Respiratory Variations of Central Venous Pressure as Indices of Pleural Pressure Swings: A Narrative Review

Umbrello, Michele; Cereghini, Sergio; Muttini, Stefano

doi:10.3390/diagnostics13061022

Cited by 5 publications

(3 citation statements)

References 55 publications

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“…Although physiologically sound and clinically appealing, the idea of using the CVP swings (ΔCVP) as a surrogate of Ppl uctuations still seems experimental. Recently, this approach has been revaluated [31]: various authors have reported good and signi cant correlation between ΔCVP and ΔP ES , although a poor agreement, and, in patients breathing spontaneously, ΔCVP was related to the level of inspiratory effort [32,33]. Very recent experts' statement suggested that swings in CVP could be monitored as surrogate of work of breathing to detect strenuous inspiratory efforts and prevent patient-self-induced lung injury (P-SILI) [34].…”

Section: Discussionmentioning

confidence: 99%

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

Franchi,

Detti,

Fogagnolo

et al. 2023

Preprint

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Purpose: Transpulmonary pressure (PL) calculation requires esophageal pressure (PES) as a surrogate of pleural pressure (Ppl), but its calibration is a cumbersome technique. Central venous pressure (CVP) swings may reflect tidal variations in Ppl and could be used instead of PES, but the interpretation of CVP waveforms could be difficult due to superposition of heartbeat-induced pressure changes. Thus, we developed a digital filter able to remove the cardiac noise to obtain a filtered CVP (f-CVP). The aim of the study was to evaluate the accuracy of CVP and filtered CVP swings (ΔCVP and Δf-CVP, respectively) in estimating esophageal respiratory swings (ΔPES) and compare PL calculated with CVP, f-CVP and PES; then we tested the diagnostic accuracy of the f-CVP method to identify unsafe high PL levels. Methods: Twenty patients with acute respiratory failure (defined as PO2/FiO2 ratio below 200 mmHg) treated with invasive mechanical ventilation and monitored with esophageal balloon and central venous catheter were enrolled prospectively. For each patient a recording session at baseline was performed, repeated if a modification in ventilatory settings occurred. PES, CVP and airway pressure during an end-inspiratory and -expiratory pause were simultaneously recorded; CVP, f-CVP and PES waveforms were analyzed off-line and used to calculate transpulmonary pressure (PLCVP, PLf-CVP, PLPES, respectively). Results: Δf-CVP correlated better than ΔCVP with ΔPES (r=0.8, p=0.001 vs r=0.08, p=0.73), with a lower bias in Bland Altman analysis (mean bias -0.16, LoA -1.31, 0.98 cmH2O vs mean bias -0.79, LoA -3.14, 1.55 cmH2O). Both PLf-CVP and PLCVP correlated well with PLPES (r=0.98, p<0.001 vs r=0.94, p<0.001), again with a lower bias in Bland Altman analysis (0.15, LoA – 0.95, 1.26 cmH2O vs 0.80, LoA – 1.51, 3.12, cmH2O). PLf-CVP discriminated high PL value with an area under the receiver operating characteristic curve 0.99 (standard deviation, SD, 0.02) (AUC difference= 0.01 [-0.024; 0.05], p= 0.48). Conclusions: In mechanically ventilated patients with acute respiratory failure, Δf-CVP estimated ΔPES and PL obtained from digital filtered CVP represented a reliable value of standard PL measured with the esophageal method and could identify patients with non-protective ventilation settings.

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Section: Discussionmentioning

confidence: 99%

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

Franchi,

Detti,

Fogagnolo

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Second, the current investigation, estimated the inspiratory effort by esophageal pressure swing (∆Pes) even though the gold standard measurement is PTP. Third, in a noncompliant heart, the transmission of pleural pressure to the cardiac cavities can be blunted, and even small changes in volume can produce large changes in pressure: in such cases, the agreement between ∆CVP and ∆Pes will be particularly poor [47,48], so we caution against the extension of our results to patients with significant cardiac pathology. Further studies are warranted to verify if our findings could be reproduced in non-COVID-19-related acute respiratory failure patients.…”

Section: Limitationsmentioning

confidence: 97%

“…Since excessive inspiratory effort can lead to complications such as self-inflicted-lung-injury (SILI) [45,46], ∆CVP could be a useful tool to track the dangerous inspiratory effort in patients with C-ARDS, especially in the case of limited resources. Moreover, ∆CVP could be used to screen patients who would eventually benefit from monitoring Pes [47].…”

Section: Clinical Consequencesmentioning

confidence: 99%

Assessment of Inspiratory Effort in Spontaneously Breathing COVID-19 ARDS Patients Undergoing Helmet CPAP: A Comparison between Esophageal, Transdiaphragmatic and Central Venous Pressure Swing

