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

Hahn, Robert W.; He, Rui; Li, Yuhong

doi:10.5114/ait.2022.121003

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…First, vasodilation decreases the mean circulatory filling pressure, which must be overcome by plasma volume expansion and/or catecholamine administration to maintain macro- and microcirculation. 99 Second, urinary excretion is strongly inhibited, which has been attributed to low arterial pressure 100 and also to a specific effect of inhaled anesthesia on the kidney. 101 The third factor is the inhibition of the lymphatic return of interstitial fluid that is discussed in the current review.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia-induced Lymphatic Dysfunction

Dull,

Hahn,

Dull

2024

Anesthesiology

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General anesthetics adversely alters the distribution of infused fluid between the plasma compartment and the extravascular space. This maldistribution occurs largely from the effects of anesthetic agents on lymphatic pumping, which can be demonstrated by macroscopic fluid kinetics studies in awake versus anesthetized patients. The magnitude of this effect can be appreciated as follows: a 30% reduction in lymph flow may result in a fivefold increase of fluid-induced volume expansion of the interstitial space relative to plasma volume. Anesthesia-induced lymphatic dysfunction is a key factor why anesthetized patients require greater than expected fluid administration than can be accounted for by blood loss, urine output, and insensible losses. Anesthesia also blunts the transvascular refill response to bleeding, an important compensatory mechanism during hemorrhagic hypovolemia, in part through lymphatic inhibition. Last, this study addresses how catecholamines and hypertonic and hyperoncotic fluids may mobilize interstitial fluid to mitigate anesthesia-induced lymphatic dysfunction.

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Section: Discussionmentioning

confidence: 99%

Anesthesia-induced Lymphatic Dysfunction

Dull,

Hahn,

Dull

2024

Anesthesiology

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“…The background is more complex during anesthesia where crystalloid fluid is indicated even if no bleeding occurs. A short explanation for this indication is that general anesthesia reduces the driving pressure for circulation, which is called the mean circulatory filling pressure (MCFP), by some 25% [ 111 ]. Both venous return and cardiac output are determined by the difference between MCFP and the pressure in the right atrium (i.e., the central venous pressure).…”

Section: Fluid Therapy Indications In the Surgical Settingmentioning

confidence: 99%

Role of Crystalloids in the Perioperative Setting: From Basics to Clinical Applications and Enhanced Recovery Protocols

Lorente,

Hahn,

Jover

et al. 2023

JCM

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Perioperative fluid management, a critical aspect of major surgeries, is characterized by pronounced stress responses, altered capillary permeability, and significant fluid shifts. Recognized as a cornerstone of enhanced recovery protocols, effective perioperative fluid management is crucial for optimizing patient recovery and preventing postoperative complications, especially in high-risk patients. The scientific literature has extensively investigated various fluid infusion regimens, but recent publications indicate that not only the volume but also the type of fluid infused significantly influences surgical outcomes. Adequate fluid therapy prescription requires a thorough understanding of the physiological and biochemical principles that govern the body’s internal environment and the potential perioperative alterations that may arise. Recently published clinical trials have questioned the safety of synthetic colloids, widely used in the surgical field. A new clinical scenario has arisen in which crystalloids could play a pivotal role in perioperative fluid therapy. This review aims to offer evidence-based clinical principles for prescribing fluid therapy tailored to the patient’s physiology during the perioperative period. The approach combines these principles with current recommendations for enhanced recovery programs for surgical patients, grounded in physiological and biochemical principles.

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“…The normal value of Pmsf in humans ranges between 2 and 10 mmHg [5,20]. Changes in Pmsf re ect changes in circulating blood volume and indicate changes in volume status [12,15,16,21,22]. Pmsf varies according to clinical condition, volume status, and vasodilatory tone [23] and increases after uid infusion and vasopressor administration [24,25].…”

Section: Introductionmentioning

confidence: 99%

Changes in the venous return system and mortality in patients with constrictive pericarditis after pericardial stripping: a retrospective cohort study

Chen

Liu

2023

Preprint

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This study aimed to explore changes in the venous return system in patients with Constrictive pericarditis(CP) after pericardial stripping and examine their value in predicting mortality. An 8-year single-center retrospective cohort study including patients with CP after pericardial stripping surgery in Intensive care unit (ICU), Peking Union Medical College Hospital. Hemodynamic parameters were analyzed in 90 patients at 11 time points including before and after surgery and every 4 to 9 hours in the first 48 hours in the ICU (0h, t1-t3, 24h, t4-t6, 48h). Mean systemic filling pressure (Pmsf) and resistance to venous return (RVr) were significantly higher in patients who died (non-survival group) than survivors (P = 0.016 and 0.022, respectively). There was a negative correlation between Pmsf at 24h and lactate clearance rate at 6h, while the difference in Pmsf − central venous pressure (CVP) between 48h and 0h was positively correlated with both total fluid balance at 48h and serum creatinine at the time of transfer out of the ICU. Pmsf at 0h, Pmsf at 24h, Pmsf − CVP at 0h, RVr before surgery, RVr at 24h, APACHE II score, and SOFA score were evaluated as predictors of 28-day mortality. The area under the receiver operating characteristic curve was largest for RVr before surgery (0.771; 95% confidence interval, 0.583–0.958; P = 0.034). Pmsf at 0h, Pmsf at 24h, Pmsf − CVP at 0h, RVr before surgery, and RVr at 24h, respectively, combined with APACHE II and SOFA were significant predictors of 28-day mortality. SOFA combined with RVr before surgery had the best performance (area under the receiver operating characteristic curve, 0.883; 95% confidence interval, 0.758–1.000; P = 0.003). Conclusions: Pmsf, Pmsf − CVP, and RVr can be used as valid indicators for prognostic assessment in patients with constrictive pericarditis after pericardial stripping.

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

Cited by 7 publications

References 26 publications

Anesthesia-induced Lymphatic Dysfunction

Anesthesia-induced Lymphatic Dysfunction

Role of Crystalloids in the Perioperative Setting: From Basics to Clinical Applications and Enhanced Recovery Protocols

Changes in the venous return system and mortality in patients with constrictive pericarditis after pericardial stripping: a retrospective cohort study

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