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Estimating mean circulatory filling pressure in clinical practice: a systematic review comparing three bedside methods in the critically ill
The bedside hemodynamic assessment of the critically ill remains challenging since blood volume, arterial–venous interaction and compliance are not measured directly. Mean circulatory filling pressure (P(mcf)) is the blood pressure throughout the vascular system at zero flow. Animal studies have sho...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010367/ https://www.ncbi.nlm.nih.gov/pubmed/29926230 http://dx.doi.org/10.1186/s13613-018-0418-2 |
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author | Wijnberge, Marije Sindhunata, Daniko P. Pinsky, Michael R. Vlaar, Alexander P. Ouweneel, Else Jansen, Jos R. Veelo, Denise P. Geerts, Bart F. |
author_facet | Wijnberge, Marije Sindhunata, Daniko P. Pinsky, Michael R. Vlaar, Alexander P. Ouweneel, Else Jansen, Jos R. Veelo, Denise P. Geerts, Bart F. |
author_sort | Wijnberge, Marije |
collection | PubMed |
description | The bedside hemodynamic assessment of the critically ill remains challenging since blood volume, arterial–venous interaction and compliance are not measured directly. Mean circulatory filling pressure (P(mcf)) is the blood pressure throughout the vascular system at zero flow. Animal studies have shown P(mcf) provides information on vascular compliance, volume responsiveness and enables the calculation of stressed volume. It is now possible to measure P(mcf) at the bedside. We performed a systematic review of the current P(mcf) measurement techniques and compared their clinical applicability, precision, accuracy and limitations. A comprehensive search strategy was performed in PubMed, Embase and the Cochrane databases. Studies measuring P(mcf) in heart-beating patients at the bedside were included. Data were extracted from the articles into predefined forms. Quality assessment was based on the Newcastle–Ottawa Scale for cohort studies. A total of 17 prospective cohort studies were included. Three techniques were described: P(mcf) hold, based on inspiratory hold-derived venous return curves, P(mcf) arm, based on arterial and venous pressure equilibration in the arm as a model for the entire circulation, and P(mcf) analogue, based on a Guytonian mathematical model of the circulation. The included studies show P(mcf) to accurately follow intravascular fluid administration and vascular compliance following drug-induced hemodynamic changes. Bedside P(mcf) measures allow for more direct assessment of circulating blood volume, venous return and compliance. However, studies are needed to determine normative P(mcf) values and their expected changes to therapies if they are to be used to guide clinical practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-018-0418-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6010367 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-60103672018-07-04 Estimating mean circulatory filling pressure in clinical practice: a systematic review comparing three bedside methods in the critically ill Wijnberge, Marije Sindhunata, Daniko P. Pinsky, Michael R. Vlaar, Alexander P. Ouweneel, Else Jansen, Jos R. Veelo, Denise P. Geerts, Bart F. Ann Intensive Care Review The bedside hemodynamic assessment of the critically ill remains challenging since blood volume, arterial–venous interaction and compliance are not measured directly. Mean circulatory filling pressure (P(mcf)) is the blood pressure throughout the vascular system at zero flow. Animal studies have shown P(mcf) provides information on vascular compliance, volume responsiveness and enables the calculation of stressed volume. It is now possible to measure P(mcf) at the bedside. We performed a systematic review of the current P(mcf) measurement techniques and compared their clinical applicability, precision, accuracy and limitations. A comprehensive search strategy was performed in PubMed, Embase and the Cochrane databases. Studies measuring P(mcf) in heart-beating patients at the bedside were included. Data were extracted from the articles into predefined forms. Quality assessment was based on the Newcastle–Ottawa Scale for cohort studies. A total of 17 prospective cohort studies were included. Three techniques were described: P(mcf) hold, based on inspiratory hold-derived venous return curves, P(mcf) arm, based on arterial and venous pressure equilibration in the arm as a model for the entire circulation, and P(mcf) analogue, based on a Guytonian mathematical model of the circulation. The included studies show P(mcf) to accurately follow intravascular fluid administration and vascular compliance following drug-induced hemodynamic changes. Bedside P(mcf) measures allow for more direct assessment of circulating blood volume, venous return and compliance. However, studies are needed to determine normative P(mcf) values and their expected changes to therapies if they are to be used to guide clinical practice. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-018-0418-2) contains supplementary material, which is available to authorized users. Springer International Publishing 2018-06-20 /pmc/articles/PMC6010367/ /pubmed/29926230 http://dx.doi.org/10.1186/s13613-018-0418-2 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Review Wijnberge, Marije Sindhunata, Daniko P. Pinsky, Michael R. Vlaar, Alexander P. Ouweneel, Else Jansen, Jos R. Veelo, Denise P. Geerts, Bart F. Estimating mean circulatory filling pressure in clinical practice: a systematic review comparing three bedside methods in the critically ill |
title | Estimating mean circulatory filling pressure in clinical practice: a systematic review comparing three bedside methods in the critically ill |
title_full | Estimating mean circulatory filling pressure in clinical practice: a systematic review comparing three bedside methods in the critically ill |
title_fullStr | Estimating mean circulatory filling pressure in clinical practice: a systematic review comparing three bedside methods in the critically ill |
title_full_unstemmed | Estimating mean circulatory filling pressure in clinical practice: a systematic review comparing three bedside methods in the critically ill |
title_short | Estimating mean circulatory filling pressure in clinical practice: a systematic review comparing three bedside methods in the critically ill |
title_sort | estimating mean circulatory filling pressure in clinical practice: a systematic review comparing three bedside methods in the critically ill |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010367/ https://www.ncbi.nlm.nih.gov/pubmed/29926230 http://dx.doi.org/10.1186/s13613-018-0418-2 |
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