Lassola,

Miori,

Sanna

et al. 2023

Diagnostics

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Introduction: The clinical features of COVID-19 are highly variable. It has been speculated that the progression across COVID-19 may be triggered by excessive inspiratory drive activation. The aim of the present study was to assess whether the tidal swing in central venous pressure (ΔCVP) is a reliable estimate of inspiratory effort. Methods: Thirty critically ill patients with COVID-19 ARDS underwent a PEEP trial (0–5–10 cmH2O) during helmet CPAP. Esophageal (ΔPes) and transdiaphragmatic (ΔPdi) pressure swings were measured as indices of inspiratory effort. ΔCVP was assessed via a standard venous catheter. A low and a high inspiratory effort were defined as ΔPes ≤ 10 and >15 cmH2O, respectively. Results: During the PEEP trial, no significant changes in ΔPes (11 [6–16] vs. 11 [7–15] vs. 12 [8–16] cmH2O, p = 0.652) and in ΔCVP (12 [7–17] vs. 11.5 [7–16] vs. 11.5 [8–15] cmH2O, p = 0.918) were detected. ΔCVP was significantly associated with ΔPes (marginal R2 0.87, p < 0.001). ΔCVP recognized both low (AUC-ROC curve 0.89 [0.84–0.96]) and high inspiratory efforts (AUC-ROC curve 0.98 [0.96–1]). Conclusions: ΔCVP is an easily available a reliable surrogate of ΔPes and can detect a low or a high inspiratory effort. This study provides a useful bedside tool to monitor the inspiratory effort of spontaneously breathing COVID-19 patients.

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Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

Franchi,

Detti,

Fogagnolo

et al. 2024

J Clin Monit Comput

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Transpulmonary pressure (PL) calculation requires esophageal pressure (PES) as a surrogate of pleural pressure (Ppl), but its calibration is a cumbersome technique. Central venous pressure (CVP) swings may reflect tidal variations in Ppl and could be used instead of PES, but the interpretation of CVP waveforms could be difficult due to superposition of heartbeat-induced pressure changes. Thus, we developed a digital filter able to remove the cardiac noise to obtain a filtered CVP (f-CVP). The aim of the study was to evaluate the accuracy of CVP and filtered CVP swings (ΔCVP and Δf-CVP, respectively) in estimating esophageal respiratory swings (ΔPES) and compare PL calculated with CVP, f-CVP and PES; then we tested the diagnostic accuracy of the f-CVP method to identify unsafe high PL levels, defined as PL>10 cmH2O. Twenty patients with acute respiratory failure (defined as PaO2/FiO2 ratio below 200 mmHg) treated with invasive mechanical ventilation and monitored with an esophageal balloon and central venous catheter were enrolled prospectively. For each patient a recording session at baseline was performed, repeated if a modification in ventilatory settings occurred. PES, CVP and airway pressure during an end-inspiratory and -expiratory pause were simultaneously recorded; CVP, f-CVP and PES waveforms were analyzed off-line and used to calculate transpulmonary pressure (PLCVP, PLf-CVP, PLPES, respectively). Δf-CVP correlated better than ΔCVP with ΔPES (r = 0.8, p = 0.001 vs. r = 0.08, p = 0.73), with a lower bias in Bland Altman analysis in favor of PLf-CVP (mean bias − 0.16, Limits of Agreement (LoA) -1.31, 0.98 cmH2O vs. mean bias − 0.79, LoA − 3.14, 1.55 cmH2O). Both PLf-CVP and PLCVP correlated well with PLPES (r = 0.98, p < 0.001 vs. r = 0.94, p < 0.001), again with a lower bias in Bland Altman analysis in favor of PLf-CVP (0.15, LoA − 0.95, 1.26 cmH2O vs. 0.80, LoA − 1.51, 3.12, cmH2O). PLf-CVP discriminated high PL value with an area under the receiver operating characteristic curve 0.99 (standard deviation, SD, 0.02) (AUC difference = 0.01 [-0.024; 0.05], p = 0.48). In mechanically ventilated patients with acute respiratory failure, the digital filtered CVP estimated ΔPES and PL obtained from digital filtered CVP represented a reliable value of standard PL measured with the esophageal method and could identify patients with non-protective ventilation settings.

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Respiratory Variations of Central Venous Pressure as Indices of Pleural Pressure Swings: A Narrative Review

Cited by 5 publications

References 55 publications

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

Assessment of Inspiratory Effort in Spontaneously Breathing COVID-19 ARDS Patients Undergoing Helmet CPAP: A Comparison between Esophageal, Transdiaphragmatic and Central Venous Pressure Swing

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

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