Central Venous Pressure Values Research Articles

Hepatic vein Doppler ultrasound to estimate central venous pressure in mechanically ventilated children.

Monitoring central venous pressure (CVP) is crucial for managing critically ill patients yet poses challenges in pediatric cases. This study aimed to correlate CVP with hepatic vein Doppler and IVC ultrasound variables in children. Mechanically ventilated children underwent simultaneous ultrasound and CVP measurements. Hepatic vein Doppler assessed peak velocities (A, S, V, D) and systolic filling fraction. IVC ultrasound included respiratory variability indices, IVC/aorta ratio, and IVC/body surface area ratio. Fifty-three children were included (median age of 8.3months and weight of 6.3kg). Significant correlations were found between CVP values and all hepatic vein Doppler-based variables. The strongest correlation was found between CVP and the sum of the absolute values of the A- and D-wave peak velocities (AD velocity), with a ρ = 0.61 (95% confidence interval [CI] of 0.40 to 0.75; p < 0.001). The AD velocity > 38.55cm/s was able to discriminate patients with CPV > 12mmHg with a sensitivity of 100%, specificity of 95.3%, positive predictive value of 83.3%, and negative predictive value of 100%. No correlations were observed between CVP and variables derived from IVC respiratory variability indices or the IVC/aorta ratio. Conclusion: Hepatic vein Doppler ultrasound provides variables that significantly correlate with CVP and may be useful for estimating cardiac preload in mechanically ventilated children. Indices derived from IVC ultrasound were not reliable for estimating CVP. What is known? • Increased central venous pressure (CVP) can cause interstitial edema and reduce vital organ perfusion, leading to organic dysfunctions, with encapsulated organs such as the kidneys and liver being at higher risk. • However, measuring CVP in children poses challenges due to the difficulties and risks of central venous catheterization, frequent partial or total luminal obstructions in venous catheters, and potential technical errors in measurements. What is new? • Variables obtained through hepatic vein Doppler ultrasonography outperformed those obtained by inferior vena cava ultrasound for estimating CVP in this population. • Hepatic vein Doppler ultrasonography holds potential as an accurate, safe, and non-invasive method for discriminating patients with increased cardiac preload.

Positive correlation between echocardiographic tricuspid E peak velocity and central venous pressure in dogs: A preliminary study.

In the absence of vascular obstruction, central venous pressure (CVP) is a hydrostatic pressure in the cranial and caudal vena cava, providing valuable information about cardiac function and intravascular volume status. It is also a component in evaluating volume resuscitation in patients with septic shock and monitoring patients with right heart disease, pericardial disease, or volume depletion. Central venous pressure is calculated in dogs by invasive central venous catheterization, which is considered high-risk and impractical in critically ill patients. This study aimed to investigate the feasibility of using echocardiographic tricuspid E/E' as a noninvasive method to estimate CVP in anesthetized healthy dogs under controlled hypovolemic conditions. Ten male mixed-breed dogs were included in the study after a thorough health assessment. For hypovolemia induction, blood withdrawal was performed, and echocardiographic factors of the tricuspid valve, including peak E and E' velocities, were measured during CVP reduction. Repeated measures analysis of variance and Bonferroni post hoc tests were employed to compare the average difference between measured echocardiographic indices and CVP values derived from catheterization and intermittent measurement methods. Spearman's ρ correlation coefficient was used to evaluate the correlation between echocardiographic indices and CVP. E peak velocity had a significant negative correlation with venous blood pressure phases (r=-0.44, P=.001), indicating a decrease in peak E velocity with progressive CVP reduction. However, tricuspid valve E' peak velocity and E/E' did not correlate with CVP, suggesting that these parameters are not reliable for CVP estimation in dogs.

The effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position: A quasi-experimental study.

The aim of this study was to research the effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position. This study was a non-randomized and non-controlled, quasi-experimental repeated measures study. The study was conducted with 50 intensive care patients aged 18 and over in a general surgery intensive care unit in Turkey. With each patient in the supine position, the bed head was raised to an angle of 0°, 20°, 30°, and 45° without a pillow, and the hemodynamic parameters of central venous pressure, systolic and diastolic blood pressure, heart rate, breathing rate, and peripheral oxygen saturation were recorded after 0 and 10 min. It was found that the mean central venous pressure value measured at min 0 and 10 was higher when the intensive care patients' bed head angle was raised to 45° than when the bed head was at an angle of 0° or 20° (p < .05). It was found that the patients' other hemodynamic parameters were not affected by different bed head angles. It was concluded as a result of this research that in intensive care patients in the supine position, only central venous pressure was affected by bed head angle, and that central venous pressure measurement can be reliably made at a bed head angle of 30°.

