Aya, HD

Carsetti, A

Cecconi, M

Fletcher, N

Mellinghoff, J

Pierantozzi, S

Rhodes, A

PubMed

HD Aya

A Carsetti

S Pierantozzi

J Mellinghof

N Fletcher

A Rhodes

M Cecconi

Springer - Publisher Connector

CHANGES ON MEAN SYSTEMIC FILLING PRESSURE AND MICROCIRCULATION AFTER A FLUID CHALLENGE

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Intensive Care Medicine Experimental

Changes On Mean Systemic Filling Pressure And Microcirculation After a Fluid Challenge

Kingston University Research Repository

ORAL PRESENTATION Open AccessChanges on mean systemic filling pressure andmicrocirculation after a fluid challengeHD Aya1,2*, A Carsetti1, S Pierantozzi1, J Mellinghof1, N Fletcher1,2, A Rhodes1,2, M Cecconi1,2From ESICM LIVES 2015Berlin, Germany. 3-7 October 2015IntroductionIn a previous study we observed that a fluid challenge of4 ml/Kg is adequate to raise the mean systemic fillingpressure (Pmsf) and to increase venous return in fluidresponsive patients.ObjectivesThe objective of this study is to describe the changes onmicrocirculation after a fluid challenge and describe therelationship with the changes on Pmsf. Our hypothesisis that changes in Pmsf could induce changes on thenumber of perfused vessels (PVD).Methods24 post-operative cardiac patients were prospectivelyenrolled. Arterial pressure and central venous pressurewas measured invasively. Cardiac output (CO) wasmeasured with a non-calibrated LiDCOplus monitor(LiDCO, Cambridge). Pmsf was measured using thestop-flow arterial venous equilibrium pressure method(1). Sublingual microcirculation was recorded withCytoCam (Braedius Medical, Amsterdam, The Nether-lands). Data was recorded at baseline, immediatelyafter the fluid infusion, 5 and 10 minutes after the endof 4 ml/Kg of crystalloids infused in 5 minutes. Ateach time at least three sublingual microcirculationvideos were acquired to assess total vessel density(TVD), microcirculatory flow index (MFI), proportionof perfused vessel (PPV), perfused vessel density (PVD)and microcirculatory heterogeneity index (MHI).Analysis was performed with AVA software v. 3.2(MicroVision Medical, Amsterdam, The Netherlands).Responders are defined by an increase in CO greaterthan 10%.ResultsChanges on haemodynamics and microcirculatoryindices are presented in table 1 and 2. Pmsf increased inboth groups. There were no significant changes inmicrocirculatory parameters, either in responders ornon-responders. There was no significant correlationbetween changes on PVD and changes in CO (t = 0.08,p= 0.59) or Pmsf (t = 0.12, p= 0.41).1St George’s University Hospitals NHS Foundation Trust, Adult Critical Care,London, United KingdomFull list of author information is available at the end of the articleTable 1. Changes on haemodynamicsResponders (n = 14) Non-Responders (n = 10)Baseline Peak value Post-FC p Baseline Peak value Post-FC pSV (ml) 78.5 (63.3 - 91.3) 94.5 (80.3 - 102 .8) 0.001 69.5 (57 - 87.5) 75.5 (56.5 - 86.8) 0.1Pmsf (mmHg) 23 (16.5 - 26) 28 (20.8 - 29) 0.01 25 (20.8 - 27.5) 26.5 (23.8 - 32) 0.04HR (bpm) 83 (77.5 - 89.3) 84 (79.3 - 89.3) 0.25 80 (74.3 - 86.5) 80 (74 - 91) 0.20CVP (mmHg) 9 (7.8 - 11) 10.5 (7 - 12.3) 0.24 11.5 (8.5 - 13.5) 13.5 (10.3 - 15) 0.04MAP (mmHg) 72 (67.8 - 84.8) 86.5 (80.8 - 94) 0.001 78 (69.5 - 80.3) 80 (76.3 - 83.5) 0.03Aya et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A20http://www.icm-experimental.com/content/3/S1/A20© 2015 Aya et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal work is properly cited.ConclusionsDespite the changes in Pmsf and macrohaemodynamics,a fluid challenge does not improve microcirculation inpatients after cardiac surgery.Authors’ details1St George’s University Hospitals NHS Foundation Trust, Adult Critical Care,London, United Kingdom. 2St George’s University of London, CardiovascularInstitute, London, United Kingdom.Published: 1 October 2015Reference1. Aya HD, Rhodes A, Fletcher N, et al: Transient stop-flow arm arterial-venous equilibrium pressure measurement: determination of precisionof the technique. J Clin Monit Comput 2015.doi:10.1186/2197-425X-3-S1-A20Cite this article as: Aya et al.: Changes on mean systemic fillingpressure and microcirculation after a fluid challenge. Intensive CareMedicine Experimental 2015 3(Suppl 1):A20.Submit your manuscript to a journal and benefi t from:7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available online7 High visibility within the fi eld7 Retaining the copyright to your article    Submit your next manuscript at 7 springeropen.comTable 2. Changes on microcirculatory indicesResponders (n = 14) Non-Responders (n = 10)Baseline Peak value Post-FC p Baseline Peak value Post-FC pMFI 2.83 (2.66 - 3) 2.83 (2.5 - 3) 0.75 2.92 (2.56 - 3) 2.85 (2.35 - 2.95) 0.21TVD (n/mm) 10.8 (9 - 12.6) 12 (10.2 - 12.9) 0.3 12.6 (11.4 - 13) 12.1 (9.5 - 14.4) 0.79PVD (n/mm) 9.9 (8.8 - 12.4) 11.6 (9.9 - 12.6) 0.55 12 (10.8 - 12.7) 11.2 (8.7 - 14) 0.39PPV (%) 98.3 (94.8 - 99.2) 95.6 (90-6 - 99.1) 0.47 95.5 (94.6 - 97.4) 92.8 (89.2 - 98.7) 0.17MHI 8.8 (0 - 34) 12.2 (0 - 28) 0.86 8.8 (0 - 25.8) 6.9 (0 - 23.5) 0.48Aya et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A20http://www.icm-experimental.com/content/3/S1/A20Page 2 of 2

Changes on mean systemic filling pressure and microcirculation after a fluid challenge

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Changes on mean systemic filling pressure and microcirculation after a fluid challenge

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