Mean systemic filling pressure (Pmsf) is the pressure in the vascular system during circulatory arrest. Venous return is determined by the pressure gradient between Pmsf and right atrial pressure. Recent studies now demonstrate that Pmsf can be measured at the bedside in mechanically ventilated intensive care patients. Using continuous monitoring of cardiac output and central venous pressure, venous return curves can be constructed by performing a series of inspiratory holds. From these venous return curves the clinician can obtain Pmsf, but also other derived parameters as resistance to venous return, systemic compliance and stressed volume. Now it is feasible to study the venous side of the circulation. This review describes the importance of venous return, the measurement of Pmsf and the clinical implications of its measurement. In addition the effects of norepinephrine on venous return are described in detail.
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