J Clin Monit Comput - Evaluation of mean systemic filling pressure from pulse contour cardiac output and central venous pressure.


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JECTIVE: 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.

Resumo Limpo

jectiv volem status patient can determin measur mean system fill pressur pmsf pmsf obtain venous return curv ie relationship central venous pressur pcv blood flow evalu feasibl precis pmsf measurementmethod ten piglet construct venous return curv use seven s inspiratori hold transient increas pcv seven differ steadi state level monitor result blood flow puls contour copc flow probe around pulmonari arteri cor aorta col pmsf obtain extrapol venous return curv zero flow measur repeat evalu precis pmsfresult inspiratori hold pair data point obtain cor col copc pcv blandaltman analysi show differ cor col small signific differ present col copc pcv versus flow col copc relationship linear mean pmsf col mmhg copc blandaltman analysi pmsf col copc show bias mmhg averag coeffici variat repeat measur pmsf col copc conclus inspiratori hold pulmonari flow aortic flow equilibr cardiac output estim arteri puls contour flow probe around aorta interchang therefor venous return curv pmsf can estim accur puls contour method

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