Is target-controlled infusion better than manual controlled infusion during TIVA for elective neurosurgery? Results of a single-centre pilot study.

Maintaining optimal systemic circulatory parameters is essential to ensure adequate cerebral perfusion (CPP) during neurosurgery, especially when autoregulation is impaired. To compare two types of total intravenous anaesthesia i.e. target controlled infusion (TCI) and manually controlled infusion (MCI) with propofol and remifentanil in terms of their control of cardiovascular parameters during neurosurgical resection of intracranial pathology. Patients with supratentorial intracranial pathology were selected for the study. Patients in ASA grades III and IV and those with diseases of the circulatory system were excluded. Patients were randomly divided into two equal groups according to the method of general anaesthesia used i.e. TCI or MCI. During the neurosurgery, the values of mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS) and central venous pressure were monitored and recorded at the designated 14 relevant (i.e. critical from the anaesthetist's and neurosurgeon's points of view) measurement points. Fifty patients (25 TCI and 25 MCI) were enrolled in the study. The groups did not differ with respect to sex, age and BMI, operation time or volume of removed lesions. TCI-anaesthetised patients had better MAP stability at the respective time points. Due to the greater stability of MAP, which has a direct effect on CPP, TCI appears to be the method of choice in anaesthesia for intracranial surgery.

Incidence and Determinants of Acute Kidney Injury after Prone Positioning in Severe COVID-19 Acute Respiratory Distress Syndrome

(1) Background: Acute kidney injury (AKI) is common among critically ill COVID-19 patients, but its temporal association with prone positioning (PP) is still unknown, and no data exist on the possibility of predicting PP-associated AKI from bedside clinical variables. (2) Methods: We analyzed data from 93 COVID-19-related ARDS patients who underwent invasive mechanical ventilation (IMV) and at least one PP cycle. We collected hemodynamic variables, respiratory mechanics, and circulating biomarkers before, during, and after the first PP cycle. PP-associated AKI (PP-AKI) was defined as AKI diagnosed any time from the start of PP to 48 h after returning to the supine position. A t-test for independent samples was used to test for the differences between groups, while binomial logistical regression was performed to assess variables independently associated with PP-associated AKI. (3) Results: A total of 48/93 (52%) patients developed PP-AKI, with a median onset at 24 [13.5–44.5] hours after starting PP. No significant differences in demographic characteristics between groups were found. Before starting the first PP cycle, patients who developed PP-AKI had a significantly lower cumulative fluid balance (CFB), even when normalized for body weight (p = 0.006). Central venous pressure (CVP) values, measured before the first PP (OR 0.803, 95% CI [0.684–0.942], p = 0.007), as well as BMI (OR 1.153, 95% CI = [1.013–1.313], p = 0.031), were independently associated with the development of PP-AKI. In the multivariable regression analysis, a lower CVP before the first PP cycle was independently associated with ventilator-free days (OR 0.271, 95% CI [0.123–0.936], p = 0.011) and with ICU mortality (OR:0.831, 95% CI [0.699–0.989], p = 0.037). (4) Conclusions: Acute kidney injury occurs frequently in invasively ventilated severe COVID-19 ARDS patients undergoing their first prone positioning cycle. Higher BMI and lower CVP before PP are independently associated with the occurrence of AKI during prone positioning.

Role of albumin-induced volume expansion therapy for cerebral vasospasm in aneurysmal subarachnoid hemorrhage: A systematic review.

