Werner-Moller Per, Sondergaard Soren, Jakob Stephan M, Takala Jukka, Berger David
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.
Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Ostra, Gothenburg , Sweden.
J Appl Physiol (1985). 2019 Jun 1;126(6):1503-1513. doi: 10.1152/japplphysiol.00897.2018. Epub 2019 Feb 28.
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 (MSFP) and MSFP estimated using inspiratory holds depends on the volume status. We now compare three indirect estimates of MSFP with MSFP in euvolemia, bleeding, and hypervolemia in a model of anesthetized pigs ( = 9) with intact circulation. MSFP was estimated using instantaneous beat-to-beat venous return during tidal ventilation (MSFP), right atrial pressure-flow data pairs at flow nadir during inspiratory holds (MSFP), and a dynamic model analog adapted to pigs (MSFP). MSFP was underestimated by MSFP and MSFP in all volume states. Volume status modified the difference between MSFP and all indirect methods (method × volume state interaction, ≤ 0.020). All methods tracked changes in MSFP concordantly, with the lowest bias seen for MSFP [bias (confidence interval): -0.4 (-0.7 to -0.0) mmHg]. We conclude that indirect estimates of MSFP are unreliable in this experimental setup. 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 MSFP concordantly.
与零血流时的平均体循环充盈压（MSFP）相比，各种间接评估平均体循环充盈压的方法得出的结果存在争议。我们最近报道，通过右心房球囊闭塞测量的零血流时的MSFP（MSFP）与使用吸气暂停估计的MSFP之间的差异取决于容量状态。我们现在在具有完整循环的麻醉猪模型（n = 9）中，比较三种间接估计的MSFP与正常容量、出血和高容量状态下的MSFP。使用潮气量通气期间的瞬时逐搏静脉回流量（MSFP）、吸气暂停期间血流最低点时的右心房压力-流量数据对（MSFP）以及适用于猪的动态模型模拟（MSFP）来估计MSFP。在所有容量状态下，MSFP和MSFP均低估了MSFP。容量状态改变了MSFP与所有间接方法之间的差异（方法×容量状态交互作用，P≤0.020）。所有方法均一致地跟踪了MSFP的变化，其中MSFP的偏差最低[偏差（置信区间）：-0.4（-0.7至-0.0）mmHg]。我们得出结论，在该实验设置中，MSFP的间接估计不可靠。对于使用吸气暂停操作、瞬时逐搏静脉回流量或动态模型模拟对MSFP进行间接估计时，准确性受基础容量状态影响。所有研究的方法均一致地跟踪了MSFP的变化。
