title: Impact of positive pressure ventilation on mean systemic filling pressure in critically ill patients after death.
abstract: Mean systemic filling pressure (Pms) defines the pressure measured in the venous-arterial system when the cardiac output is nil. Its estimation has been proposed in patients with beating hearts by building the venous return curve, using different pairs of right atrial pressure/cardiac output during mechanical ventilation. We raised the hypothesis according to which the Pmsis altered by tidal ventilation and positive end-expiratory pressure (PEEP), which would challenge this extrapolation method based on cardiopulmonary interactions. We conducted a two-center, noninterventional, observational, and prospective study, using an arterial and a venous catheter to measure the pressure in the circulatory system at the time of death in critically ill, mechanically ventilated patients with a PEEP. Arterial (Part) and venous pressures (Pra) were recorded in five conditions: at end expiration and end inspiration with and without PEEP and finally once the ventilator was disconnected. Partand Pradid not differ in any experimental conditions. Tidal ventilation increased Praand Partby 2.4 and 1.9 mmHg, respectively, whereas PEEP increased both values by 1.2 and 1 mmHg, respectively. After disconnection of the ventilator, Praand Partwere 10.0 ± 4.2 and 9.9 ± 4.2 mmHg, respectively. Pmsincreases during mechanical ventilation, with an effect of tidal ventilation and PEEP. This calls into question the validity of its evaluation in heart-beating patients using cardiopulmonary interactions during mechanical ventilation.NEW & NOTEWORTHYThe physiology of the mean systemic filling pressure (Pms) is not well understood in human beings. This study is the first report of a tidal ventilation- and positive end-expiratory pressure-related increase in Pmsin critically ill patients. The results challenge the utility and the value estimating Pmsin heart-beating patients by reconstruction of the venous return curve using varying inflation pressures.
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.|University of Versailles Saint-Quentin en Yvelines, Faculty of Medicine Paris Ile-de-France Ouest, Saint-Quentin en Yvelines, France.|INSERM U-1018, Centre de Recherche en Épidémiologie et Santé des Populations, Team 5 (EpReC, Renal, and Cardiovascular Epidemiology), Université de Versailles Saint-Quentin en Yvelines, Villejuif, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France.|University of Versailles Saint-Quentin en Yvelines, Faculty of Medicine Paris Ile-de-France Ouest, Saint-Quentin en Yvelines, France.
authors.forename: Alix
authors.initials: A
authors.lastname: Aubry
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France.|University of Versailles Saint-Quentin en Yvelines, Faculty of Medicine Paris Ile-de-France Ouest, Saint-Quentin en Yvelines, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Paternot
authors.affiliation: Intensive Care Unit, University Hospital of Amiens, Amiens, France; and.|Unité INSERM 1088, University of Picardie Jules Verne, Amiens, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Maizel
authors.affiliation: Intensive Care Unit, University Hospital of Amiens, Amiens, France; and.|Unité INSERM 1088, University of Picardie Jules Verne, 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; antoine.vieillard-baron@aphp.fr.|University of Versailles Saint-Quentin en Yvelines, Faculty of Medicine Paris Ile-de-France Ouest, Saint-Quentin en Yvelines, France.|INSERM U-1018, Centre de Recherche en Épidémiologie et Santé des Populations, Team 5 (EpReC, Renal, and Cardiovascular Epidemiology), Université de Versailles Saint-Quentin en Yvelines, Villejuif, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
mesh_terms: D000368:Aged; D001158:Arteries / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D016638:Critical Illness; D005260:Female; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D014680:Veins / Q000502:physiology; D014690:Venous Pressure / Q000502:physiology*
keywords: mean systemic filling pressure; mechanical ventilation; venous return