This study reviews the effect of albumin-induced volume expansion therapy on symptomatic vasospasm and clinical outcome in aneurysmal subarachnoid hemorrhage (aSAH). Computer searches carried out from the Scopus, Medline, Embase, Web of Science, the Cochrane Library, and Internet documents; hand searching of medical journals; and review of reference lists. Randomized controlled trials (RCT) and observational studies (OSs) comparing albumin therapy in combination or alone with crystalloid therapy for the treatment of cerebral vasospasm in aSAH were included in the study. Risk-of-bias assessment was conducted using ROB2.0 and ROBINS-I tools for RCTs and Oss, respectively. Out of a total of 1078 searches, one RCT (published in two articles) and one observational (retrospective) study were included for final analysis. In RCT, albumin was used for volume expansion therapy with a baseline crystalloid regime and comparison made between hypervolemic and normovolemic groups and it showed no beneficial effects on symptomatic vasospasm and clinical outcomes based on the Glasgow outcome scale. Furthermore, the use of albumin showed a tendency for sodium retention with lowering of glomerular filtration rate, limiting the amount of total fluid required for targeted central venous pressure values, and thereby avoiding fluid overload manifestations. The retrospective study results between albumin versus non-albumin groups (crystalloids only) supported improved outcomes in the former group with lower in-hospital mortality. Cardiorespiratory complications were equivocal in RCT and increased in non-albumin group in the retrospective study. Risk-of-bias assessment analyses revealed "some concerns" in RCT and "serious" limitation in OS due to its retrospective design. Albumin-induced volume expansion therapy for cerebral vasospasm does not have substantiative evidence to improve cerebral vasospasm and clinical outcomes in aSAH. Studies with well-designed RCTs are required to compare the use of albumin for volume expansion therapy versus standard fluid management using crystalloids to mitigate the scarcity of published data.

Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction.

The present analysis from the multicentre prospective Altshock-2 registry aims to better define clinical features, in-hospital course, and management of cardiogenic shock complicating acutely decompensated heart failure (ADHF-CS) as compared with that complicating acute myocardial infarction (AMI-CS). All patients with AMI-CS or ADHF-CS enrolled in the Altshock-2 registry between March 2020 and February 2022 were selected. The primary objective was the characterization of ADHF-CS patients as compared with AMI-CS. In-hospital length of stay and mortality were secondary endpoints. One-hundred-ninety of the 238 CS patients enrolled in the aforementioned period were considered for the present analysis: 101 AMI-CS (80% ST-elevated myocardial infarction and 20% non-ST-elevated myocardial infarction) and 89 ADHF-CS. As compared with AMI-CS, ADHF-CS patients were younger [63 (IQR 59-76) vs. 67 (IQR 54-73) years, P=0.01], but presented with higher creatinine [1.6 (IQR 1.0-2.6) vs. 1.2 (IQR 1.0-1.4) mg/dL, P<0.001], bilirubin [1.3 (IQR 0.9-2.3) vs. 0.6 (IQR 0.4-1.1) mg/dL, P=0.01], and central venous pressure values [14mmHg (IQR 8-12) vs. 10mmHg (IQR 7-14),P=0.01]. Norepinephrine was the most common catecholamine used in AMI-CS (79.3%), whereas epinephrine was used more commonly in ADHF-CS (65.5%); 75.8% vs. 46.6% received a temporary mechanical support in AMI-CS and ADHF-CS, respectively (P<0.001). Length of hospital stay was longer in the latter [28 (IQR 13-48) vs. 17 (IQR 9-29) days, P=0.001]. Heart replacement therapies were more frequently used in the ADHF-CS group (heart transplantation 13.5% vs. 0% and left ventricular assist device 11% vs. 2%, P<0.01 and 0.01, respectively). In-hospital mortality was 41.1% (38.6% AMI-CS vs. 43.8% ADHF-CS, P=0.5). ADHF-CS is characterized by a higher prevalence of end-organ and biventricular dysfunction at presentation, a longer hospital length of stay, and higher need of heart replacement therapies when compared with AMI-CS. In-hospital mortality was similar between the two aetiologies. Our data warrant development of new management protocols focused on CS aetiology.

The Effect of Fluid Pre-loading on Vital Signs and Hemodynamic Parameters in a Porcine Model of Lipopolysaccharide-Induced Endotoxemia.

