Central venous pressure: we need to bring clinical use into physiological context

Abstract

The correct measurement of CVP is pivotal to its proper clinical application. This relates to defining the pressure gradient for venous return and heart efficiency. The clinical appreciation of CVP should be restored by educational efforts of its physiological context.

Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation

“…Indeed, adult studies inconsistently find CVP to predict posttransplantation graft function . This is not surprising given that CVP is a complex parameter depending on multiple factors: pericardial pressure, intrathoracic pressure, intra‐abdominal pressure, vascular resistance, blood volume, and cardiac function . Esophageal Doppler monitoring was similarly not found to be predictive of improved postoperative renal function—which may be due to substantial intraoperative crystalloid use (average 103 mL kg −1 ) across all patients.…”

Shock treatment in a cohort of Scandinavian intensive care units in 2014

“…The low proportion of more comprehensive hemodynamic monitoring methods used in the management of shock is surprising. We believe there is a need for further research and education in the field of hemodynamic monitoring regarding how it should be used to improve outcome in patients with shock.…”

Central venous pressure as an adjunct to flow-guided volume optimisation after induction of general anaesthesia

“…A recent consensus article described the clinical value of CVP in vague terms only [11]. CVP apparently represents the volume status only when the heart is stopped, whereas in CVP the intact circulation is modified by many factors, including intrathoracic and intra-abdominal pressures, transmural pressure and vessel distensibility [3]. The dependency on intrathoracic pressure probably explains why CVP rose after the induction of anaesthesia in the present study, despite the fact that general anaesthesia causes vasodilatation (Table 1).…”

“…CVP increases because of rapid accidental or deliberate volume loading [2] and is a widely used haemodynamic measure of cardiovascular filling [3]. However, the scientific view which has received support in outcome studies [4,5], is that fluid responsiveness, rather than CVP, should be used to guide fluid therapy.…”