Venous Pressure Measurements Research Articles

Performance checklist and its influence on knowledge and satisfaction of intensive care nurses: A quasi-experimental study.

The purpose of this study was to evaluate the impact of using a performance checklist on knowledge and satisfaction of intensive care nurses. This study was a quasi-experimental study and performed on 70 intensive care nurses in two groups. Performance checklists had to be filled by the nurses in experiment group during central venous pressure (CVP) measurement procedure. Knowledge and the nurses about standards of CVP measurement and their satisfaction were evaluated in both groups by a researcher-made questionnaire. The data were analysed using the SPSS software. In the experiment group, the level of knowledge significantly increased after the intervention (p= .001) and the majority of nurses (85.7%) had a high level of satisfaction. Also, there was a significant difference between mean knowledge scores of the two groups after the intervention (p= .006). This showed that applying performance checklists can influence nurses' knowledge and should consider a simple indirect educational method.

Abstract 15532: Pressure Measurement From a Peripheral Iv Correlates Well With Invasive Central Venous Pressure Measurement

Introduction: Despite its importance in cardiac patients, accurate central venous pressure (CVP) estimation remains a challenge. Noninvasive methods, such as jugular venous pressure measurement, are highly dependent on examiner experience, and the gold-standard invasive methods require procedures that carry risk of complication. Recent studies suggest that pressure measurement directly from a patient’s peripheral intravenous (IV) catheter, termed peripheral venous pressure (PVP), appears promising as an accurate and noninvasive method for CVP estimation. Methods: To be included in the study, patients were either receiving right heart catheterization (RHC) or had an existing pulmonary artery catheter (PAC) in place. CVP was measured using standard technique either during RHC or at bedside from the PAC. The same pressure tubing was then connecting to the patient’s existing IV, regardless of the location or catheter gauge, for measurement of the PVP. Results: Seventeen patients were prospectively enrolled. The majority (70.6%) had their CVP and PVP measured during RHC. In the overall cohort, 35.3% were on mechanical circulatory support, and 29.4% were on inotropes at the time of measurement. CVP and PVP measurements were significantly correlated with one another (Pearson’s r = 0.73, p < 0.001; Figure 1A). Sensitivity analysis was performed to exclude one notable outlier, which strengthened the correlation (Pearson’s r = 0.91, p < 0.001; Figure 1B). Conclusions: This data suggests that PVP is a promising and simple method for the noninvasive estimation of CVP.

Design and Haemodynamic Analysis of a Novel Anchoring System for Central Venous Pressure Measurement.

In recent years, treatment of heart failure patients has proved to benefit from implantation of pressure sensors in the pulmonary artery (PA). While longitudinal measurement of PA pressure profoundly improves a clinician's ability to manage HF, the full potential of central venous pressure as a clinical tool has yet to be unlocked. Central venous pressure serves as a surrogate for the right atrial pressure, and thus could potentially predict a wider range of heart failure conditions. However, it is unclear if current sensor anchoring methods, designed for the PA, are suitable to hold pressure sensors safely in the inferior vena cava. The purpose of this study was to design an anchoring system for accurate apposition in inferior vena cava and evaluate whether it is a potential site for central venous pressure measurement. A location inferior to the renal veins was selected as an optimal site based on a CT scan analysis. Three anchor designs, a 10-strut anchor, and 5-struts with and without loops, were tested on a custom-made silicone bench model of Vena Cava targeting the infra-renal vena cava. The model was connected to a pulsatile pump system and a heated water bath that constituted an in-vitro simulation unit. Delivery of the inferior vena cava implant was accomplished using a preloaded introducer and a dilator as a push rod to deploy the device at the target area. The anchors were subjected to manual compression tests to evaluate their stability against dislodgement. Computational Fluid Dynamics (CFD) analysis was completed to characterize blood flow in the anchor's environment using pressure-based transient solver. Any potential recirculation zones or disturbances in the blood flow caused by the struts were identified. We demonstrated successful anchorage and deployment of the 10-strut anchor in the Vena Cava bench model. The 10-strut anchor remained stable during several compression attempts as compared with the other two 5-strut anchor designs. The 10-strut design provided the maximum number of contact points with the vessel in a circular layout and was less susceptible to movement or dislodgement during compression tests. Furthermore, the CFD simulation provided haemodynamic analysis of the optimum 10-strut anchor design. This study successfully demonstrated the design and deployment of an inferior vena cava anchoring system in a bench test model. The 10-strut anchor is an optimal design as compared with the two other 5-strut designs; however, substantial in-vivo experiments are required to validate the safety and accuracy of such implants. The CFD simulation enabled better understanding of the haemodynamic parameters and any disturbances in the blood flow due to the presence of the anchor. The ability to place a sensor technology in the vena cava could provide a simple and minimally invasive approach for heart failure patients.

Occlusion Pressure of the Thoracic Duct in Fontan Patients With Lymphatic Failure: Does Dilatation Challenge Contractility?

The Fontan circulation challenges the lymphatic system. Increasing production of lymphatic fluid and impeding lymphatic return, increased venous pressure may cause lymphatic dilatation and decrease lymphatic contractility. In-vitro studies have reported a lymphatic diameter-tension curve, with increasing passive stretch affecting the intrinsic contractile properties of each thoracic duct segment. We aimed to describe thoracic duct occlusion pressure and asses if thoracic duct dilation impairs contractility in individuals with a Fontan circulation and lymphatic failure. Central venous pressure and thoracic duct measurements were retrospectively collected from 31 individuals with a Fontan circulation. Thoracic duct occlusion pressure was assessed during a period of external manual compression and used as an indicator of lymphatic vessel contractility. Measurements of pressure were correlated with measurements of the thoracic duct diameter in images obtained by dynamic contrast-enhanced MR lymphangiography. The average central venous pressure and average pressure of the thoracic duct were 17 mm Hg. During manual occlusion, the thoracic duct pressure significantly increased to 32 mm Hg. The average thoracic duct diameter was 3.3 mm. Thoracic duct diameter correlated closely with the central venous pressure. The rise in pressure following manual occlusion showed an inverse correlation with the diameter of the thoracic duct. Higher central venous pressures are associated with increasing diameters of the thoracic duct. When challenged by manual occlusion, dilated thoracic ducts display a decreased ability to increase pressure. Dilatation and a resulting decreased contractility may partly explain the challenged lymphatic system in individuals with a Fontan circulation.

