Defining human mean circulatory filling pressure in the intensive care unit

In a cohort of 311 intensive care unit (ICU) patients, median mean circulatory filling pressure (Pmcf) measured after cardiac arrest was 15 mmHg (interquartile range 12–18). In 48% of cases, arterial blood pressure remained higher than central venous pressure, but correction for arterial-to-venous compliance differences did not result in clinically relevant alterations of Pmcf. Fluid balance, use of vasopressors or inotropes, and being on mechanical ventilation were associated with a higher Pmcf.

Download Full-text

Mean Arterial Pressure Should Above 65 mmHg at Vasopressor Weaning — Exploratory Study of Optimal Weaning Blood Pressure for Patients in Intensive Care Unit

10.21203/rs.3.rs-249723/v1 ◽

2021 ◽

Author(s):

Zichen Wang ◽

Luming Zhang ◽

Wen Ma ◽

Chengzhuo Li ◽

Haiyan Yin ◽

...

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Intensive Care ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Hospital Mortality ◽

Icu Patients ◽

Arterial Blood ◽

Mortality Probability ◽

Severe Hypotension

Abstract Objective:Vasopressors are one of the main treatments for severe hypotension or shock, which commonly occurs in intensive care unit (ICU) patients. However, only a few studies have been conducted on the appropriate timing for vasopressor weaning. This study aims to explore the effect of blood pressure at vasopressor weaning on the probability of in-hospital mortality.Design: Single-center retrospective observational study.Setting: ICU from Beth Israel Deaconess Medical Center between 2008 and 2019.Patients: ICU patients who received vasopressor treatment were selected. Patients younger than 18 years old, died before vasopressor weaning or without blood pressure measurement at weaning were excluded. Finally, 8,298 patients were included.Result: General additive model (GAM) result showed that blood pressures at weaning had “U-shape” non-linear relationship with in-hospital mortality probability. The optimal levels of weaning mean arterial pressure(WMAP), weaning systolic blood pressure(WSBP), and weaning diastolic blood pressure(WDBP) were 85, 120, and 65 mmHg, respectively. Subgroup analysis showed the optimal WMAP, WSBP,WDBP has deviations between diagnoses. The “cut-point” of a lower mortality probability for WMAP was 65 mmHg. ROC curves showed that mean arterial blood pressure as an indicator exhibited the best prediction performance. Cox regression demonstrated that patients with WMAP equal to or higher than 65 mmHg will have 61% lower risk of in-hospital mortality.Conclusion: WMAP is a powerful indicator for in-hospital mortality, and its value should be greater than 65 mmHg and close to 85 mmHg to reach the highest survival probability for ICU patients after vasopressor treatment.

Download Full-text

Below-Target Postoperative Arterial Blood Pressure but Not Central Venous Pressure Is Associated With Delayed Graft Function

Transplantation Proceedings ◽

10.1016/j.transproceed.2012.03.058 ◽

2013 ◽

Vol 45 (1) ◽

pp. 46-50 ◽

Cited By ~ 12

Author(s):

M. Gingell-Littlejohn ◽

H. Koh ◽

E. Aitken ◽

P.G. Shiels ◽

C. Geddes ◽

...

Keyword(s):

Blood Pressure ◽

Central Venous Pressure ◽

Arterial Blood Pressure ◽

Venous Pressure ◽

Graft Function ◽

Delayed Graft Function ◽

Central Venous ◽

Arterial Blood

Download Full-text

Radial artery applanation tonometry for continuous noninvasive arterial blood pressure monitoring in the cardiac intensive care unit

Clinical Research in Cardiology ◽

10.1007/s00392-015-0816-5 ◽

2015 ◽

Vol 104 (6) ◽

pp. 518-524 ◽

Cited By ~ 13

Author(s):

Nicolas Langwieser ◽

Luisa Prechtl ◽

Agnes S. Meidert ◽

Alexander Hapfelmeier ◽

Christian Bradaric ◽

...

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Intensive Care ◽

Arterial Blood Pressure ◽

Blood Pressure Monitoring ◽

Applanation Tonometry ◽

Pressure Monitoring ◽

Cardiac Intensive Care Unit ◽

Arterial Blood ◽

Cardiac Intensive Care

Download Full-text

Functional Interaction between Angiotensin and Sympathetic Reflexes in Cats

Clinical Science ◽

10.1042/cs0620051 ◽

1982 ◽

Vol 62 (1) ◽

pp. 51-56 ◽

Cited By ~ 17

Author(s):

R. Hatton ◽

D. P. Clough ◽

S. A. Adigun ◽

J. Conway

Keyword(s):

Blood Pressure ◽

Central Venous Pressure ◽

Arterial Blood Pressure ◽

Venous Pressure ◽

Partial Recovery ◽

Ang Ii ◽

Central Venous ◽

Efferent Nerve ◽

Arterial Blood ◽

Sympathetic Reflexes

1. Lower-body negative pressure (LBNP) was used to stimulate sympathetic reflexes in anaesthetized cats. At −50 mmHg for 10 min it caused transient reduction in central venous pressure and systemic arterial blood pressure. Arterial blood pressure was then restored within 30 s and there was a tachycardia. Central venous pressure showed only partial recovery. The resting level of plasma renin activity (PRA; 2.9–3.2 ng h−1 ml−1) did not change until approximately 5 min into the manoeuvre. 2. When converting-enzyme inhibitor (CEI) was given 75 s after the onset of suction it caused a greater and more sustained fall in arterial blood pressure than when administered alone. The angiotensin II (ANG II) antagonist [Sar1,Ala8]ANG II produced similar effects after a short-lived pressor response. 3. This prolonged fall in arterial blood pressure produced by CEI was not associated with reduced sympathetic efferent nerve activity. This indicates that the inhibitor affects one of the peripheral actions of angiotensin and in so doing produces vasodilatation of neurogenic origin. 4. These findings suggest that angiotensin, at a level which does not exert a direct vasoconstrictor action, interacts with the sympathetic nervous system to maintain arterial blood pressure when homeostatic reflexes are activated. A reduction in the efficiency of these reflexes by CEI may contribute to its hypotensive effect.

