Abstract
BackgroundPrevious studies have shown a good agreement between central venous pressure (CVP) measurements from catheters placed in superior vena cava and catheters placed in the abdominal cava/common iliac vein. However, the influence of intra-abdominal pressure on such measurements remains unknown.MethodsWe conducted a prospective, observational study in a tertiary teaching hospital. We enrolled patients who had indwelling catheters in both superior vena cava (double lumen catheter) and femoroiliac veins (dialysis catheter) and into the bladder. Pressures were measured from all the sites, CVP, femoroiliac venous pressure (FIVP), and intra-abdominal pressure.ResultsA total of 30 patients were enrolled (age 62 ± 14 years; SAPS II 62 (52–76)). Fifty complete sets of measurements were performed. All of the studied patients were mechanically ventilated (PEP 3 cmH20 (2–5)). We observed that the concordance between CVP and FIVP decreased when intra-abdominal pressure increased. We identified 14 mmHg as the best intra-abdominal pressure cutoff, and we found that CVP and FIVP were significantly more in agreement below this threshold than above (94% versus 50%, P = 0.002).ConclusionsWe reported that intra-abdominal pressure affected agreement between CVP measurements from catheter placed in superior vena cava and catheters placed in the femoroiliac vein. Agreement was excellent when intra-abdominal pressure was below 14 mmHg.
Highlights
Previous studies have shown a good agreement between central venous pressure (CVP) measurements from catheters placed in superior vena cava and catheters placed in the abdominal cava/common iliac vein
We hypothesized that intra-abdominal hypertension could alter measurement of venous pressure and modify agreement between measurements from catheter placed in the superior vena cava, reflecting CVP, and catheter placed in the femoroiliac vein
CVP and femoroiliac venous pressure (FIVP) were significantly more in agreement below this threshold than above (0.94 versus 0.5, P = 0.002; Figure 2)
Summary
Previous studies have shown a good agreement between central venous pressure (CVP) measurements from catheters placed in superior vena cava and catheters placed in the abdominal cava/common iliac vein. Venous access is preferred via the internal jugular or subclavian vein with measurements of CVP in the superior vena cava above the right atrium. This approach is potentially hazardous, risking carotid artery puncture, pneumothorax, and neurologic damage [2,3]. We hypothesized that intra-abdominal hypertension could alter measurement of venous pressure and modify agreement between measurements from catheter placed in the superior vena cava, reflecting CVP, and catheter placed in the femoroiliac vein. Observational study to compare pressure measured in the superior vena cava (CVP) and in the femoroiliac vein (FIVP) according to intraabdominal pressure
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