T G Eskesen, M Wetterslev, A Perner
PURPOSE: Central venous pressure (CVP) has been shown to have poor predictive value for fluid responsiveness in critically ill patients. We aimed to re-evaluate this in a larger sample subgrouped by baseline CVP values. METHODS: In April 2015, we systematically searched and included all clinical studies evaluating the value of CVP in predicting fluid responsiveness. We contacted investigators for patient data sets. We subgrouped data as lower (<8 mmHg), intermediate (8-12 mmHg) and higher (>12 mmHg) baseline CVP...
March 2016: Intensive Care Medicine
Xiao-Ting Wang, Bo Yao, Da-Wei Liu, Hong-Min Zhang
PURPOSE: The aim of this study was to investigate changes in central venous pressure (CVP) of patients with septic shock over 7 days after intensive care unit admission and its effect on organ function and clinical prognosis. METHODS: Baseline data, 7 days' CVP, and laboratory data of 105 patients with septic shock were consecutively recorded. According to the value of mean CVP of 7 days, cases were divided into three groups: low (<8 mmHg), normal (8-12 mmHg), and high (>12 mmHg) CVP...
November 2015: Shock
David A Berlin, Jan Bakker
Recent studies challenge the utility of central venous pressure monitoring as a surrogate for cardiac preload. Starting with Starling's original studies on the regulation of cardiac output, this review traces the history of the experiments that elucidated the role of central venous pressure in circulatory physiology. Central venous pressure is an important physiologic parameter, but it is not an independent variable that determines cardiac output.
December 2015: Critical Care: the Official Journal of the Critical Care Forum
Pierre Bouzat, Guillaume Walther, Thomas Rupp, Patrick Levy, Samuel Vergès
No abstract text is available yet for this article.
July 15, 2014: American Journal of Respiratory and Critical Care Medicine
Judson B Williams, Eric D Peterson, Daniel Wojdyla, Ralf Harskamp, Kevin W Southerland, T Bruce Ferguson, Peter K Smith, Carmelo A Milano, Renato D Lopes
OBJECTIVE: Although hemodynamic monitoring is often performed after coronary artery bypass grafting (CABG), the role of monitoring postoperative central venous pressure (CVP) measurement as a predictor of clinical outcomes is unknown. As such, this study tests the hypothesis that postoperative CVP is predictive of operative mortality or renal failure. METHODS: This is an observational cohort study of detailed clinical data from 2390 randomly selected patients undergoing high-risk CABG or CABG/valve at 55 hospitals participating in the Society of Thoracic Surgeons' National Cardiac Surgery Database 2004-2005...
December 2014: Journal of Critical Care
Johann Smith Cerón Arias, Manuel Felipe Muñoz Nañez
INTRODUCTION: The determination of the values of central venous pressure has long been used as a guideline for volumetric therapy in the resuscitation of the critical patient, but the performance of such parameter is currently being questioned as an effective measurement of cardiac preload. This has aroused great interest in the search for more accurate parameters to determine cardiac preload and a patient's blood volume. GOALS AND METHODS: Based on literature currently available, we aim to discuss the performance of central venous pressure as an effective parameter to determine cardiac preload...
April 2012: Colombia Médica: CM
Alexander Levitov, Paul E Marik
Fluid challenges are considered the cornerstone of resuscitation in critically ill patients. However, clinical studies have demonstrated that only about 50% of hemodynamically unstable patients are volume responsive. Furthermore, increasing evidence suggests that excess fluid resuscitation is associated with increased mortality. It therefore becomes vital to assess a patient's fluid responsiveness prior to embarking on fluid loading. Static pressure (CVP, PAOP) and echocardiographic (IVC diameter, LVEDA) parameters fails to predict volume responsiveness...
2012: Cardiology Research and Practice
Paul E Marik, Xavier Monnet, Jean-Louis Teboul
The clinical determination of the intravascular volume can be extremely difficult in critically ill and injured patients as well as those undergoing major surgery. This is problematic because fluid loading is considered the first step in the resuscitation of hemodynamically unstable patients. Yet, multiple studies have demonstrated that only approximately 50% of hemodynamically unstable patients in the intensive care unit and operating room respond to a fluid challenge. Whereas under-resuscitation results in inadequate organ perfusion, accumulating data suggest that over-resuscitation increases the morbidity and mortality of critically ill patients...
March 21, 2011: Annals of Intensive Care
Paul E Marik, Rodrigo Cavallazzi
BACKGROUND: Despite a previous meta-analysis that concluded that central venous pressure should not be used to make clinical decisions regarding fluid management, central venous pressure continues to be recommended for this purpose. AIM: To perform an updated meta-analysis incorporating recent studies that investigated indices predictive of fluid responsiveness. A priori subgroup analysis was planned according to the location where the study was performed (ICU or operating room)...
July 2013: Critical Care Medicine
Jacinta J Maas, Michael R Pinsky, Rob B de Wilde, Evert de Jonge, Jos R Jansen
OBJECTIVE: We studied the variable effects of norepinephrine infusion on cardiac output in postoperative cardiac surgical patients in whom norepinephrine increased mean arterial pressure. We hypothesized that the directional change in cardiac output would be determined by baseline cardiac function, as quantified by stroke volume variation, and the subsequent changes in mean systemic filling pressure and vasomotor tone. DESIGN: Intervention study. SETTING: ICU of a university hospital...