Background Animal models of distributive hypotension and resuscitation allow the assessment of hemodynamic monitoring modalities and resuscitation strategies. The fluid-first paradigm for resuscitation is currently being challenged with clinical trials. In this investigation, venous return and perfusion are assessed, and full hemodynamics are characterized, in a porcine model of endotoxemic hypotension with and without fluid pre-loading. Methods Two groups of six pigs had the induction of standardized endotoxemic hypotension("critical hypotension"). Group 1 underwent four 10 cc/kg crystalloid boluses, and Group 2 was not fluid pre-resuscitated. Both groups underwent progressive norepinephrine (NE) up-titration to 0.25 mcg/kg/minute over 30 minutes. Vital signs, central parameters, and laboratory values were obtained at baseline, "critical hypotension,"after each bolus and during NE administration. Results Endotoxemia decreased the systemic vascular resistance (SVR) in Group 1 (1031±106 dyn/s/cm-5 versus738±258 dyn/s/cm-5; P=0.03) and Group 2 (1121±196 dyn/s/cm-5 versus759±342 dyn/s/cm-5; P=0.003). In Group 1, the four fluid boluses decreased heart rate (HR), pulmonary capillary wedge pressure (PCWP), and central venous pressure (CVP) (P<0.05). No changes were observed in blood pressure, cardiac output (CO), or lactate. NE up-titration increased HR in Group 1and decreased CVP in both groups. Higher final CVP (11 {3} versus4 {4} mmHg; P=0.01) and PCWP (5 {1} versus2 {2} mmHg; P=0.005) values were observed in Group 1 relative to Group 2, reflecting increased venous return. Conclusions Porcine endotoxemic hypotension and resuscitation were robustly characterized. In this model, fluid loading improved venous return with NE, though perfusion (CO) was preserved by increased NE-induced chronotropy.

In-silico hemodynamic ramp testing of ventricular assist device implanted patients using acausal cardiovascular-VAD modeling.

While cardiovascular system and mechanical circulatory support devices are efficiently model the effect of disease and assistance, they can also lend valuable insights into clinical procedures. This study demonstrates the use of a CVS-VAD model for an invasive procedure; hemodynamic ramp testing, in-silico. The CVS model is developed using validated models in literature, using Simscape™. An analytically derived pump model is calibrated for the HeartWare VAD. Dilated cardiomyopathy is used as an illustrative example of heart failure, and heart failure patients are created virtually by calibrating the model with requisite disease parameters obtained from published patient data. A clinically applied ramp study protocol is adopted whereby speed optimization is performed following clinically accepted hemodynamic normalization criteria. Trends in hemodynamic variables in response to pump speed increments are obtained. Optimal speed ranges are obtained for the three virtual patients based on target values of central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and mean arterial pressure (MAP) for hemodynamic stabilization. Appreciable speed changes in the mild case (300 rpm), slight changes in the moderate case (100 rpm), and no changes in the simulated severe case are possible. The study demonstrates a novel application of cardiovascular modeling using an open-source acausal model, which can be potentially beneficial for medical education and research.

Relationship between positive end-expiratory pressure levels, central venous pressure, systemic inflammation and acute renal failure in critically ill ventilated COVID-19 patients: a monocenter retrospective study in France.

The role of positive pressure ventilation, central venous pressure (CVP) and inflammation on the occurrence of acute kidney injury (AKI) have been poorly described in mechanically ventilated patient secondary to coronavirus disease 2019 (COVID-19). This was a monocenter retrospective cohort study of consecutive ventilated COVID-19 patients admitted in a French surgical intensive care unit between March 2020 and July 2020. Worsening renal function (WRF) was defined as development of a new AKI or a persistent AKI during the 5 days after mechanical ventilation initiation. We studied the association between WRF and ventilatory parameters including positive end-expiratory pressure (PEEP), CVP, and leukocytes count. Fifty-seven patients were included, 12 (21%) presented WRF. Daily PEEP, 5 days mean PEEP and daily CVP values were not associated with occurrence of WRF. 5 days mean CVP was higher in the WRF group compared to patients without WRF (median [IQR], 12 mm Hg [11-13] vs. 10 mm Hg [9-12]; P=0.03). Multivariate models with adjustment on leukocytes and Simplified Acute Physiology Score (SAPS) II confirmed the association between CVP value and risk of WRF (odd ratio, 1.97; 95% confidence interval, 1.12-4.33). Leukocytes count was also associated with occurrence of WRF in the WRF group (14 G/L [11-18]) and the no-WRF group (9 G/L [8-11]) (P=0.002). In mechanically ventilated COVID-19 patients, PEEP levels did not appear to influence occurrence of WRF. High CVP levels and leukocytes count are associated with risk of WRF.

