Skip to main content
SpringerLink
Log in

Evaluation of mean systemic filling pressure from pulse contour cardiac output and central venous pressure

  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Objective

The volemic status of a patient can be determined by measuring mean systemic filling pressure (Pmsf). Pmsf is obtained from the venous return curve, i.e. the relationship between central venous pressure (Pcv) and blood flow. We evaluated the feasibility and precision of Pmsf measurement.

Methods

In ten piglets we constructed venous return curves using seven 12 s inspiratory holds transiently increasing Pcv to seven different steady state levels and monitored the resultant blood flow, by pulse contour (COpc) and by flow probes around the pulmonary artery (COr) and aorta (COl). Pmsf is obtained by extrapolation of the venous return curve to zero flow. Measurements were repeated to evaluate the precision of Pmsf.

Results

During the inspiratory holds, 133 paired data points were obtained for COr, COl, COpc and Pcv. Bland–Altman analysis showed no difference between COr and COl, but a small significant difference was present between COl and COpc. All Pcv versus flow (COl or COpc) relationships were linear. Mean Pmsf was 10.78 with COl and 10.37 mmHg with COpc. Bland–Altman analysis for Pmsf with COl and with COpc, showed a bias of 0.40 ± 0.48 mmHg. The averaged coefficient of variation for repeated measurement of Pmsf with COl was 6.2% and with COpc 6.1%.

Conclusions

During an inspiratory hold pulmonary flow and aortic flow equilibrate. Cardiac output estimates by arterial pulse contour and by a flow probe around the aorta are interchangeable. Therefore, the venous return curve and Pmsf can be estimated accurately by pulse contour methods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gelman S. Venous function and central venous pressure: a physiologic story. Anesthesiology. 2008;108:735–748.

    Article  PubMed  Google Scholar 

  2. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134:172–178.

    Article  PubMed  Google Scholar 

  3. Versprille A, Jansen JR. Mean systemic filling pressure as a characteristic pressure for venous return. Pflugers Arch. 1985;405:226–233.

    Article  PubMed  CAS  Google Scholar 

  4. Magder S. Clinical usefulness of respiratory variations in arterial pressure. Am J Respir Crit Care Med. 2004;169:151–155.

    Article  PubMed  Google Scholar 

  5. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121:2000–2008.

    Article  PubMed  Google Scholar 

  6. Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg. 2001;92:984–989.

    Article  PubMed  CAS  Google Scholar 

  7. Magder S, Lagonidis D, Erice F. The use of respiratory variations in right atrial pressure to predict the cardiac output response to PEEP. J Crit Care. 2001;16:108–114.

    Article  PubMed  CAS  Google Scholar 

  8. Reuter DA, Felbinger TW, Kilger E, et al. Optimizing fluid therapy in mechanically ventilated patients after cardiac surgery by on-line monitoring of left ventricular stroke volume variations. Comparison with aortic systolic pressure variations. Br J Anaesth. 2002;88:124–126.

    Article  PubMed  CAS  Google Scholar 

  9. Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723–740.

    Article  PubMed  Google Scholar 

  10. Guyton AC, Lindsey AW, Abernathy B, Richardson T. Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol. 1957;189:609–615.

    PubMed  CAS  Google Scholar 

  11. Guyton AC. Determination of cardiac output by equating venous return curves with cardiac response curves. Physiol Rev. 1955;35:123–129.

    PubMed  CAS  Google Scholar 

  12. Maas JJ, Geerts BF, van den Berg PC, et al. Assessment of venous return curve and mean systemic filling pressure in postoperative cardiac surgery patients. Crit Care Med. 2009;37:912–918.

    Article  PubMed  Google Scholar 

  13. Den Hartog EA, Versprille A, Jansen JR. Systemic filling pressure in intact circulation determined on basis of aortic versus central venous pressure relationships. Am J Physiol. 1994;267:H2255–H2258.

