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Communication Dans Un Congrès Année : 2017

Effect of positive end-expiratory pressure and tidal ventilation on the mean systemic filling pressure

Résumé

Introduction Mean systemic filling pressure (MSFP) defines the pressure measured in the veno-arterial circulatory system when the cardiac output is nil. Representing the upstream pressure of the venous return gradient, it is considered as a major hemodynamic parameter. Because of the difficulties of its measurement, it is not routinely used in clinical practice but some authors proposed to use heart–lung interaction under mechanical ventilation for its estimation. Our objective was to demonstrate how MSFP is modified by positive pressure ventilation. Patients and methods We conducted a bi-centric non interventional, prospective and observational study to measure the pressure encountered in the circulatory system at the time of death in critically-ill patients on an arterial catheter and a central venous catheter. We included 112 patients with previously inserted catheters and mechanical ventilation with a positive end-expiratory pressure (PEEP) at the time of death. After calibration and supine positioning, arterial and venous pressures were recorded in five conditions: at end-expiration and end-inspiration with and without PEEP and finally after disconnection from the ventilator. Results Pressure measured on arterial and central venous catheters did not differ, both representing MSFP. Both arterial and central venous pressures increase with tidal ventilation and with PEEP. The position of the arterial or the venous central catheters did not have any impact on these results. Conclusion MSFP measured both on arterial and central venous catheters is altered by mechanical ventilation, with a tidal volume and PEEP effect, questioning the use of cardio-pulmonary interactions under mechanical ventilation for its extrapolation.
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Dates et versions

hal-03967010 , version 1 (01-02-2023)

Identifiants

  • HAL Id : hal-03967010 , version 1

Citer

Xavier Repessé, Cyril Charron, Alix Aubry, Alexis Paternot, Julien Maizel, et al.. Effect of positive end-expiratory pressure and tidal ventilation on the mean systemic filling pressure. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress, Jan 2017, Paris, France. pp.P35. ⟨hal-03967010⟩

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