Effect of volume status on the estimation of mean systemic filling pressure

Various methods for indirect assessment of mean systemic filling pressure (MSFP) produce controversial results compared with MSFP at zero blood flow. We recently reported that the difference between MSFP at zero flow measured by right atrial balloon occlusion (MSFP_RAO) and MSFP estimated using inspiratory holds depends on the volume status. We now compare three indirect estimates of MSFP with MSFP_RAO in euvolemia, bleeding, and hypervolemia in a model of anesthetized pigs (n = 9) with intact circulation. MSFP was estimated using instantaneous beat-to-beat venous return during tidal ventilation (MSFP_{inst_VR}), right atrial pressure-flow data pairs at flow nadir during inspiratory holds (MSFP_{nadir_hold}), and a dynamic model analog adapted to pigs (MSFP_a). MSFP_RAO was underestimated by MSFP_{nadir_hold} and MSFP_a in all volume states. Volume status modified the difference between MSFP_RAO and all indirect methods (method × volume state interaction, P ≤ 0.020). All methods tracked changes in MSFP_RAO concordantly, with the lowest bias seen for MSFP_a [bias (confidence interval): -0.4 (-0.7 to -0.0) mmHg]. We conclude that indirect estimates of MSFP are unreliable in this experimental setup. NEW & NOTEWORTHY For indirect estimations of MSFP using inspiratory hold maneuvers, instantaneous beat-to-beat venous return, or a dynamic model analog, the accuracy was affected by the underlying volume state. All methods investigated tracked changes in MSFP_RAO concordantly.