Comparison of different techniques of central venous pressure measurement in mechanically ventilated critically ill patients

Roger, Claire; Muller, Laurent; Riou, Bruno; Molinari, Nicolas; Louart, Benjamin; Kerbrat, H; Teboul, Jean‐Louis; Lefrant, Jean‐Yves

doi:10.1093/bja/aew386

Cited by 20 publications

(18 citation statements)

References 36 publications

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“…The distal port was connected to a differential pressure transducer which was filled with a 0.9% saline solution. CVP measurements were zeroed at mid-thoracic position at the level of the fifth rib [27], and the value was taken during either end-inspiration or end-expiration, at the base of "c" wave [28]. Transmural CVP was calculated as the difference between CVP and Pes [29].…”

Section: Measurementmentioning

confidence: 99%

Central venous pressure swing outperforms diaphragm ultrasound as a measure of inspiratory effort during pressure support ventilation in COVID-19 patients

Lassola

Miori

Sanna

et al. 2021

J Clin Monit Comput

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Purpose The COVID-19-related shortage of ICU beds magnified the need of tools to properly titrate the ventilator assistance. We investigated whether bedside-available indices such as the ultrasonographic changes in diaphragm thickening ratio (TR) and the tidal swing in central venous pressure (ΔCVP) are reliable estimates of inspiratory effort, assessed as the tidal swing in esophageal pressure (ΔPes). Methods Prospective, observational clinical investigation in the intensive care unit of a tertiary care Hospital. Fourteen critically-ill patients were enrolled (age 64 ± 7 years, BMI 29 ± 4 kg/m2), after 6 [3; 9] days from onset of assisted ventilation. A three-level pressure support trial was performed, at 10 (PS10), 5 (PS5) and 0 cmH2O (PS0). In each step, the esophageal and central venous pressure tidal swing were recorded, as well as diaphragm ultrasound. Results The reduction of pressure support was associated with an increased respiratory rate and a reduced tidal volume, while minute ventilation was unchanged. ΔPes significantly increased with reducing support (5 [3; 8] vs. 8 [14; 13] vs. 12 [6; 16] cmH2O, p < 0.0001), as did the diaphragm TR (9.2 ± 6.1 vs. 17.6 ± 7.2 vs. 28.0 ± 10.0%, p < 0.0001) and the ΔCVP (4 [3; 7] vs. 8 [5; 9] vs. 10 [7; 11] cmH2O, p < 0.0001). ΔCVP was significantly associated with ΔPes (R2 = 0.810, p < 0.001), as was diaphragm TR, albeit with a lower coefficient of determination (R2 = 0.399, p < 0.001). Conclusions In patients with COVID-19-associated respiratory failure undergoing assisted mechanical ventilation, ΔCVP is a better estimate of inspiratory effort than diaphragm ultrasound.

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Section: Measurementmentioning

confidence: 99%

Central venous pressure swing outperforms diaphragm ultrasound as a measure of inspiratory effort during pressure support ventilation in COVID-19 patients

Lassola

Miori

Sanna

et al. 2021

J Clin Monit Comput

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“…1,2 Although monitoring central venous pressure through the insertion of a central venous catheter is regarded as the gold standard, it is invasive and timeconsuming. 3 Moreover, several complications related to central venous catheter insertion include injury to local structures, phlebitis at the insertion site, air embolism, hematoma, arrhythmia, and catheter malposition. 4 A nondiameter.…”

Section: Introductionmentioning

confidence: 99%

Correlation of Inferior Vena Cava diameter and IVC Collapsibility Index with Central Venous Pressure (CVP) in critically ill surgical patients

