Experimental validation of a mean systemic pressure analog against zero-flow measurements in porcine VA-ECMO

Moller, Per Werner; Heinisch, Paul Philipp; Hana, Anisa; Bachmann, K; Søndergaard, Søren; Jakob, Stephan M.; Takala, Jukka; Berger, David

doi:10.1152/japplphysiol.00804.2021

Cited by 14 publications

(11 citation statements)

References 37 publications

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“…Their reported hemodynamic changes agreed with Guyton´s views [6]. Later evaluations showed that P msa correlates well with more invasive laboratory methods of measuring P ms [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 64%

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Mean systemic filling pressure indicates fluid responsiveness and anesthesia-induced "unstressed" blood volume

Hahn

Li³

2022

Preprint

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Background. The mean systemic filling pressure (Pms) play a central role for the understanding of the circulation. We studied whether the Pms indicates fluid responsiveness before and after induction of general anesthesia and whether the Pms response to bolus infusions of fluid indicates an anesthesia-induced increase of the "unstressed" blood volume. Methods. An analog to Pms based on cardiac output, the mean arterial pressure, and central venous pressure (Pmsa) was calculated in 86 patients before induction of general anesthesia and before each of 3 successive bolus infusions of 3 ml/kg of colloid fluid. An increase in stroke volume of ≥ 10% from a bolus infusion indicated fluid responsiveness. Changes in blood volume were estimated from anthropometric data and the hemodilution. Results. Pmsa was lower in fluid responders than in non-responders before induction (13.2 ± 2.2 vs. 14.7 ± 2.7 mmHg; mean ± SD, P< 0.01) and after induction of general anesthesia (11.4 ± 2.1 vs. 12.8 ± 2.1 mmHg; P< 0.006). Changes in Pmsa resulting from the infusions did not differ depending on the stroke volume response. Receiver operator characteristic curves showed an average area under the curve of 0.70. The decrease in Pmsa due to the anesthesia-induced increase of the vascular compliance was fully compensated by the colloid fluid. A linear correlation between Pmsa and the volume changes suggested that the anesthesia increased the "unstressed" blood volume by 1.2 L. Conclusions. Pmsa was lower in fluid responders than in non-responders. General anesthesia increased the need for blood volume by 1.2 L.

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Section: Introductionmentioning

confidence: 64%

“…Basic studies have been performed in pigs, where P ms has been derived by ventilatory maneuvers [21,22] and, recently, with extracorporeal membrane oxygenation [11].…”

Section: Literaturementioning

confidence: 99%

Mean systemic filling pressure indicates fluid responsiveness and anesthesia-induced "unstressed" blood volume

Hahn

Li³

2022

Preprint

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“…but agreed with Guyton's views [6]. Later evaluations have compared P msa with more invasive laboratory methods of measuring P ms [7][8][9][10]. A review by Cooke et al found that P msa was lower in fluid responders than in non-responders, but the studied patients were usually subjected to complex treatments, including intensive care [11].…”

mentioning

confidence: 61%

Mean systemic filling pressure indicates fluid responsiveness and anaesthesia-induced unstressed blood volume

Hahn¹,

He²,

Li³

2022

ait

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The mean systemic filling pressure (P ms ) is the pressure that develops in the systemic circulation if the heart suddenly stops [1]. The importance of P ms for vascular status was first studied by the physiologist Arthur Guyton. His view was that the heart fills passively. Therefore, cardiac output (CO) is determined by the venous return (VR), which is, in turn, driven by the difference between P ms and the central venous pressure (CVP) and modified by other factors that oppose venous return (RVR). The theories surrounding the role of P ms as a key determinant of circulation are sometimes called "Guyton's haemodynamics" and offer complementary views on how to interpret haemodynamic data [2]. Guyton's experiments were performed on animals in a highly

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“…The fact that it does not assess RVr may affect its reliability. However, the method has also been validated against Pmsf determined at full arterio-venous pressure equilibrium [ 38 ] and against Pmsf estimated by the heart–lung interactions method [ 39 ].…”

Section: Mathematical Estimation: Parkin and Leaning’s Methodsmentioning

confidence: 99%

Venous return and mean systemic filling pressure: physiology and clinical applications

et al. 2022

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Venous return is the flow of blood from the systemic venous network towards the right heart. At steady state, venous return equals cardiac output, as the venous and arterial systems operate in series. However, unlike the arterial one, the venous network is a capacitive system with a high compliance. It includes a part of unstressed blood, which is a reservoir that can be recruited via sympathetic endogenous or exogenous stimulation. Guyton’s model describes the three determinants of venous return: the mean systemic filling pressure, the right atrial pressure and the resistance to venous return. Recently, new methods have been developed to explore such determinants at the bedside. In this narrative review, after a reminder about Guyton’s model and current methods used to investigate it, we emphasize how Guyton’s physiology helps understand the effects on cardiac output of common treatments used in critically ill patients.

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Experimental validation of a mean systemic pressure analog against zero-flow measurements in porcine VA-ECMO

Cited by 14 publications

References 37 publications

Mean systemic filling pressure indicates fluid responsiveness and anesthesia-induced "unstressed" blood volume

Mean systemic filling pressure indicates fluid responsiveness and anesthesia-induced "unstressed" blood volume

Mean systemic filling pressure indicates fluid responsiveness and anaesthesia-induced unstressed blood volume

Venous return and mean systemic filling pressure: physiology and clinical applications

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