The presence of norepinephrine at the time of death in critically ill patients was associated with a higher 1-minute mean systemic filling pressure (14 vs. 11.4 mmHg; P=0.0004).
Observational (n=202)
What is the value and what are the clinical determinants of mean systemic filling pressure in critically ill patients?
Mean systemic filling pressure in critically ill patients is highly variable and is significantly increased by the use of norepinephrine.
Effect estimate: β = 2.67
Absolute Event Rate: 14% vs 11.4%
p-value: p=0.0004
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.
Repessé et al. (Sat,) conducted a observational in Critically ill patients (n=202). Norepinephrine at the time of death vs. No norepinephrine was evaluated on 1-minute mean systemic filling pressure (Pmsf) (β = 2.67, p=0.0004). The presence of norepinephrine at the time of death in critically ill patients was associated with a higher 1-minute mean systemic filling pressure (14 vs. 11.4 mmHg; P=0.0004).