Download Full-text

The Effect of Haemodilution on Arterial Blood Pressure, Central Venous Pressure, Intracranial and Intra-Ocular Pressures in Pigs

Scandinavian Journal of Thoracic and Cardiovascular Surgery ◽

10.3109/14017438109100586 ◽

1981 ◽

Vol 15 (3) ◽

pp. 273-277 ◽

Cited By ~ 8

Author(s):

Ivar Hørven ◽

Tryggve Lundar ◽

Per Lilleaasen ◽

Einar Hysing ◽

Oddvar Stokke

Keyword(s):

Blood Pressure ◽

Central Venous Pressure ◽

Arterial Blood Pressure ◽

Venous Pressure ◽

Central Venous ◽

Arterial Blood

Download Full-text

Inpatient Peripherally Inserted Central Venous Catheter Complications: Should Peripherally Inserted Central Catheter Lines be Placed in the Intensive Care Unit Setting?

The American Surgeon ◽

10.1177/000313481708300848 ◽

2017 ◽

Vol 83 (8) ◽

pp. 925-927 ◽

Cited By ~ 3

Author(s):

Michael Martyak ◽

Ishraq Kabir ◽

Rebecca Britt

Keyword(s):

Intensive Care Unit ◽

Interventional Radiology ◽

Intensive Care ◽

Infection Rate ◽

Blood Stream Infection ◽

Blood Stream ◽

Central Line ◽

Complication Rates ◽

Central Venous ◽

Icu Patients

Peripherally inserted central venous catheters (PICCs) are now commonly used for central access in the intensive care unit (ICU) setting; however, there is a paucity of data evaluating the complication rates associated with these lines. We performed a retrospective review of all PICCs placed in the inpatient setting at our institution during a 1-year period from January 2013 to December 2013. These were divided into two groups: those placed at the bedside in the ICU and those placed by interventional radiology in non-ICU patients. Data regarding infectious and thrombotic complications were collected and evaluated. During the study period, 1209 PICC line placements met inclusion criteria and were evaluated; 1038 were placed by interventional radiology in non-ICU patients, and 171 were placed at the bedside in ICU patients. The combined thrombotic and central line associated blood stream infection rate was 6.17 per cent in the non-ICU group and 10.53 per cent in the ICU group (P = 0.035). The thrombotic complication rate was 5.88 per cent in the non-ICU group and 7.60 per cent in the ICU group (P = 0.38), whereas the central line associated blood stream infection rate was 0.29 per cent in the non-ICU group and 2.92 per cent in the ICU group (P = 0.002). This study seems to suggest that PICC lines placed at the bedside in the ICU setting are associated with higher complication rates, in particular infectious complications, than those placed by interventional radiology in non-ICU patients. The routine placement of PICC lines in the ICU settings needs to be reevaluated given these findings.

Download Full-text

Central venous pressure and mean circulatory filling pressure in the dogfish Squalus acanthias: adrenergic control and role of the pericardium

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00282.2006 ◽

2006 ◽

Vol 291 (5) ◽

pp. R1465-R1473 ◽

Cited By ~ 7

Author(s):

Erik Sandblom ◽

Michael Axelsson ◽

Anthony P. Farrell

Keyword(s):

Central Venous Pressure ◽

Venous Return ◽

Venous Pressure ◽

Filling Pressure ◽

Control Fish ◽

Central Venous ◽

Venous Capacitance ◽

Mean Circulatory Filling Pressure ◽

Adrenergic Control ◽

Venous Vasculature

Subambient central venous pressure (Pven) and modulation of venous return through cardiac suction (vis a fronte) characterizes the venous circulation in sharks. Venous capacitance was estimated in the dogfish S qualus acanthias by measuring the mean circulatory filling pressure (MCFP) during transient occlusion of cardiac outflow. We tested the hypothesis that venous return and cardiac preload can be altered additionally through adrenergic changes of venous capacitance. The experiments involved the surgical opening of the pericardium to place a perivascular occluder around the conus arteriosus. Another control group was identically instrumented, but lacked the occluder, and was subjected to the same pharmacological protocol to evaluate how pericardioectomy affected cardiovascular status. Routine Pven was negative (−0.08 ± 0.02 kPa) in control fish but positive (0.09 ± 0.01 kPa) in the pericardioectomized group. Injections of 5 μg/kg body mass ( Mb) of epinephrine and phenylephrine (100 μg/kg Mb) increased Pven and MCFP, whereas isoproterenol (1 μg/kg Mb) decreased both variables. Thus, constriction and relaxation of the venous vasculature were mediated through the respective stimulation of α- and β-adrenergic receptors. α-Adrenergic blockade with prazosin (1 mg/kg Mb) attenuated the responses to phenylephrine and decreased resting Pven in pericardioectomized animals. Our results provide convincing evidence for adrenergic control of the venous vasculature in elasmobranchs, although the pericardium is clearly an important component in the modulation of venous function. Thus active changes in venous capacitance have previously been underestimated as an important means of modulating venous return and cardiac performance in this group.

Download Full-text