Abstract
Purpose
To evaluate an analogue of mean systemic filling pressure (P msa) 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 P msa 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 P msa 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 P msa (CPvol), its dynamic changes and the dynamic changes in P msa–right atrial pressure gradient relative to the P msa change (E vol) were investigated.
Results
CPvol was lower and E vol was higher in responders vs. non-responders. Furthermore, in patients receiving a second fluid bolus, E vol correlated with the degree of increase in cardiac output. Multivariate regression analysis identified both CPvol and E vol 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.
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Conflicts of interest
Geoffrey Parkin and Mark Leaning are directors of CPL Innovations, a software company in the area of cardiovascular decision support systems. The other authors have no conflicts of interest to declare.
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Take home message: Cardiac power scaled to the mean systemic filling pressure and dynamic assessments of the venous return pressure gradient relative to the change in mean systemic filling pressure provided quantitative assessments of the efficiency of volume expansion to increase cardiac output.
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Gupta, K., Sondergaard, S., Parkin, G. et al. Applying mean systemic filling pressure to assess the response to fluid boluses in cardiac post-surgical patients. Intensive Care Med 41, 265–272 (2015). https://doi.org/10.1007/s00134-014-3611-2
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DOI: https://doi.org/10.1007/s00134-014-3611-2