Peripheral Venous Pressure as an Indicator of Preload Responsiveness during Volume Resuscitation from Hemorrhage

Michael Kinsky, Nicole Ribeiro, Maxime Cannesson, Donald Deyo, George Kramer, Michael Salter, Muzna Khan, Hyunsu Ju, William E. Johnston

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Fluid resuscitation of hypovolemia presumes that peripheral venous pressure (PVP) increases more than right atrial pressure (RAP), so the net pressure gradient for venous return (PVP-RAP) rises. However, the heart and peripheral venous system function under different compliances that could affect their respective pressures during fluid infusion. In a porcine model of hemorrhage resuscitation, we examined whether RAP increases more than PVP, thereby reducing the venous return pressure gradient and blood flow. METHODS: Anesthetized pigs (n = 8) were bled to a mean arterial blood pressure of 40 mm Hg and resuscitated with stored blood and albumin for pulmonary artery occlusion pressures (PAOPs) of 5, 10, 15, and 20 mm Hg. Venous pressures, inferior vena cava blood flow (ultrasonic flowprobe), and left ventricular diastolic compliance (Doppler echocardiography) were measured. Stroke volume variability was calculated. RESULTS: With volume resuscitation, the slope of RAP exceeded PVP (P ≤ 0.0001) when PAOP is 10 to 20 mm Hg, causing the pressure gradient for venous return to progressively decrease. Inferior vena cava blood flow did not further increase after PAOP > 10 mm Hg. The E/e′ ratio increased (P = 0.001) during resuscitation indicating reduced diastolic compliance. A significant curvilinear relationship was found between PVP and stroke volume variability (R2 = 0.62; P <0.001), where fluid responders had PVP <15 mm Hg. CONCLUSIONS: Fluid resuscitation above a PAOP 10 mm Hg reduces myocardial compliance and reduces the venous return pressure gradient. The hemodynamic response to fluid resuscitation becomes limited by diastolic properties of the heart. PVP measurement during hemorrhage resuscitation may predict fluid responsiveness and nonresponsiveness.

Original languageEnglish (US)
Pages (from-to)114-122
Number of pages9
JournalAnesthesia and Analgesia
Volume123
Issue number1
DOIs
StatePublished - Jul 1 2016

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Venous Pressure
Resuscitation
Hemorrhage
Atrial Pressure
Pulmonary Artery
Compliance
Pressure
Inferior Vena Cava
Stroke Volume
Arterial Pressure
Swine
Hypovolemia
Doppler Echocardiography
Ultrasonics
Albumins
Hemodynamics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Peripheral Venous Pressure as an Indicator of Preload Responsiveness during Volume Resuscitation from Hemorrhage. / Kinsky, Michael; Ribeiro, Nicole; Cannesson, Maxime; Deyo, Donald; Kramer, George; Salter, Michael; Khan, Muzna; Ju, Hyunsu; Johnston, William E.

In: Anesthesia and Analgesia, Vol. 123, No. 1, 01.07.2016, p. 114-122.

Research output: Contribution to journalArticle

Kinsky, Michael ; Ribeiro, Nicole ; Cannesson, Maxime ; Deyo, Donald ; Kramer, George ; Salter, Michael ; Khan, Muzna ; Ju, Hyunsu ; Johnston, William E. / Peripheral Venous Pressure as an Indicator of Preload Responsiveness during Volume Resuscitation from Hemorrhage. In: Anesthesia and Analgesia. 2016 ; Vol. 123, No. 1. pp. 114-122.
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AU - Cannesson, Maxime

AU - Deyo, Donald

AU - Kramer, George

AU - Salter, Michael

AU - Khan, Muzna

AU - Ju, Hyunsu

AU - Johnston, William E.

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N2 - BACKGROUND: Fluid resuscitation of hypovolemia presumes that peripheral venous pressure (PVP) increases more than right atrial pressure (RAP), so the net pressure gradient for venous return (PVP-RAP) rises. However, the heart and peripheral venous system function under different compliances that could affect their respective pressures during fluid infusion. In a porcine model of hemorrhage resuscitation, we examined whether RAP increases more than PVP, thereby reducing the venous return pressure gradient and blood flow. METHODS: Anesthetized pigs (n = 8) were bled to a mean arterial blood pressure of 40 mm Hg and resuscitated with stored blood and albumin for pulmonary artery occlusion pressures (PAOPs) of 5, 10, 15, and 20 mm Hg. Venous pressures, inferior vena cava blood flow (ultrasonic flowprobe), and left ventricular diastolic compliance (Doppler echocardiography) were measured. Stroke volume variability was calculated. RESULTS: With volume resuscitation, the slope of RAP exceeded PVP (P ≤ 0.0001) when PAOP is 10 to 20 mm Hg, causing the pressure gradient for venous return to progressively decrease. Inferior vena cava blood flow did not further increase after PAOP > 10 mm Hg. The E/e′ ratio increased (P = 0.001) during resuscitation indicating reduced diastolic compliance. A significant curvilinear relationship was found between PVP and stroke volume variability (R2 = 0.62; P <0.001), where fluid responders had PVP <15 mm Hg. CONCLUSIONS: Fluid resuscitation above a PAOP 10 mm Hg reduces myocardial compliance and reduces the venous return pressure gradient. The hemodynamic response to fluid resuscitation becomes limited by diastolic properties of the heart. PVP measurement during hemorrhage resuscitation may predict fluid responsiveness and nonresponsiveness.

AB - BACKGROUND: Fluid resuscitation of hypovolemia presumes that peripheral venous pressure (PVP) increases more than right atrial pressure (RAP), so the net pressure gradient for venous return (PVP-RAP) rises. However, the heart and peripheral venous system function under different compliances that could affect their respective pressures during fluid infusion. In a porcine model of hemorrhage resuscitation, we examined whether RAP increases more than PVP, thereby reducing the venous return pressure gradient and blood flow. METHODS: Anesthetized pigs (n = 8) were bled to a mean arterial blood pressure of 40 mm Hg and resuscitated with stored blood and albumin for pulmonary artery occlusion pressures (PAOPs) of 5, 10, 15, and 20 mm Hg. Venous pressures, inferior vena cava blood flow (ultrasonic flowprobe), and left ventricular diastolic compliance (Doppler echocardiography) were measured. Stroke volume variability was calculated. RESULTS: With volume resuscitation, the slope of RAP exceeded PVP (P ≤ 0.0001) when PAOP is 10 to 20 mm Hg, causing the pressure gradient for venous return to progressively decrease. Inferior vena cava blood flow did not further increase after PAOP > 10 mm Hg. The E/e′ ratio increased (P = 0.001) during resuscitation indicating reduced diastolic compliance. A significant curvilinear relationship was found between PVP and stroke volume variability (R2 = 0.62; P <0.001), where fluid responders had PVP <15 mm Hg. CONCLUSIONS: Fluid resuscitation above a PAOP 10 mm Hg reduces myocardial compliance and reduces the venous return pressure gradient. The hemodynamic response to fluid resuscitation becomes limited by diastolic properties of the heart. PVP measurement during hemorrhage resuscitation may predict fluid responsiveness and nonresponsiveness.

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