Singh

Thapa

Limbu

et al. 2021

J. Soc. Surg. Nepal

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Introduction: Central Venous Pressure is a valuable parameter in the management of critically ill surgical patients in the ICU. Non-invasive methods to extrapolate the volume status of the patient can aid clinicians in expediting proper treatment. The objective of this study is to find a correlation between Inferior Vena cava (IVC) diameter and collapsibility index (CI) with Central venous pressure (CVP) in critically ill surgical patients. Methods: This cross-sectional study included 60 critically ill patients from September 2020 – 31st February 2021. We recorded the patient's age, sex, heart rate, blood pressure, CVP, volume status, IVC minimum, and maximum diameter. After taking consent and explaining the procedure to the patient, the maximum IVC anteroposterior diameter was noted at the end of inspiration and end of expiration in centimeters. IVC collapsibility index was calculated using the formula ([IVCdmax-IVCdmin]/IVCdmax*100%). Following this, the CVP of the patient was measured. Results: Among the patients evaluated, 32 were females. The mean age of the participants was 44.90 ± 15.76 years. The mean central venous pressure maintained was 11.10 ± 2.11cm H2O with an inferior vena cava collapsibility index of 29.69 ± 8.75. There was a negative correlation between CVP and IVC collapsibility index (%), which was statistically significant (r = -0.701, n = 60, p < 0.01). A strong positive correlation between CVP and maximum IVC diameter (r = 0.712, n = 60, p < 0.01) and minimum IVC diameter (r = 0.796, n = 60, p < 0.01) was found. Conclusion: Inferior Vena Cava diameter and IVC Collapsibility Index can be used as a reliable substitute to central venous pressure to determine the patient's volume status.

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“…However, information about additional intraoperative adjustments of the transducer level was not included in the current study. Mean CVP value obtained over several cardiac and respiratory cycles through the monitor [ 7 ] (Intellivue MX700 and MX800 [Philips, Boeblingen, Germany] for neuro- and cardiac surgery, respectively) was recorded and used for the calculation of the actual SVR. As the SVR displayed by the monitoring devices (i.e.…”

Section: Methodsmentioning

confidence: 99%

Is measurement of central venous pressure required to estimate systemic vascular resistance? A retrospective cohort study

Noh

Hong

et al. 2021

BMC Anesthesiol

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Background The clinical range of central venous pressure (CVP) (typically 5 to 15 mmHg) is much less than the range of mean arterial blood pressure (60 to 120 mmHg), suggesting that CVP may have little impact on estimation of systemic vascular resistance (SVR). The accuracy and feasibility of using an arbitrary CVP rather than actual CVP for the estimation of SVR during intraoperative period is not known. Methods Using vital records obtained from patients who underwent neurological and cardiac surgery, the present study retrospectively calculated SVR using fixed values of CVP (0, 5, 10, 15, and 20 mmHg) and randomly changing values of CVP (5 to 15 mmHg) and compared these calculated SVRs with actual SVR, calculated using actual CVP. Differences between actual SVR and SVRs based on fixed and random CVPs were quantified as root mean square error (RMSE) and mean absolute percentage error (MAPE). Bland-Altman analysis and four-quadrant plot analysis were performed. Results A total of 34 patients are included, including 18 who underwent neurosurgery and 16 who underwent cardiac surgery; 501,380 s (139.3 h) of data was analyzed. The SVR derived from a fixed CVP of 10 mmHg (SVRf10) showed the highest accuracy (RMSE: 115 and 104 [dynes/sec/cm− 5] and MAPE: 6.3 and 5.7% in neurological and cardiac surgery, respectively). The 95% limits of agreement between SVRf10 and actual SVR were − 208.5 (95% confidence interval [CI], − 306.3 to − 148.1) and 242.2 (95% CI, 181.8 to 340.0) dynes/sec/cm− 5 in neurosurgery and − 268.1 (95% CI, − 367.5 to − 207.7) and 163.2 (95% CI, 102.9 to 262.6) dynes/sec/cm− 5 in cardiac surgery. All the SVRs derived from the fixed CVPs (regardless of its absolute value) showed excellent trending ability (concordance rate > 0.99). Conclusions SVR can be estimated from a fixed value of CVP without causing significant deviation or a loss of trending ability. However, caution is needed when using point estimates of SVR when the actual CVP is expected to be out of the typical clinical range. Trial registration This study was registered Clinical Research Information Service, a clinical trial registry in South Korea (KCT0006187).

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Comparison of different techniques of central venous pressure measurement in mechanically ventilated critically ill patients

Abstract: In mechanically ventilated patients, CVP is a reliable method for assessing CVP Taking into account transmitted respiratory pressures, CVP had a higher proportion of outliers and precision than CVP.

Cited by 20 publications

References 36 publications

Central venous pressure swing outperforms diaphragm ultrasound as a measure of inspiratory effort during pressure support ventilation in COVID-19 patients

Central venous pressure swing outperforms diaphragm ultrasound as a measure of inspiratory effort during pressure support ventilation in COVID-19 patients

Correlation of Inferior Vena Cava diameter and IVC Collapsibility Index with Central Venous Pressure (CVP) in critically ill surgical patients

Is measurement of central venous pressure required to estimate systemic vascular resistance? A retrospective cohort study

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