Vasopressor effects on venous return in septic patients: a review

Impact of endotracheal tube taping site on tube displacement during head movements

“…4 On the other hand, vasopressin could increase mean circulatory filling pressure during the hyperdynamic phase of sepsis without affecting heart rate, resistance to venous return or arterial resistance. 5 Feldheiser et al 1 are correct that a focus on the arterial pressure neglects the vasopressor effects on the microcirculation, venous return, splanchnic perfusion, right ventricular performance and the pulmonary circulation, which together account for most of the volume of the circulatory system. Although the study by Laterre et al 6 failed to show beneficial effects of a selective V1a receptor agonist on ventilator-free and vasopressor-free days or on secondary outcome measures, the selepressin group had higher mean arterial pressure and lower norepinephrine requirement, significantly less cardiovascular dysfunction, significantly higher urine output, significantly lower net fluid balance in the first 24 h, and was significantly less likely to receive steroids than the placebo group.…”

“…The recent article by Ortais et al 1 demonstrated the impact of the endotracheal tube taping site on tube displacement during head movements. According to the data presented, the mandible was considered to be a better and safer taping site for the tube in prevention of adverse events.…”

“…The haemodynamic disturbances caused by sepsis are complex and vary between patients. Careful management is required in order to maintain a reasonable level of tissue perfusion.The authors report that, in contrast to norepinephrine, vasopressin has no, or minimal, effect on venous compliance, and increases venous resistance and unstressed venous volume 1. However, one could argue that the cited references may not support the applicability of this statement in septic patients.…”

Driving forces of venous return

“…Therefore, we thank Dr Dalmau for his comments on our previously published review of vasopressor effects on venous return in septic patients. 1 He raises a concern regarding reliance on the mean circulatory filling pressure (MCFP), as it might not have any physical significance in the circulation and describes it as a virtual concept. It would be more accurate, and more realistic, to describe the venous return with detailed pressure and volume profiles as proposed in the work of Brengelmann, 2 where it is stated that the concept of pressure difference between MCFP and right atrial pressure (RAP) should be abandoned.…”

How to end the ‘venous return’ controversy

“…No one knows. Given the powerful intuitive appeal the VR model has, and the fact that it has been associated with a rationale for early vasopressor therapy [8][9][10] (when, in reality, counterbalancing vasodilation with vasopressor agents is simply a matter of common sense), I doubt that people will easily embrace sound physical principles to understand haemodynamics and leave the venous return assumption behind.…”