a percentage error of 36 to 37%. The calibrated pulse pressure method performed best. Changes in stroke volume were trended very well (concordance rates 73–100%, r2 0.26 to 0.987, for pulse pressure methods and 71–100%, r2 0.236 to 0.977, for integration methods). Conclusions Pulmonary artery pulse contour methods reliably detect acute changes in stroke volume with good accuracy and moderate precision and accurately trend short-term changes in cardiac output over time.

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“…Mean systemic filling pressures have been previously measured in intact rats [ 14 ], dogs [ 15 ] and pigs [ 16 ], producing values between 7 and 13 mmHg. MSFP has been measured in humans following cardiac arrest in intensive care [ 17 ] and estimated in various cohorts of patients in clinical settings [ 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of dynamic changes in stressed intravascular volume, mean systemic filling pressure and cardiovascular compliance: Pilot investigation and study protocol

et al. 2020

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The mean systemic filling pressure (MSFP) represents an interaction between intravascular volume and global cardiovascular compliance (GCC). Intravascular volume expansion using fluid resuscitation is the most frequent intervention in intensive care and emergency medicine for patients in shock and with haemodynamic compromise. The relationship between dynamic changes in MSFP, GCC and left ventricular compliance is unknown. We conducted prospective interventional pilot study following euthanasia in post cardiotomy adult sheep, investigating the relationships between changes in MSFP induced by rapid intravascular filling with fluids, global cardiovascular compliance and left ventricular compliance. This pilot investigation suggested a robust correlation between a gradual increase in the intravascular stressed volume from 0 to 40 ml/kg and the MSFP r = 0.708 95% CI 0.435 to 0.862, making feasible future prospective interventional studies. Based on the statistical modelling from the pilot results, we expect to identify a strong correlation of 0.71 ± 0.1 (95% CI) between the MSFP and the stressed intravascular volume in a future study.

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

Cited by 23 publications

References 42 publications

The inspiration hold maneuver is a reliable method to assess mean systemic filling pressure but its clinical value remains unclear

The inspiration hold maneuver is a reliable method to assess mean systemic filling pressure but its clinical value remains unclear

Right ventricular stroke volume assessed by pulmonary artery pulse contour analysis

Comparison of dynamic changes in stressed intravascular volume, mean systemic filling pressure and cardiovascular compliance: Pilot investigation and study protocol

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