Elevated mean systemic filling pressure due to intermittent positive-pressure ventilation

Chihara, Eiichi; Hashimoto, Satoru; Kinoshita, Takashi; Hirose, Munetaka; Tanaka, Yoshifumi; Morimoto, Taketoshi

doi:10.1152/ajpheart.1992.262.4.h1116

Cited by 18 publications

(15 citation statements)

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“…The linearity of the fits was affected neither by the changes in the haemodynamic condition during endotoxin nor during endotoxin after fluid infusion. Our P sf values during the baseline conditions were in the range (7.6-10.7 mm Hg) found for the intact circulation during normovolaemic conditions [2,5,11,12,17,[23][24][25]. P sf increased by 1.7 ± 2.3 mm Hg after endotoxin and did not further change after volume expansion.…”

Section: Discussionsupporting

confidence: 62%

Effects of endotoxin infusion on mean systemic filling pressure and flow resistance to venous return

Hiesmayr

Jansen

Versprille

1996

Pfl�gers Archiv European Journal of Physiology

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Mean systemic filling pressure (P sf ) is an indicator of the filling state of the systemic circulation. Cardiac output (Q) is related linearly to the difference between P sf and central venous pressure (P cv ), according to: Q = (P sf 9 P cv )/R sf , where R sf is the flow resistance downstream from the sites where blood pressure is equal to P sf . In 16 anaesthetized pigs we evaluated P sf , R sf and Q during baseline conditions, continuous endotoxin infusion and after subsequent fluid loading. P sf and R sf were determined from simultaneous measurements of Q and P cv at seven levels of lung inflation. The following results were obtained. P sf was 8.1 ± 1.8 mm Hg (mean ± SD) during baseline conditions, increased after endotoxin infusion to 9.9 ± 3.2 mm Hg (P = 0.04) and remained the same after infusion of 18 ml · kg -1 of Ringer's lactate. R sf increased from 0.34 ± 0.07 to 0.80 ± 0.34 mm Hg · ml -1 · s by endotoxin and decreased after fluid infusion to 0.58 ± 0.14. Q changed inversely proportional to R sf (P = 0.001). R sf changes were highly correlated with the changes in total systemic flow resistance (R s ) (P < 0.001). Endotoxin caused haemoconcentration and a decrease in plasma volume. The stability of P sf during endotoxin infusion and after volume loading indicate that the stressed volume was well maintained and changes in blood volume are compensated by changes in nonstressed volume. The increase in R sf can be attributed to arteriolar vasoconstriction, venous vasoconstriction and haemoconcentration.

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Section: Discussionsupporting

confidence: 62%

Effects of endotoxin infusion on mean systemic filling pressure and flow resistance to venous return

Hiesmayr

Jansen

Versprille

1996

Pfl�gers Archiv European Journal of Physiology

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“…Second, it demonstrates the adverse hemodynamic changes that can accompany intubation and induction of general anesthesia on this type of patient. Although intubation with positive pressure ventilation can have varying hemodynamic effects on the cardiovascular system, in part based on the type of anesthesia and the volume status of the patient, right atrial pressure generally increases with little change in left atrial pressure [12]. We believe the further elevation of right atrial pressure in this patient with severe tricuspid regurgitation resulted in an increase in the gradient from the right to left atrium and resulted in a decline in systemic oxygenation.…”

Section: Discussionmentioning

confidence: 79%

Nonsurgical closure of a patent foramen ovale in a patient with carcinoid heart disease and severe hypoxia from interatrial shunting

Marenco

Naimi

Hijazi

et al. 2000

Cathet. Cardiovasc. Intervent.

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We report the percutaneous transcatheter closure of a patent foramen ovale using an Amplatzer septal occluder in a rare patient with carcinoid heart disease involving both the right and left heart who presented with severe hypoxemia secondary to intra-atrial shunting. We believe this is the first report of this technique being utilized in a patient with carcinoid heart disease and it may represent an alternative to surgical closure in these patients at high risk for surgical complications.

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“…Whether P AW during tidal ventilation may directly influence MSFP is an unresolved question. Jellinek et al (23) and Chihara et al (13) reported increased MSFP during inspiratory hold maneuvers and positive pressure tidal ventilation, respectively. Increase of upstream pressure with higher PEEP has been shown by Fessler et al (14,15) and us (4), and it has been attributed to larger stressed volume by Nanas and Magder (35).…”

Section: H416mentioning

confidence: 98%

Right atrial pressure and venous return during cardiopulmonary bypass

Moller

Winkler

Hurni

et al. 2017

American Journal of Physiology-Heart and Circulatory Physiology

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The relevance of right atrial pressure (RAP) as the backpressure for venous return (Q) and mean systemic filling pressure as upstream pressure is controversial during dynamic changes of circulation. To examine the immediate response of Q (sum of caval vein flows) to changes in RAP and pump function, we used a closed-chest, central cannulation, heart bypass porcine preparation ( = 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 Q were studied using variable pump speed at constant airway pressure (P) and constant pump speed at variable P Within each volume state, the immediate changes in Q and RAP could be described with a single linear regression, regardless of whether RAP was altered by pump speed or P ( = 0.586-0.984). RAP was inversely proportional to pump speed from zero to maximum flow ( = 0.859-0.999). Changing P caused immediate, transient, directionally opposite changes in RAP and Q (RAP: ≤ 0.002 and Q: ≤ 0.001), where the initial response was proportional to the change in Q driving pressure. Changes in P 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 Q and that Guyton's model of circulatory equilibrium qualitatively predicts the dynamic response from changing RAP. 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.

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Elevated mean systemic filling pressure due to intermittent positive-pressure ventilation

Cited by 18 publications

References 0 publications

Effects of endotoxin infusion on mean systemic filling pressure and flow resistance to venous return

Effects of endotoxin infusion on mean systemic filling pressure and flow resistance to venous return

Nonsurgical closure of a patent foramen ovale in a patient with carcinoid heart disease and severe hypoxia from interatrial shunting

Right atrial pressure and venous return during cardiopulmonary bypass

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