Article

Comparison of superior vena cava and femoroiliac vein pressure according to intra-abdominal pressure

AP-HP, Hôpital Saint-Antoine, Service de réanimation médicale, Paris, 75571 Cedex 12, France. .
Annals of Intensive Care (Impact Factor: 3.31). 06/2012; 2(1):21. DOI: 10.1186/2110-5820-2-21
Source: PubMed

ABSTRACT

Previous studies have shown a good agreement between central venous pressure (CVP) measurements from catheters placed in superior vena cava and catheters placed in the abdominal cava/common iliac vein. However, the influence of intra-abdominal pressure on such measurements remains unknown.
We conducted a prospective, observational study in a tertiary teaching hospital. We enrolled patients who had indwelling catheters in both superior vena cava (double lumen catheter) and femoroiliac veins (dialysis catheter) and into the bladder. Pressures were measured from all the sites, CVP, femoroiliac venous pressure (FIVP), and intra-abdominal pressure.
A total of 30 patients were enrolled (age 62 ± 14 years; SAPS II 62 (52-76)). Fifty complete sets of measurements were performed. All of the studied patients were mechanically ventilated (PEP 3 cmH20 (2-5)). We observed that the concordance between CVP and FIVP decreased when intra-abdominal pressure increased. We identified 14 mmHg as the best intra-abdominal pressure cutoff, and we found that CVP and FIVP were significantly more in agreement below this threshold than above (94% versus 50%, P = 0.002).
We reported that intra-abdominal pressure affected agreement between CVP measurements from catheter placed in superior vena cava and catheters placed in the femoroiliac vein. Agreement was excellent when intra-abdominal pressure was below 14 mmHg.

Download full-text

Full-text

Available from: Arnaud Galbois
  • [Show abstract] [Hide abstract]
    ABSTRACT: L’hypertension intra-abdominale (HIA) et le syndrome du compartiment abdominal sont fréquemment rencontrés chez les patients de réanimation, et leur présence constitue un facteur indépendant d’augmentation de la morbimortalité. Ces deux situations cliniques sont susceptibles d’interagir avec le système cardiovasculaire. Cette interaction concerne les trois composantes de la fonction cardiaque: précharge et postcharge ventriculaires, contractilitémyocardique. En règle générale, chez le patient grave de réanimation, la transmission à l’étage thoracique (augmentation de la pression intrathoracique) de l’HIA et la surélévation diaphragmatique entraînent une baisse du débit cardiaque, conséquence de la réduction du retour veineux et de la contractilité associées à une augmentation de la postcharge ventriculaire prédominant sur le ventricule droit. L’HIA s’accompagne également d’une réduction des débits rénal et hépatosplanchnique et d’une gêne au retour veineux cérébral. Les indices dynamiques d’évaluation de la précharge-dépendance conservent toute leur pertinence en présence d’une HIA. Le réanimateur doit cependant avoir à l’esprit que les valeurs seuils des différents paramètres dynamiques et en particulier celle de la variabilité respiratoire de la pression artérielle pulsée sont plus élevées en présence d’une HIA. Cette notion est d’importance pour prévenir toute administration d’une expansion volémique excessive susceptible de majorer l’HIA et donc son retentissement cardiovasculaire et viscéral. La décompression abdominale, lorsqu’elle est possible, permet le plus souvent la correction des désordres hémodynamiques.
    No preview · Article · Mar 2013 · Réanimation
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the 1980s and 1990s, the major focus in the catheterization laboratory shifted to the diagnosis and treatment of the patient with acute and chronic coronary artery disease. The hemodynamic assessment which was an essential part in the evaluation of patients with structural heart disease in the 1970s was being replaced by the rapidly evolving field of echocardiography. On the other hand, the increasing interest in pulmonary arterial hypertension (PAH), the increasing interest in implantation of LVADs, and the evolution in the percutaneous management of structural heart disease have rekindled the interest in right heart catheterization and procedures.
    No preview · Article · Jan 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The aim of the present study was to determine the use of static and dynamic haemodynamic parameters for predicting fluid responsiveness prior to volume expansion (VE) in intensive care unit (ICU) patients with systemic inflammatory response syndrome (SIRS). Methods: We conducted a prospective, multicentre, observational study in 6 French ICUs in 2012. ICU physicians were audited concerning their use of static and dynamic haemodynamic parameters before each VE performed in patients with SIRS for 6 consecutive weeks. Results: The median volume of the 566 VEs administered to patients with SIRS was 1,000ml [500-1,000ml]. Although at least one static or dynamic haemodynamic parameter was measurable before 99% (IC95%, 99% - 100%) of VEs, at least one them was used in only 38% (IC95%, 34% - 42%) of cases: static parameters in 11% of cases (IC95%, 10% - 12%) and dynamic parameters in 32% (IC95%, 30% - 34%). Static parameters were never used when uninterpretable. For 15% of VEs (IC95%, 12% - 18%), a dynamic parameter was measured in the presence of contraindications. Among dynamic parameters, respiratory variations in arterial pulse pressure (PPV) and passive leg raising (PLR) were measurable and interpretable before 17% and 90% of VEs, respectively. Conclusions: Haemodynamic parameters are underused for predicting fluid responsiveness in current practice. In contrast to static parameters, dynamic parameters are often incorrectly used in the presence of contraindications. PLR is more frequently valid than PPV for predicting fluid responsiveness in ICU patients.
    No preview · Article · Nov 2015