Skip to main content
SpringerLink
Log in

Effects of arterial and venous pressure alterations on transcapillary fluid exchange during raised tissue pressure

  • Originals
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To assess local haemodynamic effects of raised tissue pressure per se and of arterial and venous pressure variations during raised tissue pressure, and to evaluate the vascular waterfall phenomenon.

Design

An isolated pump-perfused sympathectomised cat skeletal muscle enclosed in a plethysmograph.

Interventions

Hydrostatic capillary pressure (Pc), tissue volume alterations and blood flow wre recorded at various arterial (PA) or venous (PV) pressure levels at a raised tissue pressure (Ptissue). Total vascular resistance (Rtot) and its three consecutive sections, arterial resistance (Rart), venular resistance (Pvenule), and venous outflow orifice resistance (Rorifice), were recorded.

Results

Increase in Ptissue increased Pc due to a marked increase in Rorifice and unchanged Rart and, when Ptissue>PV by about 90% of the Ptissue increase. During the raised Ptissue, a PA increase (95 to 115 mmHg) increased Pc (by 3.1±1.1 mmHg) causing fluid filtration, and a PA decrease (95 to 75 mmHg) decreased Pc (by 2.4±0.5 mmHg) causing fluid absorption. Rart was unchanged, indicating impaired autoregulation. Increased PV had no haemodynamic effects when PV<Ptissue due to a gradual decrease in Rorifice towards zero when PV reached Ptissue. At PV>Ptissue blood flow and Pc increased gradually, causing fluid filtration.

Conclusions

Tissue volume is increased by raised an decreased by lowered PA, the latter may be of use to decrease ICP in the injured brain. The results indicate that PEEP or head elevation will not influence ICP from the venous side if CVP<ICP. Finally, the “vascular waterfall phenomenon” was rejected as Rorifice is a normal variable fluid resistance.

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. Rosner MJ, Daughton S (1990) Cerebral perfusion pressure management in head injury. J Trauma 30:933–941

    Google Scholar 

  2. Asgeirsson B, Grände PO, Nordström CH (1994) A new therapy of post-trauma brain oedema based on haemodynamic principles for brain volume regulation. Intensive Care Med 20:260–267

    Google Scholar 

  3. Todd NV, Graham DI (1990) Blood-brain barrier damage in traumatic brain contusions. Acta Neurochir [Suppl] 51:296–299

    Google Scholar 

  4. Shapiro HM, Marshall LF (1978) Intracranial pressure responses to PEEP in head-injured patients. J Trauma 18:254–256

    Google Scholar 

  5. Luce JM, Huseby JS, Kirk W, Butler J (1982) Mechanism by which positive end-expiratory pressure increases cerebrospinal fluid pressure in dogs. J Appl Physiol 52:231–235

    Google Scholar 

  6. Rosner MJ, Coley IB (1986) Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg 65:636–641

    Google Scholar 

  7. Kenning JA, Toutant SM, Saunders RL (1991) Upright patient positioning in the management of intracranial hypertension. Surg Neurol 15:148–152

    Google Scholar 

  8. Feldman Z, Kanter MJ, Robertson CS, Contant CF, Hayes C, Sheinberg MA, Villareal CA, Narayan RK, Grossman RG (1992) Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg 76:207–211

    Google Scholar 

  9. Cooper KR, Boswell PA, Choi SC (1985) Safe use of PEEP in patients with severe head injury. J Neurosurg 63:552–555

    Google Scholar 

  10. Hocroft JW, Link DP, Lantz BMT, Green JF, Weber CJ (1984) Venous return and the pneumatic antishock garment in hypovolemic baboons. J Trauma 24:921–1002

    Google Scholar 

  11. Nielsen HV (1991) Transmural pressures and tissue perfusion in man. Acta Physiol Scand 143 [Suppl 603]:85–92

    Google Scholar 

  12. Gosselin RE, Kaplow SM (1991) Venous waterfalls in coronary circulation. J Theoretical Biology 149:265–279

    Google Scholar 

  13. Yada K, Nagakawa Y, Tsurn M (1973) Circulatory disturbance of the venous system during experimental intracranial hypertension. J Neurosurg 39:723–729

