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

Journal of Applied Physiology
Per Werner-MollerDavid Berger

Abstract

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 MSF...Continue Reading

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Citations

Jul 23, 2019·Journal of Applied Physiology·G L Brengelmann
Jul 23, 2019·Journal of Applied Physiology·Rafael Dalmau
Sep 14, 2019·American Journal of Physiology. Heart and Circulatory Physiology·George L Brengelmann
Oct 8, 2020·Intensive Care Medicine Experimental·David BergerStephan M Jakob
Apr 2, 2021·Journal of Clinical Monitoring and Computing·Loek P B MeijsJan Bakker

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Methods Mentioned

BETA
RAP
right heart bypass

Software Mentioned

MSFP
MSFP RAO
LabVIEW
_ VR
inst
SPSS

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