Is central venous pressure monitoring appropriate for assessment of perioperative fluid balance?

Abstract

Central venous pressure (CVP) has been the mainstay of perioperative fluid balance monitoring in the UK for many years. The relationship between CVP and right heart function is based on extrapolation of the Frank–Starling principle which assumes that CVP is proportional to right ventricular end diastolic volume and so contractility.

Reliability of the fluid balance in neonates

“…This study shows that keeping a fluid balance on a neonatal high‐care ward shows poor agreement with daily changes in body weight, with more than 40% of the comparisons showing clinically relevant differences. Our findings confirm earlier reports in adults showing poor agreement of fluid balance with changes in body weight (4,5,13), central venous monitoring (14) or bioelectrical impedance measurements (15).…”

Usefulness of the fluid balance: A randomised controlled trial in neonates

“…To our knowledge, this is the first randomised controlled trial examining the clinical usefulness of the fluid balance. Our findings confirm earlier reports in different patient categories showing poor agreement of fluid balance with changes in body weight, 5 central venous monitoring 14 or bioelectrical impedance measurements. 15 Although the theoretical concept of estimating the fluid status by recording fluid in-and output seems logical and sound, the lack of usefulness of the fluid balance may be largely explained by the inaccuracy of the fluid balance.…”