    Google Scholar 

  14. Geerts BF, Maas JJ, Aarts LP, et al. Partitioning the resistances along the vascular tree: effects of dobutamine and hypovolemia in piglets with an intact circulation. J Clin Monit Comput. 2010;24:377–384.

    Article  PubMed  Google Scholar 

  15. Hiesmayr M, Jansen JR, Versprille A. Effects of endotoxin infusion on mean systemic filling pressure and flow resistance to venous return. Pflugers Arch. 1996;431:741–747.

    Article  PubMed  CAS  Google Scholar 

  16. Jansen JR, Schreuder JJ, Bogaard JM, et al. Thermodilution technique for measurement of cardiac output during artificial ventilation. J Appl Physiol. 1981;51:584–591.

    PubMed  CAS  Google Scholar 

  17. Jansen JR, Schreuder JJ, Settels JJ, et al. An adequate strategy for the thermodilution technique in patients during mechanical ventilation. Intensive Care Med. 1990;16:422–425.

    Article  PubMed  CAS  Google Scholar 

  18. Jansen JR, Schreuder JJ, Punt KD, et al. Mean cardiac output by thermodilution with a single controlled injection. Crit Care Med. 2001;29:1868–1873.

    Article  PubMed  CAS  Google Scholar 

  19. Jansen JR, Maas JJ, Pinsky MR. Bedside assessment of mean systemic filling pressure. Curr Opin Crit Care. 2010;16:231–236.

    Article  PubMed  Google Scholar 

  20. Jellinek H, Krenn H, Oczenski W, et al. Influence of positive airway pressure on the pressure gradient for venous return in humans. J Appl Physiol. 2000;88:926–932.

    PubMed  CAS  Google Scholar 

  21. Schipke JD, Heusch G, Sanii AP, et al. Static filling pressure in patients during induced ventricular fibrillation. Am J Physiol Heart Circ Physiol. 2003;285:H2510–H2515.

    PubMed  CAS  Google Scholar 

  22. Jansen JR. Standard pulse contour methods are not applicable in animals. Intensive Care Med. 2006;32:2084–2085.

    Article  PubMed  Google Scholar 

  23. Langewouters GJ, Wesseling KH, Goedhard WJ. The static elastic properties of 45 human thoracic and 20 abdominal aortas in vitro and the parameters of a new model. J Biomech. 1984;17:425–435.

    Article  PubMed  CAS  Google Scholar 

  24. Samar RE, Coleman TG. Mean circulatory pressure and vascular compliances in the spontaneously hypertensive rat. Am J Physiol. 1979;237:H584–H589.

    PubMed  CAS  Google Scholar 

  25. Honda T, Fuqua JM, Edmonds CH, et al. Applications of total artificial heart for studies of circulatory physiology; measurement of resistance to venous return in postoperative awake calves. Preliminary report. Ann Biomed Eng. 1976;4:271–279.

    Article  PubMed  CAS  Google Scholar 

  26. Pinsky MR. Instantaneous venous return curves in an intact canine preparation. J Appl Physiol. 1984;56:765–771.

    PubMed  CAS  Google Scholar 

  27. Guyton AC, Polizo D, Armstrong GG. Mean circulatory filling pressure measured immediately after cessation of heart pumping. Am J Physiol. 1954;179:261–267.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Intensive Care, H4Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands

    Jacinta J. Maas MD & Jos R. C. Jansen MSc, PhD

  2. Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands

    Bart F. Geerts MD, MSc

Authors
  1. Jacinta J. Maas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bart F. Geerts MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jos R. C. Jansen MSc, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacinta J. Maas MD.

Additional information

Maas JJ, Geerts BF, Jansen JRC. Evaluation of mean systemic filling pressure from pulse contour cardiac output and central venous pressure.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maas, J.J., Geerts, B.F. & Jansen, J.R.C. Evaluation of mean systemic filling pressure from pulse contour cardiac output and central venous pressure. J Clin Monit Comput 25, 193–201 (2011). https://doi.org/10.1007/s10877-011-9294-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-011-9294-0

Keywords

Search

Navigation