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Determinants of Venous Return

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Hemodynamic Monitoring

Part of the book series: Lessons from the ICU ((LEICU))

Abstract

The cardiovascular system is a close loop system, where pressures and resistances of every part affect the flow through the whole system. Under steady conditions, cardiac output and venous return are equal, so the determinants of cardiac output are also determinants of venous return. However, in this chapter, we will examine the circulation starting from the peripheral tissues, which is where blood flow is finely controlled and where the oxygen consumption takes place. The metabolic demand of every tissue and organ is the main regulator of blood flow, particularly at the level of arterioles and meta-arterioles. Then, the resistance to blood flow between the peripheral vessels and the right atrium, the ability of the heart to maintain a low right atrial pressure and the degree of filling of the circulation are all factors that affect and somehow determine the venous return. The degree of filling of the circulation can be estimated by the mean systemic filling pressure (Pmsf), which can be measured at the bedside in critically ill patients. Knowing the Pmsf value will help clinicians to understand the haemodynamic situation and to interpret the changes that follow the therapeutic interventions. From this perspective, all those interventions are targeted to improve and maintain tissue perfusion, and not only to correct haemodynamic values.

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Conflict of Interest

Hollmann D. Aya received financial support for educational programmes and for attending symposia from LiDCO. Maurizio Cecconi has received honoraria for speaking at symposia, financial support for educational programmes and honoraria for advisory board from Edwards Lifesciences, LiDCO, Deltex, Applied Physiology, Massimo, Bmeye, Cheetah, and Imacor.

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Authors and Affiliations

  1. Critical Care Department, St Bartholomew’s Hospital – Heart Center, Barts Health NHS Trust, London, UK

    Hollmann D. Aya

  2. IRCCS Istituto Clinico Humanitas, Rozzano, MI, Italy

    Maurizio Cecconi

  3. Humanitas University, Pieve Emanuele, MI, Italy

    Maurizio Cecconi

Authors
  1. Hollmann D. Aya
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  2. Maurizio Cecconi
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Correspondence to Hollmann D. Aya .

Editor information

Editors and Affiliations

  1. Critical Care Medicine Dept., University of Pittsburgh, Pittsburgh, PA, USA

    Michael R. Pinsky

  2. Bicetre University Hospital, Paris South University, Le Kremlin-Bicêtre, France

    Jean-Louis Teboul

  3. Department of Intensive Care, Erasme University Hospital, Brussels, Belgium

    Jean-Louis Vincent

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© 2019 European Society of Intensive Care Medicine

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Aya, H.D., Cecconi, M. (2019). Determinants of Venous Return. In: Pinsky, M.R., Teboul, JL., Vincent, JL. (eds) Hemodynamic Monitoring. Lessons from the ICU. Springer, Cham. https://doi.org/10.1007/978-3-319-69269-2_4

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  • DOI: https://doi.org/10.1007/978-3-319-69269-2_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-69268-5

  • Online ISBN: 978-3-319-69269-2

  • eBook Packages: MedicineMedicine (R0)

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