    Google Scholar 

  14. Permutt S, Bromberger-Barnea B, Bane HN (1962) Alveolar pressure, pulmonary pressure, and the vascular waterfall. Med Thorac 19:239–260

    Google Scholar 

  15. Badeer HS, Hicks JW (1992) Hemodynamics of vascular “water-fall”: is the analogy justified? Respir Physiol 87:205–217

    Google Scholar 

  16. Grände PO (1992) New haemodynamic aspects on treatment of posttraumatic brain oedema Proceeding, Swedish Society of Anaesthesia and Intensive Care, Lund, vol 6; 2, pp 41–46

    Google Scholar 

  17. Grände PO, Borgström P, Mellander S (1979) On the nature of basal vascular tone in cat skeletal muscle and its dependence on transmural pressure stimuli. Acta Physiol Scand 107:365–376

    Google Scholar 

  18. Borgström P, Clementz L, Grände PO (1981) A servo controlled roller-pump for constant flow or constant pressure blood perfusion under normal pulsatile or non-pulsatile conditions. Acta Physiol Scand 112:437–442

    Google Scholar 

  19. Björnberg J, Grände PO, Maspers M, Mellander S (1988) Site of autoregulatory reactions in the vascular bed of cat skeletal muscle as determined with a new technique for segmental vascular resistance recordings. Acta Physiol Scand 133:199–210

    Google Scholar 

  20. Grände PO, Borgström P (1978) An electronic differential pressure flowmeter and a resistance meter for continuous measurement of vascular resistance. Acta Physiol Scand 102:224–230

    Google Scholar 

  21. Järhult J, Mellander S (1974) Autoregulation of hydrostatic capillary pressure in skeletal muscle during regional arterial hypo- and hypertension. Acta Physiol Scand 91:32–41

    Google Scholar 

  22. Wolff HG, Forbes HS (1928) The cerebral circulation. V. Observations of the pial circulation during changes in intracranial pressure. Arch Neurol Psychiatr 20:1035–1047

    Google Scholar 

  23. Cold GE, Taagehoj Jensen F (1978) Cerebral autoregulation in unconscious patients with brain injury. Acta Anaesth Scand 22: 270–280

    Google Scholar 

  24. Faraci FM, Baumbach GM, Heistad DD (1989) Myogenic mechanisms in the cerebral circulation. J Hypertension 7 [Suppl 4]:61–64

    Google Scholar 

  25. Heistad DD, Kontos HA (1983) Cerebral circulation. In: Shepard JT, Abboud FM (eds) Handbook of Physiology, vol 3. William & Wilkins, Baltimore, pp 137–182

    Google Scholar 

  26. Folkow B, Mellander S (1970) Measurements of capillary filtration coefficient and its use in studies of the control of capillary exchange. In: Crone C, Lassen NA (eds) Capillary permeability. The transfer of molecules and ions between capillary blood and tissue. Munksgaard, Copenhagen, pp 614–623

    Google Scholar 

  27. Cobbold A, Folkow B, Kjellmer I, Mellander S (1963) Nervous and local chemical control of pre-capillary sphincters in skeletal muscle as measured by changes in filtration coefficient. Acta Physiol Scand 57:180–192

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physiology and Biophysics, University and University Hospital of Lund, S-223 62, Lund, Sweden

    B. Asgeirsson & P. O. Grände

  2. Anaesthesiology and Intensive Care, University and University Hospital of Lund, S-223 62, Lund, Sweden

    B. Asgeirsson & P. O. Grände

Authors
  1. B. Asgeirsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. O. Grände
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Asgeirsson, B., Grände, P.O. Effects of arterial and venous pressure alterations on transcapillary fluid exchange during raised tissue pressure. Intensive Care Med 20, 567–572 (1994). https://doi.org/10.1007/BF01705723

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01705723

Key words

Search

Navigation