THE EFFECT OF THE COMBINATION OF SEMI FOWLER POSITION AND RIGHT LATERAL ON HEMODYNAMIC CHANGES IN HEART FAILURE PATIENTS IN THE CVCU ROOM GRANDMED HOSPITAL LUBUK PAKAM

The results of a survey of the world community and in Indonesia, the most common disease and the most common cause of death is heart disease. Data from the World Health Organization (WHO) shows the prevalence that males experience more heart disease than females. Systemic and pulmonary disorders often occur because blood flow fails to enter the tissues due to failure of the heart pump, which affects the patient's hemodynamics. Changes in position have an impact on changes in central venous pressure values. The purpose of this study was to determine whether or not there was an effect of giving a combination of semi-Fowler's position with right lateral to changes in hemodynamic status of heart failure patients. Quasi experiment with one group pre test and post test method was used in this study. There were 10 respondents who were sampled using the quota sampling technique. This research was conducted at GrandMed Lubuk Pakam Hospital. The measuring instrument used in this study is an observation sheet. Data analysis was performed using paired simple T test. The results of this study obtained a p value = 0.001, this indicates that there is an effect of giving a combination of semi-Fowler's position with right lateral to changes in hemodynamic status in heart failure patients. Semi-Fowler's and lateral position actions help reduce oxygen consumption and increase maximum lung expansion and overcome damage to gas exchange so that it can reduce tightness and affect hemodynamic status. It is expected that nurses will provide education to patients so they want to change the semi-fowler's position with a right lateral combination in order to improve the patient's hemodynamic quality.&#x0D; &#x0D;

Implementation of Fuzzy Logic in Managing Common Anesthesia

Using fuzzy sets for reasoning is what we mean when we talk about fuzzy logic. Contradictory natures are prevalent phenomena in the medical field. Guidelines are used by anesthesiologists when taking care of patients. After gauging the patient’s vitals, he may make adjustments to the flow of medication and fluids, or even the ventilator settings. Knowledge about the real world is typically sketchy, inaccurate, and inconsistent. Due to the inherent representation of subjective human conceptions used in much medical decision making, fuzzy logic seems well-suited for use in anaesthesia. We have developed a fuzzy expert system using fuzzy methodology for the aim of fluid management during general anaesthesia. The desired intravenous fluid rate (IFR) is the defuzzified value that is output by the fuzzy expert system. Fuzzy inputs serve as antecedent parts of rules for a fuzzy expert system, and some examples of such inputs are mean arterial pressure (HUO), hourly urine output (HUO), and central venous pressure (CVP). It would only cost a little sum to have a human operator sometimes enter MAP, HUO, and CVP values into a personal computer for this purpose. The study’s overarching goal was to devise a method for approximating IFR by making use of a linguistic description of MAP and HUO. Fuzzy sets, including decreasing, constant, and growing MAP and HUO rates of change, would assist to illustrate the trend in a patient’s fluid state. To regulate fluid levels more precisely would be possible. Expert guidance in addition to the calculated use of fuzzy methods are essential for achievement of the desired outcome. Patients must be in generally good health before this mode may be used on them, and they must be undergoing minimally invasive surgery. Moderate to severe blood loss after surgery need more complex modalities involving more factors.

Diagnostic value of an increase in central venous pressure during SBT for prediction of weaning failure in mechanically ventilated patients: A cross-sectional study.

Timely and successful extubation is an essential step forward in clinical practice to minimize complications of mechanical ventilation and unsuccessful weaning processes. Thus, research into predictive factors of weaning outcome to optimize spontaneous breathing trial (SBT) precision before extubation is critical in intensive care practices. In this study, we aimed to investigate the predictive factors of the weaning outcome before and during SBT in mechanically ventilated patients. In this cross-sectional study, 159 mechanically ventilated patients who were eligible for SBT were enrolled. Of these patients, 140 had successful extubation, whereas the remainder failed. Each patient's PaCO2 and PaO2 levels, respiratory rate (RR), SpO2, mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) values at the start of SBT, 3 min later, and at the end of SBT were measured. These values, along with the patients'clinical characteristics, were then investigated to determine if there was any correlation between these variables and the weaning outcome. Our analysis revealed that increase in CVP, independent of hemoglobin (Hb) concentration, PaO2, SpO2, duration of mechanical ventilation (MV), length of intensive care unit (ICU) stay, and SBT process, as well as underlying disease, was positively correlated with extubation/weaning failure. While age, gender, vital signs (MAP, RR, and HR), sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation (APACHE) scores had no significant correlation with patients'extubation outcomes. According to our findings, integrating CVP assessment into SBT besides routine indices measurement and monitoring can be considered for the prediction of weaning outcome in critically ill mechanically ventilated patients.

