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01-07-2013 | Original

Changes in the mean systemic filling pressure during a fluid challenge in postsurgical intensive care patients

Authors: Maurizio Cecconi, Hollmann D. Aya, Martin Geisen, Claudia Ebm, Nick Fletcher, R. Michael Grounds, Andrew Rhodes

Published in: Intensive Care Medicine | Issue 7/2013

Abstract

Purpose

The difference between mean systemic filling (Pmsf) and central venous pressure (CVP) is the venous return gradient (dVR). The aim of this study is to assess the significance of the Pmsf analogue (Pmsa) and the dVR during a fluid challenge.

Methods

We performed a prospective observational study in postsurgical patients. Patients were monitored with a central venous catheter, a LiDCO™plus and the Navigator™. A 250-ml intravenous fluid challenge was given over 5 min. A positive response to the fluid challenge was defined as either a stroke volume (SV) or cardiac output increase of greater than 10 %.

Results

A total of 101 fluid challenges were observed in 39 patients. In 43 events (42.6 %) the SV and CO increased by more than 10 %. Pmsa increased similarly during a fluid challenge in responders and non-responders (3.1 ± 1.9 vs. 3.1 ± 1.8, p = 0.9), whereas the dVR increased in responders (1.16 ± 0.8 vs. 0.2 ± 1, p < 0.001) as among non-responders CVP increased along with Pmsa (2.9 ± 1.7 vs. 3.1 ± 1.8, p = 0.15). Resistance to venous return did not change immediately after a fluid challenge. Heart performance (Eh) decreased significantly among non-responders (0.41 ± 0.15 vs. 0.34 ± 0.13, p < 0.001) whereas among responders it did not change when compared with baseline value (0.35 ± 0.15 vs. 0.34 ± 0.12, p = 0.15).

Conclusions

The changes in Pmsa and dVR measured at the bedside during a fluid challenge are consistent with the cardiovascular model described by Guyton.

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Title: Changes in the mean systemic filling pressure during a fluid challenge in postsurgical intensive care patients
Authors: Maurizio Cecconi
Hollmann D. Aya
Martin Geisen
Claudia Ebm
Nick Fletcher
R. Michael Grounds
Andrew Rhodes
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 7/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-2928-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Changes in the mean systemic filling pressure during a fluid challenge in postsurgical intensive care patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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