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

Research output: Contribution to journalArticleResearchpeer-review

21 Citations (Scopus)


Purpose: To assess the use and validity of a mean systemic filling pressure analogue (Pmsa) in the closedloop 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 Pms, 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.

Original languageEnglish
Pages (from-to)124-133
Number of pages10
JournalJournal of Critical Care
Issue number2
Publication statusPublished - 1 Jan 1994
Externally publishedYes

Cite this