Applying mean systemic filling pressure to assess the response to fluid boluses in cardiac post-surgical patients

Kapil Gupta, Soren Sondergaard, Geoffrey Parkin, Mark Leaning, Anders Aneman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)

Abstract

Purpose: To evaluate an analogue of mean systemic filling pressure (Pmsa) and derived variables to quantitatively assess the effectiveness of volume expansion in increasing cardiac output.

Methods: Sixty-one cardiac post-surgical patients were studied and 107 fluid boluses were captured. Cardiac output, mean arterial pressure and right atrial pressure were recorded with Pmsa before and after a bolus fluid. An increase in cardiac output greater than 10 % following a fluid bolus defined a patient as a responder. Cardiac power (i.e. the product of arterial pressure and cardiac output) and Pmsa to right atrial pressure gradient (i.e. the driving pressure for venous return and hence cardiac output) were evaluated to assess the efficiency of volume expansion to increase cardiac output. Cardiac power relative to Pmsa (CPvol), its dynamic changes and the dynamic changes in Pmsa–right atrial pressure gradient relative to the Pmsa change (Evol) were investigated.

Results: CPvol was lower and Evol was higher in responders vs. non-responders. Furthermore, in patients receiving a second fluid bolus, Evol correlated with the degree of increase in cardiac output. Multivariate regression analysis identified both CPvol and Evol as independent variables associated with volume responsiveness.

Conclusions: Using an algorithm to derive a mean systemic filling pressure analogue, cardiac power and dynamic measures of the venous return pressure gradient relative to the mean systemic filling pressure provided an assessment of the efficiency of volume expansion in post-surgical cardiac patients.

Original languageEnglish
Pages (from-to)265-272
Number of pages8
JournalIntensive Care Medicine
Volume41
Issue number2
DOIs
Publication statusPublished - Feb 2015
Externally publishedYes

Keywords

  • Blood volume
  • Cardiac output
  • Cardiovascular system
  • Hemodynamics
  • Methods

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