Correlation between Glasgow Coma Scale with central venous pressure and near-infrared spectroscopy in patients with acquired brain injury in the intensive care unit of Adam Malik Hospital Medan

Abstract Background Acquired brain injury (ABI) is caused by trauma or nontrauma to the brain after birth. Increased intracranial pressure in patients with traumatic or nontraumatic brain injury affects the cerebral perfusion pressure. After traumatic brain injury, there is an increase in air content in the brain and an increase in volume of blood flow to the brain, which can cause increased intracranial pressure, herniation of brain tissue, impaired cerebral perfusion, and brain damage. Most patients with traumatic brain injury die from uncontrolled increases in intracranial pressure. Near-infrared spectroscopy (NIRS) and central venous pressure (CVP) monitoring are also associated with cerebral perfusion. This study aimed to determine the relationship between the Glasgow Coma Scale (GCS) scores and CVP and NIRS values in patients with ABI. Methods This prospective analytical study used a cross-sectional design to compare GCS scores with CVP and NIRS values in patients with traumatic and nontraumatic brain injury in the intensive care unit (ICU) of Haji Adam Malik Hospital Medan. GCS, CVP, and NIRS descriptive data in patients with brain injury were presented in terms of mean and standard deviation if the data were normally distributed, or median (interquartile range) values if the data were not normally distributed. The relationship between GCS scores and CVP and NIRS values was assessed using the Pearson correlation test if the data were normally distributed, or the Spearman test if the data were not normally distributed. Results In this study, the mean GCS score and CVP values were 7.04 ± 2.69 and 5.63 ± 25.82 mmHg, respectively. The right tissue oxygen saturation (StO2) was 55.61% ± 18.72%, and the left StO2 was 57.57% ± 17.48% with normally distributed data. There was no correlation between GCS scores and CVP values (P = 0.829), and no correlation between moderate GCS scores and right and left StO2 (P = 0.343; P = 0.121); however, there was a significantly strong positive correlation between severe GCS scores and right and left StO2 (P = 0.028, r = 0.656; P = 0.005, r = 0.777). Conclusion There was no significant correlation between GCS scores and CVP values, and no correlation between moderate GCS scores and NIRS values; however, there was a significantly strong positive correlation between severe GCS scores and NIRS values in patients with ABI at the ICU of Haji Adam Malik Hospital Medan.

Association between central venous pressure measurement and outcomes in critically ill patients with severe coma

BackgroundThe use of central venous pressure (CVP) measurements among (intensive care unit) ICU patients with severe coma has been questioned. This study aimed to investigate the application value of CVP in this population.MethodsData stored in the ICU Collaborative Research Database (eICU-CRD) and Medical Information Mart for Intensive Care III (MIMIC-III) database were reviewed. Critically ill patients with a Glasgow Coma Scale (GCS) score of 3–8 were included. The primary outcome was the in-hospital mortality rate. The statistical approaches used included multivariable Cox regression, propensity score matching (PSM), inverse probability treatment weighting (IPTW), stabilized IPTW, and restricted cubic splines (RCS) to ensure the robustness of our findings.ResultsIn total, 7386 patients were included in the study. Early CVP measurement was independently associated with in-hospital mortality [hazard ratio, 0.63; p < 0.001] in patients with severe-to-moderate coma. This result was robust in the PSM, sIPTW, and IPTW cohorts. For all patients with CVP measurements, the RCS curves showed that the risk of in-hospital mortality increased as the initial CVP time was delayed. In addition, early CVP measurement was significantly associated with lower ICU mortality, 28-day mortality, and 365-day mortality and a significantly higher number of ventilator-free days.ConclusionEarly CVP measurement could improve clinical outcomes in critically ill patients with severe coma

Accuracy of Mean Value of Central Venous Pressure from Monitor Digital Display: Influence of Amplitude of Central Venous Pressure during Respiration

