Positive end-expiratory pressure-induced increase in central venous pressure to predict fluid responsiveness: don’t forget the peripheral venous circulation!

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Positive end-expiratory pressure-induced increase in central venous pressure to predict fluid responsiveness: don’t forget the peripheral venous circulation! J. Mallat British Journal of Anaesthesia Volume 117, Issue 3, Pages 397-399 (September 2016) DOI: 10.1093/bja/aew232 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Theoretical effects of positive-end-expiratory pressure (PEEP) on heart curve and venous return curve. (a) PEEP causes in increase in intrathoracic pressure and a right shift in the heart function curve. If there were no change in mean circulatory filling pressure (MCFP), then venous return and stroke volume index (SVI) would fall (from point A to point B). Nevertheless, if PEEP also increases MCFP by an increase in stressed volume or a decrease in venous capacitance (from MCFP 1 to MCFP 2), then venous return and SVI would be maintained compared to zero end-expiratory pressure (ZEEP) states at a new equilibrium point C. (b) If there is a rise in the pressure at which flow limitation supervenes, and then the increase in MCFP would not be sufficient to buffer PEEP-induced decreases in venous return, and, therefore, SVI falls (from point A to point B). FLl, flow-limiting point at ZEEP; FL2, flow-limiting point at PEEP. British Journal of Anaesthesia 2016 117, 397-399DOI: (10.1093/bja/aew232) Copyright © 2016 The Author(s) Terms and Conditions