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Bedside assessment of total systemic vascular compliance, stressed volume, and cardiac function curves in intensive care unit patients

Maas, JJ and Pinsky, MR and Aarts, LP and Jansen, JR (2012) Bedside assessment of total systemic vascular compliance, stressed volume, and cardiac function curves in intensive care unit patients. Anesthesia and Analgesia, 115 (4). 880 - 887. ISSN 0003-2999

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Abstract

Background: Mean systemic filling pressure (Pmsf) can be measured at the bedside with minimally invasive monitoring in ventilator-dependent patients using inspiratory hold maneuvers (Pmsfhold) as the zero flow intercept of cardiac output (CO) to central venous pressure (CVP) relation. We compared Pmsfhold with arm vascular equilibrium pressure during vascular occlusion (Pmsfarm) and their ability to assess systemic vascular compliance (Csys) and stressed volume by intravascular fluid administration. Methods: In mechanically ventilated postoperative cardiac surgery patients, inspiratory holds at varying airway pressures and arm stop-flow maneuvers were performed during normovolemia and after each of 10 sequential 50-mL bolus colloid infusions. We measured CVP, Pmsfarm, stroke volume, and CO during fluid administration steps to construct CVP to CO (cardiac function) curves and Δvolume/ΔPmsf (compliance) curves. Pmsfhold was measured before and after fluid administration. Stressed volume was determined by extrapolating the Pmsf-volume curve to zero pressure intercept. Results: Fifteen patients were included. Pmsfhold and Pmsf arm were closely correlated. Csys was linear (64.3 ± 32.7 mL • mm Hg, 0.97 ± 0.49 mL • mm Hg • kg predicted body weight). Stressed volume was estimated to be 1265 ± 541 mL (28.5% ± 15% predicted total blood volume). Cardiac function curves of patients with an increase of >12% to 500 mL volume extension (volume responsive) were steep, whereas the cardiac function curves of the remaining patients were flat. Conclusions: Csys, stressed volume, and cardiac function curves can be determined at the bedside and can be used to characterize patients' hemodynamic status. Copyright © 2012 International Anesthesia Research Society.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Maas, JJ
Pinsky, MRpinsky@pitt.eduPINSKY
Aarts, LP
Jansen, JR
Centers: Other Centers, Institutes, or Units > McGowan Institute for Regenerative Medicine
Date: 1 October 2012
Date Type: Publication
Journal or Publication Title: Anesthesia and Analgesia
Volume: 115
Number: 4
Page Range: 880 - 887
DOI or Unique Handle: 10.1213/ane.0b013e31825fb01d
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0003-2999
PubMed ID: 22763909
Date Deposited: 29 Oct 2012 15:41
Last Modified: 04 Feb 2019 15:56
URI: http://d-scholarship.pitt.edu/id/eprint/16012

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