title: Value and determinants of the mean systemic filling pressure in critically ill patients.
abstract: Mean systemic filling pressure (Pmsf) is a major determinant of venous return. Its value is unknown in critically ill patients (ICU). Our objectives were to report Pmsf in critically ill patients and to look for its clinical determinants, if any. We performed a prospective study in 202 patients who died in the ICU with a central venous and/or arterial catheter. One minute after the heart stopped beating, intravascular pressures were recorded in the supine position after ventilator disconnection. Parameters at admission, during the ICU stay, and at the time of death were prospectively collected. One-minute Pmsf was 12.8 ± 5.6 mmHg. It did not differ according to gender, severity score, diagnosis at admission, fluid balance, need for and duration of mechanical ventilation, or length of stay. Nor was there any difference according to suspected cause of death, classified as shock (cardiogenic, septic, and hemorrhagic) and nonshock, although a large variability of values was observed. The presence of norepinephrine at the time of death (102 patients) was associated with a higher 1-min Pmsf (14 ± 6 vs. 11.4 ± 4.5 mmHg), whereas the decision to forgo life-sustaining therapy (34 patients) was associated with a lower 1-min Pmsf (10.9 ± 3.8 vs. 13.1 ± 5.3 mmHg). In a multiple-regression analysis, norepinephrine (β = 2.67, P = 0.0004) and age (β = -0.061, P = 0.022) were associated with 1-min Pmsf. One-minute Pmsf appeared highly variable without any difference according to the kind of shock and fluid balance, but was higher with norepinephrine.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France;
authors.forename: Xavier
authors.initials: X
authors.lastname: Repessé
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France;
authors.forename: Cyril
authors.initials: C
authors.lastname: Charron
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France;
authors.forename: Julia
authors.initials: J
authors.lastname: Fink
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Department of Biostatistics and Clinical Research Unit, Boulogne-Billancourt, France; and.
authors.forename: Alain
authors.initials: A
authors.lastname: Beauchet
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France;
authors.forename: Florian
authors.initials: F
authors.lastname: Deleu
authors.affiliation: Intensive Care Unit, University Hospital of Amiens, Amiens, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Slama
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France;
authors.forename: Guillaume
authors.initials: G
authors.lastname: Belliard
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France; Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin en Yvelines, France; INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France; antoine.vieillard-baron@apr.aphp.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D003643:Death; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood
chemical_list: D009638:Norepinephrine
keywords: hemodynamics; venous return