Central Venous Pressure

BackgroundCentral venous pressure (CVP) and right atrial pressure (RAP) are important parameters in the complete hemodynamic assessment of a patient. Sonographic measurement of the inferior vena cava (IVC) diameter is a non-invasive method of estimating these parameters, but there are limited data summarizing its diagnostic accuracy across multiple studies. We performed a comprehensive review of the existing literature to examine the diagnostic accuracy and clinical utility of sonographic measurement of IVC diameter as a method for assessing CVP and RAP.MethodsWe performed a systematic search using PubMed of clinical studies comparing sonographic evaluation of IVC diameter and collapsibility against gold standard measurements of CVP and RAP. We included clinical studies that were performed in adults, used current imaging techniques, and were published in English.ResultsTwenty one clinical studies were identified that compared sonographic assessment of IVC diameter with CVP and RAP and met all inclusion criteria. Despite substantial heterogeneity in measurement techniques and patient populations, most studies demonstrated moderate strength correlations between measurements of IVC diameter and collapsibility and CVP or RAP, but more favorable diagnostic accuracy using pre-specified cut points. Findings were inconsistent among mechanically ventilated patients, except in the absence of positive end-expiratory pressure.ConclusionSonographic measurement of IVC diameter and collapsibility is a valid method of estimating CVP and RAP. Given the ease, safety, and availability of this non-invasive technique, broader adoption and application of this method in clinical settings is warranted.

BackgroundThe aim was to investigate whether mean perfusion pressure (MPP) calculated as the difference between mean arterial pressure (MAP) and central venous pressure (CVP) was associated with risk of progression from AKI I to AKI III in critically ill patients.MethodsRetrospective analysis of adult patients admitted to a multi-disciplinary adult intensive care unit (ICU) between July 2007 and June 2009 who developed AKI I and in whom advanced haemodynamic monitoring was initiated within 12 h of diagnosis of AKI I. We compared patients with a MPP above and below the median value in the first 12 h of diagnosis of AKI. Multivariable logistic regression analyses were performed to identify independent risk factors for progression to AKI III, to explore the impact of MAP and CVP separately, and to investigate the impact of MPP in pre-defined sub-groups.ResultsAmong 2118 ICU patients, 790 patients (37%) developed AKI I of whom 205 underwent advanced haemodynamic monitoring within 12 h of AKI stage I. Their median MPP was 59 mmHg. AKI I patients with a MPP ≤59 mmHg had a significantly higher risk of progressing to AKI stage III (48.6% versus 34%, respectively; p = 0.0034). This association was stronger in patients with ischemic heart disease, congestive cardiac failure or without pre-existing hypertension and in patients with a MAP 1 h. As individual components, a raised CVP was independently associated with progression to AKI stage III but MAP alone was not an independent risk factor for AKI progression.ConclusionMPP <60 mmHg was independently associated with AKI progression. CVP was the key component of MPP.

BackgroundThe association of central venous pressure (CVP) and mortality and acute kidney injury (AKI) in critically ill adult patients remains unclear. We performed a meta-analysis to determine whether elevated CVP is associated with increased mortality and AKI in critically ill adult patients.MethodsWe searched PubMed and Embase through June 2019 to identify studies that investigated the association between CVP and mortality and/or AKI in critically ill adult patients admitted into the intensive care unit. We calculated the summary odds ratio (OR) and 95% CI using a random-effects model.ResultsFifteen cohort studies with a broad spectrum of critically ill patients (mainly sepsis) were included. On a dichotomous scale, elevated CVP was associated with an increased risk of mortality (3 studies; 969 participants; OR, 1.65; 95% CI, 1.19-2.29) and AKI (2 studies; 689 participants; OR, 2.09; 95% CI, 1.39-3.14). On a continuous scale, higher CVP was associated with greater risk of mortality (5 studies; 7837 participants; OR, 1.10; 95% CI, 1.03-1.17) and AKI (6 studies; 5446 participants; OR, 1.14; 95% CI, 1.06-1.23). Furthermore, per 1 mmHg increase in CVP increased the odds of AKI by 6% (4 studies; 5150 participants; OR, 1.06; 95% CI, 1.01-1.12). Further analyses restricted to patients with sepsis showed consistent results.ConclusionsElevated CVP is associated with an increased risk of mortality and AKI in critically ill adult patients admitted into the intensive care unit.Trial registrationPROSPERO, CRD42019126381.

Aluminum phosphide (ALP) is a highly toxic pesticide endangering the healthcare system. Higher central venous pressure (CVP) values may be linked to poorer outcomes in various medical conditions. This study evaluated the role of CVP and mean arterial pressure (MAP)/CVP ratio as prognostic factors for intensive care unit (ICU) admitted acute ALP-poisoned patients. This retrospective study included 145 acutely ALP-poisoned patients who were referred to the ICU during two years. Data regarding history, clinical manifestations, laboratory investigations, and outcome were collected and stratified by quartiles (Q1-Q4) of the measured CVP during the first 6 h after admission. In-hospital mortality and need for mechanical ventilation (MV) were significantly predominant in Q3 and Q4 groups of CVP levels (89.4% and 92% & 91.5% and 96%, respectively) (p-values < 0.001). After vasopressors administration, survivors demonstrated a significant mean reduction in CVP measurements (-4.5 mmHg), whereas non-survivors had a mean increase (+ 0.6 mmHg) (p = 0.011). MAP/CVP ratio has good discriminatory power (the areas under the curve (AUCs) = 0.836 and 0.846) for predicting the need for MV and in-hospital mortality, respectively. The CVP measurement (AUCs = 0.812 and 0.782, respectively) comes in second, followed by the poisoning severity score (AUCs = 0.778 and 0.768, respectively). There was a significant decrease in survival probability in patients with CVP ≥ 25 mmHg, and MAP/CVP ratio ≤ 2.48 (p-values < 0.001). Lower MAP/CVP ratios and higher CVP measurements are alarming signs, warranting a higher risk of the need for MV and in-hospital mortality in acute ALP poisoning.