Central Venous Pressure as a Predictor of Fluid Responsiveness: Is This All You Need?

Abstract

Fluid administration during and after surgery is a fundamental strategy for maintaining hemodynamic stability. Technology offers different strategies for hemodynamic monitoring and decision making about fluids administration. In particular patients may be divided into fluid-responding patients and non-fluid-responding patients. Central venous pressure, measured by a central venous catheter, is a basic measure of right heart preload, and many trials defined it as a non-trustable parameter, with many biases and confounding factors, such as mechanical ventilation and intrathoracic pressure. Nevertheless, many authors describe how a simple value like the Central venous pressure may be useful in hemodynamic monitoring during and after cardiac surgery, although it is not the best available. Moreover the results of a recent survey performed in cardiothoracic intensive care units in Italy, reported how central venous pressure was the easiest and the most frequently used parameter for the monitoring of fluid therapy. Given this state of the art, Central venous pressure seems to be the most criticized but, due to its feasibility and availability, it is still the most used parameter for the evaluation of preload and for the prediction of fluid responsiveness in operating room and Intensive Care Unit.

Tata Laksana Ketoasidosis Diabetik pada Penderita Gagal Jantung

“…21 Tekanan vena sentral yang tinggi dapat ditemukan pada penderita dengan fungsi jantung yang normal dan volume intravaskular meningkat (misalnya overload cairan) atau pada penderita dengan fungsi jantung yang menurun dan volume intravaskular normal (misalnya gagal jantung). 22 Sebaliknya, CVP dapat turun pada individu dengan fungsi jantung meningkat dan volume darah normal (misalnya selama olahraga) atau pada penderita dengan fungsi jantung normal dan volume darah menurun (misalnya kehilangan darah berat), diuresis yang berlebihan akibat diabetes atau terapi diuretik, atau venous return yang buruk pada syok kardiogenik. 21 Baku emas evaluasi respons penderita terhadap terapi cairan adalah respons hemodinamik terhadap fluid challenge.…”

Development and Validation of the Cvp-Score: A Cross-Sectional Study in Greece

“…Central venous pressure (CVP) is a hemodynamic parameter that has widely been monitored in the intensive care units (ICU) for assessing the cardiac function, the right atrium preload, the volume status and the fluid responsiveness in critically ill patients [1][2][3]. Over the course of time the usefulness and the accuracy of CVP as a strong hemodynamic and endovascular volume index has been debated and the currently available published research reveals no absolute correlation between CVP values and the total blood volume present in human circulation [4].…”

Development and Validation of the CVP Score: A Cross-Sectional Study in Greece

“…Central venous pressure (CVP) is a hemodynamic parameter that has widely been monitored in the intensive care units (ICU) for assessing cardiac function, the right atrium preload, the volume status, the fluid responsiveness in critically ill patients, and it is defined as the estimated pressure in the vena cava, so can be considered as a measurement of cardiac preload and right atrial pressure [1][2][3]. The normal range of CVP, that is measured in a supine position via a central venous catheter placed into the subclavian or internal jugular vein, is inconsistent with different depicted values, such as 2-8 mmHg [4], 0-10 mmHg [5], or 5-15 mmHg [6], available in the currently available published research.…”