Article

How to use central venous pressure measurements.

McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada.
Current Opinion in Critical Care (Impact Factor: 3.18). 07/2005; 11(3):264-70. DOI: 10.1097/01.ccx.0000163197.70010.33
Source: PubMed

ABSTRACT Central venous pressure is a very common clinical measurement, but it is frequently misunderstood and misused. As with all hemodynamic measurements, it is important to understand its basic principles.
This analysis indicates that it is best to always consider the significance of central venous pressure in the context of the corresponding cardiac output. Even more important is the use of dynamic measures to interpret the meaning of the central venous pressure. This includes the hemodynamic response to fluid load, respiratory variations in central venous pressure, and even the change in central venous pressure with changes in the patient's overall status.
The clinical application of central venous pressure measurement requires a good understanding of the concept of the interaction of the function of the heart with the function of the return of blood to the heart.

2 Followers
 · 
542 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A clinical comparison, of two methods of afterload assessment, has been made. The first method, systemic vascular resistance index (SVR(i)), is based upon the traditional formula for afterload which utilizes central venous pressure (CVP), as well as cardiac index (C(i)), and mean arterial blood pressure (MAP). The second method, total systemic vascular resistance index (TSVR(i)), also uses MAP and C(i). However, TSVR(i) ignores the contribution of CVP. This preliminary examination, of 10 randomly-selected ICU patients, has shown a high degree of correlation (ranging from 90 to 100%) between SVR(i) and TSVR(i) (P < 0.0001). Furthermore, there was also a high degree of correlation (ranging from 94 to 100%) noted between the hour-to-hour change in SVR(i) with the hour-to-hour change in TSVR(i) (P < 0.0001). The results, of this pilot study, support the premise that the use of CVP may not always be necessary for afterload evaluation in the clinical setting. Minimally-invasive means of measuring both C(i) and MAP, without CVP, may be adequate for use in assessing afterload.
    Cardiovascular Engineering 12/2010; 10(4):246-52. DOI:10.1007/s10558-010-9113-0 · 1.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Das hämodynamische Monitoring und die Differenzialtherapie mittels adäquater Volumensubstitution sowie positiv-inotroper und vasoaktiver Substanzen sind die Grundpfeiler der postoperativen intensivmedizinischen Behandlung von kardiochirurgischen Patienten. Ziel der S3-Leitlinie ist es, die Empfehlungen zum Monitoring und zur Therapie evidenzbasiert zu prüfen sowie Zielkriterien hierfür festzulegen. Die Bewertung erhobener Messparameter im Zusammenhang mit der klinischen Gesamtsituation des Patienten erlaubt die Entwicklung eines weiterführenden Therapiekonzepts und die Festlegung von Zielkriterien zur Kontrolle des Behandlungserfolgs. Bislang existieren Leitlinien und Empfehlungen lediglich für Teilbereiche der kardiochirurgischen Intensivmedizin. So bestehen Leitlinien für den Einsatz des Pulmonalarterienkatheters und der transösophagealen Echokardiographie für diesen speziellen Bereich der postoperativen Patientenversorgung. Die Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG) und die Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) haben sich daher zum Ziel gesetzt, einen nationalen Ansatz zur Sicherung und Verbesserung der Qualität der postoperativen kardiochirurgischen Intensivmedizin mit der vorliegenden evidenzbasierten S3-Konsensusleitlinie zu schaffen. Ziel dieser Leitlinie ist eine Bewertung der verfügbaren Monitoringverfahren im Hinblick auf Indikationen, Vorgehen, Aussagen, Limitationen, Kontraindikationen und Risiken; weiterhin die Differenzialtherapie mit Volumenersatzlösungen vs. positiv inotropen und vasoaktiven Substanzen, die differenzierte Katecholamintherapie einschließlich der Inodilatoren und Kalziumsensitizer sowie die Einsatzkriterien der intraaortalen Ballonpumpe. Die Leitlinie ist in einem standardisierten Prozess nach Vorgaben der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erstellt worden. Die Verabschiedung der Kernaussagen der Leitlinie erfolgte in zwei Konsensusverfahren unter Moderation der AWMF. Hemodynamic monitoring and adequate volume therapy, as well as treatment with positive inotropic drugs and vasopressors are the basic principles of postoperative intensive care treatment of patients after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations with respect to evidence-based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of target criteria to evaluate the effect of treatment. Up to now there have only been guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, such as the use of pulmonary artery catheters or transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery and the German Society for Anesthesiology and Intensive Care Medicine made an approach to ensure and improve the quality of postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. The goal of these guidelines is to assess the available monitoring methods with respect to indications, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. These guidelines have been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the AWMF. SchlüsselwörterIntensivmedizin-Kardiochirurgie-Monitoring-Volumentherapie-Positiv-inotrope und vasoaktive Substanzen KeywordsIntensive care medicine-Cardiothoracic surgery-Monitoring-Volume therapy-Positive inotropic and vasoactive drugs
    Zeitschrift für Herz- Thorax- und Gefäßchirurgie 10/2010; 24(5):294-310. DOI:10.1007/s00398-010-0790-1
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Central venous pressure (CVP) provides information regarding right ventricular filling pressure, but is often assumed to reflect left ventricular filling pressure. It remains unknown whether this assumption is correct during thermal challenges when CVP is elevated during skin-surface cooling or reduced during whole-body heating. The primary objective of this study was to test the hypothesis that changes in CVP reflect those in left ventricular filling pressure, as expressed by pulmonary capillary wedge pressure (PCWP), during lower-body negative pressure (LBNP) while subjects are normothermic, during skin-surface cooling, and during whole-body heating. In 11 subjects, skin-surface cooling was imposed by perfusing 16 degrees C water through a water-perfused suit worn by each subject, while heat stress was imposed by perfusing 47 degrees C water through the suit sufficient to increase internal temperature 0.95 +/- 0.07 degrees C (mean +/- s.e.m.). While normothermic, CVP was 6.3 +/- 0.2 mmHg and PCWP was 9.5 +/- 0.3 mmHg. These pressures increased during skin-surface cooling (7.8 +/- 0.2 and 11.1 +/- 0.3 mmHg, respectively; P < 0.05) and decreased during whole-body heating (3.6 +/- 0.1 and 6.5 +/- 0.2 mmHg, respectively; P < 0.05). The decrease in CVP with LBNP was correlated with the reduction in PCWP during normothermia (r = 0.93), skin-surface cooling (r = 0.91), and whole-body heating (r = 0.81; all P < 0.001). When these three thermal conditions were combined, the overall r value between CVP and PCWP was 0.92. These data suggest that in the assessed thermal conditions, CVP appropriately tracks left ventricular filling pressure as indexed by PCWP. The correlation between these values provides confidence for the use of CVP in studies assessing ventricular preload during thermal and combined thermal and orthostatic perturbations.
    The Journal of Physiology 12/2007; 585(Pt 1):279-85. DOI:10.1113/jphysiol.2007.137901 · 4.54 Impact Factor