Evaluation of external reference levels for central venous pressure measurements of severely obese patients in the supine position

Abstract

The most accurate eZRL for CVP measurements of severely obese patients in the supine position was two-thirds of the thoracic diameter above table level. This result is consistent with that of a previous report of non-obese patients.

Increased Intra-abdominal Pressure Exacerbates Idiopathic Intracranial Hypertension

“…Interestingly, when removed from the negative abdominal pressure device, patients in this study experienced a near immediate recurrence of IIH symptoms, which then resolved when the device was used again. In severely obese patients, central venous pressure can be elevated beyond normal values because the increased intra-abdominal pressure in obese patients increases intrathoracic pressure, leading to increased cardiac filling pressures (4). It has been proposed that the increased pleural pressure results in increased superior vena caval pressure tracking back to the brain and causing intracranial hypertension seen in IIH (2).…”

Update on the assessment of fluid responsiveness

“…However, excessive fluid volume expansion can be harmful, especially in patients with heart disease. As patients with acute circulatory failure do not usually respond to fluid loading by increasing their CO, numerous studies [1][2][3] have been conducted to develop tests that predict "fluid responsiveness". Although static indices, such as central venous pressure and pulmonary capillary wedge pressure, have been traditionally used for assessing patients' volume status, these indices have poor reliability for identifying fluid responders [4].…”