Use of a mean systemic filling pressure analogue during the closed-loop control of fluid replacement in continuous hemodiafiltration.

Abstract

PURPOSE:

To assess the use and validity of a mean systemic filling pressure analogue (Pmsa) in the closed-loop control of fluid replacement in continuous hemodiafiltration.

METHODS:

Cardiovascular variables were computer acquired from bedside monitor. Pmsa was calculated and compared with a target value. Gravitational fluid replacement to the extracorporeal hemodiafiltration circuit was regulated with a computer-controlled clamp.

RESULTS:

Ten patients (mean acute physiology and chronic health evaluation II score, 29.7; range, 21-33) received continuous venovenous hemodiafiltration for acute renal failure. Fluid replacement therapy was closed loop controlled to a target Pmsa for a total of 601 hours. During this period, 417 L of ultradiafiltrate were lost, and 409 L of replacement and nutritional fluids were administered. Despite such large fluid shifts, measured hemodynamic variables were kept within a narrow range (hour to hour variability: right atrial pressure, 1 +/- 0.1 mm Hg; mean arterial pressure 5.9 +/- 0.5 mm Hg; cardiac index, 0.44 +/- 0.05 L/m2/min). No complications of the technique occurred.

CONCLUSIONS:

The stability of cardiovascular variables achieved during Pmsa-based fluid replacement of critically ill patients with major fluid losses supports the validity of the use of the Pmsa as a measure of intravascular volume status. Such an analogue may be useful in nondialytic environments. The use of Pmsa as the basis for automated fluid replacement was safe.

• Authors: G Parkin, C Wright, R Bellomo, N Boyce
• Journal: Journal of critical care (J Crit Care) Vol. 9 Issue 2 Pg. 124-33 (Jun 1994) ISSN: 0883-9441 [Print] United States
• PMID: 7920979 (Publication Type: Clinical Trial, Journal Article)

Topics

• Acute Kidney Injury (physiopathology, therapy)
• Adult
• Aged
• Blood Volume
• Critical Illness
• Female
• Fluid Therapy (methods)
• Hemodiafiltration (methods)
• Hemodynamics
• Humans
• Male
• Middle Aged
• Monitoring, Physiologic
• Reproducibility of Results
• Signal Processing, Computer-Assisted
• Therapy, Computer-Assisted (methods)