BackgroundA simple measurement of central venous pressure (CVP)-mean by the digital monitor display has become increasingly popular. However, the agreement between CVP-mean and CVP-end (a standard method of CVP measurement by analyzing the waveform at end-expiration) is not well determined. This study was designed to identify the relationship between CVP-mean and CVP-end in critically ill patients and to introduce a new parameter of CVP amplitude (ΔCVP= CVPmax – CVPmin) during the respiratory period to identify the agreement/disagreement between CVP-mean and CVP-end. MethodsIn total, 291 patients were included in the study. CVP-mean and CVP-end were obtained simultaneously from each patient. CVP measurement difference (| CVP-mean – CVP-end |) was defined as the difference between CVP-mean and CVP-end. The ΔCVP was calculated as the difference between the peak (CVPmax) and the nadir value (CVPmin) during the respiratory cycle, which was automatically recorded on the monitor screen. Subjects with | CVP-mean – CVP-end | ≥ 2 mmHg were divided into the inconsistent group, while subjects with | CVP-mean – CVP-end | < 2 mmHg were divided into the consistent group. ResultsΔCVP was significantly higher in the inconsistent group [7.17(2.77) vs.5.24(2.18), p<0.001] than that in the consistent group. There was a significantly positive relationship between ΔCVP and | CVP-mean – CVP-end | (r=0.283, p <0.0001). Bland-Altman plot showed the bias was -0.61 mmHg with a wide 95% limit of agreement (–3.34, 2.10) of CVP-end and CVP-mean. The area under the receiver operating characteristic curves (AUC) of ΔCVP for predicting | CVP-mean – CVP-end | ≥ 2 mmHg was 0.709. With a high diagnostic specificity, using ΔCVP<3 to detect | CVP-mean – CVP-end | lower than 2mmHg (consistent measurement) resulted in a sensitivity of 22.37% and a specificity of 93.06%. Using ΔCVP>8 to detect | CVP-mean – CVP-end | >8 mmHg (inconsistent measurement) resulted in a sensitivity of 31.94% and a specificity of 91.32%. ConclusionsConclusions CVP-end and CVP-mean have statistical discrepancies in specific clinical scenarios. ΔCVP during the respiratory period is related to the variation of the two CVP methods. A high ΔCVP indicates a poor agreement between these two methods, whereas a low ΔCVP indicates a good agreement between these two methods.

Value of Central Venous Pressure Monitoring in the Patients with Sepsis-Associated Acute Kidney Injury.

Although the measurement of central venous pressure (CVP) is a common clinical tool, the role of CVP monitoring in the outcome of sepsis is controversial because threshold values of CVP are uncertain, and there are only limited data on short-term survival of patients with septic acute kidney injury (AKI). This retrospective cohort study was based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (source of the training dataset). Multivariate regression analysis was performed to clarify the relation between CVP measurement and clinical outcomes, and a univariate regression model after propensity score matching was utilized to validate our findings. A mortality prediction model for septic AKI and a risk stratification scoring approach were developed, and the emergency intensive care unit (eICU) database was used for external validation. Of the 9170 patients in the training set, 2446 (26.7%) underwent CVP measurement. No significant association was found between CVP monitoring and 28-day mortality among patients with septic AKI (odds ratio = 0.479; 95% confidence interval 0.213-1.076, P = 0.075), even after adjustments (propensity score matching; P = 0.178). Length of ICU stay and hospital stay was markedly reduced in patients undergoing CVP measurement within 3 hours (median 6.2 and 10.9 days, respectively, P < 0.001). The addition of the mean perfusion pressure initial, CVP, and the magnitude of the CVP change within 48 hours to the model significantly increased model discrimination (area under the receiver operating characteristic curve: 0.867 and 0.780, respectively, P < 0.001). These findings suggest that CVP measurement alone has little effect on the outcome of septic AKI. Nonetheless, initial CVP levels and the dynamic changes in CVP within the first 48 hours after ICU admission and the mean perfusion pressure initial can improve the accuracy of outcome prediction models.

Invasive hemodynamic monitoring for fluid management in septic shock patients

Aim Sepsis is still one of the most common causes of death, despite advances in treatment and technologies. Invasive monitoring in sepsis can improve survival. In this study, we aimed to compare the efficacy of hemodynamic monitoring in the fluid treatment of patients with septic shock. Material and Method Forty septic shock patients were divided into two groups. Group I (n = 20) was monitored with central venous pressure, and Group II (n = 20) with a cardiac output device (EV1000). Arterial blood gases were analyzed four times daily for the groups, and lactate values, diuresis status, need for dialysis, and inotrope need was recorded. For Group I, the central venous pressure and mean arterial pressure values were recorded for group II, cardiac output, cardiac index, stroke volume, stroke volume index, and mean arterial pressure values. Results There was a significant difference between the mean arterial pressures of the groups on the 1st and 2nd days (p = 0.034 and p = 0.026, respectively). In Group II, mean arterial pressures were higher on days 1 and 2. There was no significant difference between the other data recorded. Conclusion We observed no significant difference between central venous pressure monitoring and invasive monitoring in septic shock patient follow-up.