January 2013: Critical Care Medicine
Zhiyong He, Hui Qiao, Wei Zhou, Yun Wang, Zhendong Xu, Xuehua Che, Jun Zhang, Weimin Liang
PURPOSE: Recognition of intraoperative hypovolemia is important for fluid management. Previous studies demonstrated functional preload parameter pulse pressure variation (PPV) could predict volume changes in response to fluid loading and loss. In this study, we examined the correlation between PPV and other two cardiac preload indicators, central venous pressure (CVP) or initial distribution volume of glucose (IDVG), in patients after anesthesia induction. METHODS: In 30 patients undergoing scheduled craniotomy surgery, we compared measurement of PPV (%) using the Ohmeda monitor method to simultaneously measure CVP and IDVG after anesthesia induction through correlation analysis and receiver operating characteristic (ROC) curves...
December 2011: Journal of Anesthesia
J H Heijmans, Y M Ganushak, M S Theunissen, J G Maessen, P J Roekaerts
OBJECTIVES: Central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) are insensitive preload markers and sometimes misleading. The introduction of the pulse contour method for monitoring of continuous cardiac output enabled the real-time quantification of stroke volume variation (SVV). Studies evaluating the accuracy of this parameter as a measure of preload responsiveness are still limited and conflicting results have been published in cardiac surgical patients. The aim of this study was to reevaluate the predictive value of SVV regarding cardiac responsiveness to fluid therapy and to compare it with the standard preload variables in a clinical setting in the ICU after cardiac surgery...
2010: Acta Anaesthesiologica Belgica
John H Boyd, Jason Forbes, Taka-aki Nakada, Keith R Walley, James A Russell
OBJECTIVE: To determine whether central venous pressure and fluid balance after resuscitation for septic shock are associated with mortality. DESIGN: We conducted a retrospective review of the use of intravenous fluids during the first 4 days of care. SETTING: Multicenter randomized controlled trial. PATIENTS: The Vasopressin in Septic Shock Trial (VASST) study enrolled 778 patients who had septic shock and who were receiving a minimum of 5 μg of norepinephrine per minute...
February 2011: Critical Care Medicine
Thomas Ahrens
No abstract text is available yet for this article.
April 2010: Critical Care Nurse
Karim Lakhal, Stephan Ehrmann, Isabelle Runge, Dalila Benzekri-Lefèvre, Annick Legras, Pierre François Dequin, Emmanuelle Mercier, Michel Wolff, Bernard Régnier, Thierry Boulain
PURPOSE: Passive leg raising (PLR) is a maneuver performed to test the cardiac Frank-Starling mechanism. We assessed the influence of PLR-induced changes in preload on the performance of PLR-induced change in pulse pressure (Delta(PLR)PP) and cardiac output (Delta(PLR)CO) for fluid responsiveness prediction. METHODS: Sedated, nonarrhythmic patients with persistent shock were included in this prospective multicenter study. Cardiac output and pulse pressure were measured at baseline (patient supine), during PLR (lower limbs lifted to 45 degrees) and after 500-ml volume expansion...
June 2010: Intensive Care Medicine
Bruce A McKinley, Joseph F Sucher, S Rob Todd, Ernest A Gonzalez, Rosemary A Kozar, R Matthew Sailors, Frederick A Moore
Previously, we developed a protocol for shock resuscitation of severe trauma patients to reverse shock and regain hemodynamic stability during the first 24 intensive care unit (ICU) hours. Key hemodynamic measurements of cardiac output and preload were obtained using a pulmonary artery catheter (PAC). As an alternative, we developed a protocol that used central venous pressure (CVP) to guide decision making for interventions to regain hemodynamic stability [mean arterial pressure (MAP) >or= 65 mmHg and heart rate (HR) <or= 130 bpm]...
November 2009: Shock
Rajay K Jain, Benjamin L Antonio, David L Bowton, Timothy T Houle, Drew A MacGregor
In the intensive care unit (ICU) of our tertiary care university medical center, central venous pressure (CVP) measurements derived from bedside monitors differ considerably from measurements by trained intensivists using paper tracings. To quantify these differences, printed CVP tracings and concurrent respiratory waveforms were collected from 100 consecutive critically ill patients along with the corresponding monitor-displayed CVP. Four blinded intensivists interpreted the tracings. The mean difference between the intensivists and the monitor was -0...
March 2010: Shock
Jacinta J Maas, Bart F Geerts, Paul C M van den Berg, Michael R Pinsky, Jos R C Jansen
OBJECTIVE: To measure the relationship between blood flow and central venous pressure (Pcv) and to estimate mean systemic filling pressure (Pmsf), circulatory compliance, and stressed volume in patients in the intensive care unit. DESIGN: Intervention study. SETTING: Intensive care unit of a university hospital. PATIENTS: Twelve mechanically ventilated postoperative cardiac surgery patients. INTERVENTIONS: Inspiratory holds were performed during normovolemia in supine position (baseline), relative hypovolemia by placing the patients in 30 degree head-up position (hypo), and relative hypervolemia by volume loading with 0...
March 2009: Critical Care Medicine
Sheldon Magder, Fahad Bafaqeeh
Central venous pressure (CVP) is commonly measured, but its clinical use is still not clear. We argue that the interpretation of the CVP needs to be considered in conjunction with an assessment of cardiac output. The objective of this study was to define an elevated CVP as one in which there is a low probability for cardiac output to increase with a volume infusion through a Starling mechanism by relating the initial CVP (measured relative to a reference point 5 cm below the sternal angle) to the response in cardiac output with volume infusion...
2007: Journal of Intensive Care Medicine
Sheldon Magder
OBJECTIVE: To review the clinical use of central venous pressure measurements. DATA SOURCES: The Medline database, biographies of selected articles, and the author's personal database. DATA SYNTHESIS: Four basic principles must be considered. Pressure measurements with fluid-filled systems are made relative to an arbitrary reference point. The pressure that is important for preload of the heart is the transmural pressure, whereas the pressure relative to atmosphere still affects other vascular beds outside the thorax...
August 2006: Critical Care Medicine
2014-05-24 19:55:51
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