Peripheral venous pressure as a predictor of central venous pressure during orthotopic liver transplantation

Abstract

Study Objective To assess the reliability of peripheral venous pressure (PVP) as a predictor of central venous pressure (CVP) in the setting of rapidly fluctuating hemodynamics during orthotopic liver transplant surgery. Design Prospective clinical trial. Setting UCLA Medical Center, main operating room—liver transplant surgery. Patients Nine adult patients with liver failure undergoing orthotopic liver transplant surgery. Interventions A pulmonary artery catheter and a 20-g antecubital peripheral intravenous catheter dedicated to measuring PVP were placed in all patients after standard general endotracheal anesthesia induction and institution of mechanical ventilation. Measurements Peripheral venous pressure and CVP were recorded every 5 minutes and/or during predetermined, well-defined surgical events (skin incision, venovenous bypass initiation, portal vein anastamosis, 5 minute post graft reperfusion, abdominal closure). Pulmonary artery pressure and cardiac output (via thermodilution) were recorded every 15 and 30 minutes, respectively. Main Results Peripheral venous pressure (mean ± SD) was 11.0 ± 4.5 mmHg vs a CVP of 9.5 ± 5.0; the two measurements differed by an average of 1.5 ± 1.6 mmHg. Peripheral venous pressure correlated highly with CVP in every patient, and the overall correlation among all nine patients calculated using a random-effects regression model was r = 0.95 ( P < 0.0001). A Bland-Altman analysis used to determine the accuracy of PVP in comparison to CVP yielded a bias of −1.5 mmHg and a precision of ±3.1 mm Hg. Conclusion Our study confirms that PVP correlates with CVP even under adverse hemodynamic conditions in patients undergoing liver transplantation.