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Effect of volume status on the estimation of mean systemic filling pressure

Journal article
Authors Per Werner Möller
S. Sondergaard
S. M. Jakob
J. Takala
D. Berger
Published in Journal of Applied Physiology
Volume 126
Issue 6
Pages 1503-1513
ISSN 8750-7587
Publication year 2019
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Pages 1503-1513
Language en
Keywords cardiac output, hemodynamics, mean systemic filling pressure, venous return, positive pressure, right atrial pressure, venous return, cardiac-output, intensive-care, critically-ill, fluid challenge, norepinephrine, circulation, ventilation, precision, Physiology, Sport Sciences
Subject categories Sport and Fitness Sciences


Various methods for indirect assessment of mean systemic filling pressure (MSFP) produce controversial results compared with MSFP at zero blood flow. We recently reported that the difference between MSFP at zero flow measured by right atrial balloon occlusion (MSFPRAO) and MSFP estimated using inspiratory holds depends on the volume status. We now compare three indirect estimates of MSFP with MSFPRAO in euvolemia, bleeding. and hypervolemia in a model of anesthetized pigs (n = 9) with intact circulation. MSFP was estimated using instantaneous beat-to-beat venous return during tidal ventilation (MSFPinst_VR). right atrial pressure-flow data pairs at flow nadir during inspiratory holds (MSFPnadir_hold), and a dynamic model analog adapted to pigs (MSFPa). MSFPRAO was underestimated by MSFPnadir_(hold) and MSFP a in all volume states. Volume status modified the difference between MSFPRAO and all indirect methods (method X volume state interaction. P <= 0.020). All methods tracked changes in MSFPRAO concordantly, with the lowest bias seen for MSFPa [bias (confidence interval): -0.4 (-0.7 to -0.0) mmHg]. We conclude that indirect estimates of MSFP are unreliable in this experimental setup. NEW & NOTEWORTHY For indirect estimations of MSFP using inspiratory hold maneuvers, instantaneous beat-to-beat venous return. or a dynamic model analog, the accuracy was affected by the underlying volume state. All methods investigated tracked changes in MSFPRAO concordantly.

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