The impacts of corrected left ventricular ejection time combined with dobutamine on hepatocellular carcinoma patients

To evaluate the clinical effect of corrected left ventricular ejection time (LVETc) combined with dobutamine on the intraoperative management of patients undergoing hepatectomy for hepatocellular carcinoma. Sixty-eight patients with elective proposed pancreaticoduodenectomy, aged 61–78 years, body mass index 19–26 kg/m2, and ASA classification II or III, were divided into two groups (n = 34) using the random number table method: the esophageal ultrasound group (S group) and the esophageal ultrasound combined with dobutamine group (D group). In both groups, an esophageal ultrasound probe was placed after induction of anesthesia, and the left ventricular ejection time (LVET) and stroke volume (SV) were measured via a long-axis section of gastric fundus to guide fluid infusion. Nitroglycerin or a combination of dobutamine and nitroglycerine were pumped intravenously from the beginning of surgery to the completion of hemostasis after partial hepatectomy, in groups S or D, respectively. Central Venous Pressure (CVP), heart rate HR, and mean arterial pressure MAP were recorded at entry (T0), immediately after induction (T1), at the beginning of the operation (T2), during hilar occlusion (T3), after partial hepatectomy (T4), and after the operation (T5). SV and LVETc were recorded between T1 and T5. At T0 and T5, blood samples from radial artery and central vein were taken to determine the concentration of blood lactic acid, and the oxygen supply index (DO2I) and oxygen uptake rate (O2ERe) were calculated by blood gas analysis. The operation time, hilar occlusion time, intraoperative urine volume, intraoperative crystalloid and colloid infusion, intraoperative blood loss and blood transfusion, and the occurrence of cardiac gas emboli during the operation were also recorded. Adverse events of cardiovascular, pulmonary, and renal function during and after operation were registered. Sixty-four patients were included in the final analysis. Compared with group S, group D had lower CVP values at T2–T3 and higher SV values at T2–T5, reduced intraoperative blood loss, significantly increased intraoperative urine output, a smaller total dose of nitroglycerin use, and lower incidences of intraoperative hypotension and cardiac gas emboli (P < 0.05). Esophageal ultrasound detection of LVETc combined with dobutamine ensures hemodynamic stability in patients undergoing partial hepatectomy while reducing the incidence of intraoperative hypotension and air embolism.

Postoperative central venous pressure is associated with acute kidney injury in patients undergoing coronary artery bypass grafting.

The present study aimed to investigate the association of postoperative central venous pressure (CVP) with acute kidney injury (AKI) and mortality in patients undergoing coronary artery bypass grafting (CABG). Patients who underwent CABG in the MIMIC-III database were included and divided into two groups according to the optimal cutoff value of CVP for postoperative AKI determined by the receiver operating characteristic (ROC) curves. The association of CVP with AKI and mortality was determined by multivariate regression models. A 1:1 propensity score matching (PSM) was performed to balance the influence of potential confounding factors. A total of 3,564 patients were included and divided into High CVP group (CVP ≥ 10.9 mmHg) and Low CVP group (CVP < 10.9 mmHg) according to the ROC analysis. Patients in High CVP group presented with higher AKI incidence (420 (28.2%) vs. 349 (16.8), p < 0.001), in-hospital mortality (28 (1.9%) vs. 6 (0.3%), p < 0.001) and 4-year mortality (149 (15.8%) vs. 162 (11.1%), p = 0.001). Multivariate regression model showed that CVP was an independent risk factor for the postoperative AKI (OR: 1.071 (1.035, 1.109), p < 0.001), in-hospital mortality (OR: 1.187 (1.026, 1.373), p = 0.021) and 4-year mortality (HR: 1.049 (1.003, 1.096), p = 0.035). A CVP above 10.9 mmHg was significantly associated with about 50% higher risk of AKI (OR: 1.499 (1.231, 1.824), p < 0.001). After PSM, 1004 pairs of score-matched patients were generated. The multivariate logistic model showed that patients with CVP ≥ 10.9 mmHg had a significantly higher risk of AKI (OR: 1.600 (1.268, 2.018), p < 0.001) in the PSM subset. However, CVP, as a continuous or a dichotomic variable, was not independently associated with in-hospital mortality (OR: 1.202 (0.882, 1.637), p = 0.244; OR: 2.636 (0.399, 17.410), p = 0.314) and 4-year mortality (HR: 1.030 (0.974, 1.090), p = 0.297; HR: 1.262 (0.911, 1.749), p = 0.162) in the PSM dataset. A mean CVP ≥ 10.9 mmHg within the first 24 h after CABG was independently associated with a higher risk of postoperative AKI.