Published January 4, 2023 | Version v1
Journal article Open

Relationship between Mean Systemic Filling Pressure, Cardiac Power Output, Myocardial Efficiency and Venous Return Gradient in Liver Transplant Patients

Authors/Creators

  • 1. Critical Care Medicine and Emergency Medicine Physician. Hospital General de México "Eduardo Liceaga", CDMX. Obstetric Intensive Care Unit.
  • 2. Master's degree in clinical research, Critical Care Medicine and Anesthesiologists Physician. IMSS, UMAE HE No. 1 CMN, León, Guanajuato. Mexico. Intensive Care Unit.
  • 3. Critical Care Medicine and Internal Medicine Physician. Hospital General de México "Eduardo Liceaga", CDMX. Obstetric Intensive Care Unit.
  • 4. General Surgery and High specialty in abdominal organ transplant. Hospital General de México "Eduardo Liceaga", CDMX.
  • 5. Critical Care Medicine and Emergency Medicine Physician. IMSS, UMAE HE No. 1 CMN, León, Guanajuato. Mexico. Intensive Care Unit.

Description

Introduction: The mean systemic filling pressure (PMSF) depends on volemic state, vasomotor tone and cardiovascular function. Therefore, it should be causally correlated with cardiac power, myocardial efficiency and venous return gradient. The aim of the present study was to correlate PMSF with cardiac output, myocardial efficiency and venous return gradient in the perioperative period of patients undergoing orthotopic heart transplantation.

 

Material and methods. Retrospective, descriptive, analytical cohort study, from January 1, 2021 to January 31, 2022. Inclusion criteria included liver transplantation (ortothopic) adult patients with pulmonary artery catheter. Those with decompensated liver disease due to hemorrhage, grade III ascites or hepatic encephalopathy and those admitted to the ICU without pulmonary artery catheter were excluded. The aim was to correlate PMSF with cardiac power, myocardial efficiency and venous return gradient in the perioperative period of liver transplantation patients.

 

Results. A strong positive correlation was reported between cardiac power and PMSF just after placement of the pulmonary artery catheter (initial) (r= 0.929, p= <0.001), as well as between cardiac power output and PMSF in the preanhepatic phase (r= 0.591, p= 0.013). For myocardial efficiency strong negative correlations with significant p-value were found for initial PMSF and myocardial efficiency r= -0.659, p= 0.04; between myocardial efficiency and PMSF in the preanhepatic phase r= -0.635, p= 0. 006; myocardial efficiency and PMSF in the anhepatic phase, r= -0.593, p= 0.012; between myocardial efficiency and PMSF in the neohepatic phase r= -0.502, p= 0.040; and for myocardial efficiency and PMSF on admission of patients to the ICU  r=-0.571, p= 0.017. Related to the venous return gradient (PMSF - CVP) and PMSF, the correlation was r= 0.919, p= <0.001 (initial) and for the preanhepatic phase with a moderate positive correlation r= 0.490 p= 0.046.

 

Conclusion. PMSF is useful as a marker for the diagnosis and hemodynamic management of patients undergoing liver transplantation.  

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