Ultrasound-guided venous pressure measurement.

Current standard technique for venous pressure measurement is still invasive, requiring insertion of a catheter. Additionally, clinical estimation of central venous pressure (CVP) has proven unreliable compared to invasive methods. Meanwhile, different non-invasive ultrasound guided modalities may provide a valid alternative to invasive venous pressure measurement. Particularly promising is a novel compression ultrasound (CUS) which combines ultrasound properties with a tissue pressure manometer enabling even further future applications. This review provides an overview using ultrasound guided non-invasive venous pressure measurement (UGPni) in clinical trials so far and focuses on three objectives: (1) To summarize the main methods using UGPni for central venous pressure measurement (2) To outline the key findings of previous clinical trials for UGPni regarding CVP measurement with primary focus on novel compression ultrasound of a forearm vein (3) To point out limitations and possible future clinical implications of these ultrasound modalities UGPni represents an easy-to-perform and safe alternative to invasive "gold standard" diagnostic tools for measuring central venous pressure. After a brief introduction, non-specialist personnel using a portable ultrasound device can apply this method in a feasible way. Of all mentioned methods in this review CUS is the method of choice underscoring its ability to assess a patient's CVP categories correctly. Furthermore, detection of non-invasive central venous pressure in the emergency room represents an independent predictor for cardiac rehospitalization in patients with decompensated heart failure, thus helping in risk stratification as well as being an additive tool in general hemodynamic management of critically ill patients. This review concludes a significant role for ultrasound guided non-invasive venous pressure measurement suitable for a wide range of everyday clinical practice. However, further studies are warranted to proof a causal relationship in this regard.

EXPLORATORY IN-CLINIC STUDY EVALUATING FEASIBILITY OF JVP HEIGHT ASSESSMENT BY EARLY PROTOTYPE OF MACHINE VISION ALGORITHM

EXPLORATORY IN-CLINIC STUDY EVALUATING FEASIBILITY OF JVP HEIGHT ASSESSMENT BY EARLY PROTOTYPE OF MACHINE VISION ALGORITHM

A descriptive study of venous pressures and gradients while awake and both pre- and post-stent under anesthesia in patients with idiopathic intracranial hypertension

BackgroundThis study aims to explore factors that affect venous sinus pressures and associated gradients while awake and under general anesthesia (GA) both before and after venous sinus stenting (VSS) in...

Association Between Wait Time of Central Venous Pressure Measurement and Outcomes in Critical Patients With Acute Kidney Injury: A Retrospective Cohort Study.

BackgroundHemodynamic management is of paramount importance in patients with acute kidney injury (AKI). Central venous pressure (CVP) has been used to assess volume status. We intended to identify the optimal time window in which to obtain CVP to avoid the incidence of adverse outcomes in patients with AKI.MethodsThe study was based on the Medical Information Mart for Intensive Care (MIMIC) IV database. The primary outcome was in-hospital mortality. Secondary outcomes included the number of ICU-free days and norepinephrine-free days at 28 days after ICU admission, and total fluid input and fluid balance during the first and second day. A time–dose–response relationship between wait time of CVP measurement and in-hospital mortality was implemented to find an inflection point for grouping, followed by propensity-score matching (PSM), which was used to compare the outcomes between the two groups.ResultsTwenty Nine Thousand and Three Hundred Thirty Six patients with AKI were enrolled, and the risk of in-hospital mortality increased when the CVP acquisition time was >9 h in the Cox proportional hazards regression model. Compared with 8,071 patients (27.5%) who underwent CVP measurement within 9 h and were assigned to the early group, 21,265 patients (72.5%) who delayed or did not monitor CVP had a significantly higher in-hospital mortality in univariate and multivariate Cox regression analyses. After adjusting for potential confounders by PSM and adjusting for propensity score, pairwise algorithmic, overlap weight, and doubly robust analysis, the results were still stable. The HRs were 0.58–0.72, all p < 0.001. E-value analysis suggested robustness to unmeasured confounding.ConclusionsAmong adults with AKI in ICU, increased CVP wait time was associated with a greater risk of in-hospital mortality. In addition, early CVP monitoring perhaps contributed to shortening the length of ICU stays and days of norepinephrine use, as well as better fluid management.

Correlation between hepatic venous pressure gradient and portal venous pressure gradient in hepatitis B cirrhosis with different hepatic veins anatomy

PurposeThe hepatic venous pressure gradient (HVPG) has been employed as the gold standard for indicating the portal venous pressure gradient (PPG) in the diagnosis of portal hypertension (PHT). However, little has been reported on whether the HVPG can accurately estimate the PPG in patients with hepatic vein collateral shunts. We aimed to explore the correlation between the HVPG and the PPG in hepatitis B cirrhosis patients with different hepatic vein anatomies. MethodsA total of 461 hepatitis B cirrhosis patients with portal hypertension (PHT) who were treated with a transjugular intrahepatic portosystemic shunt (TIPS) between January 2016 and June 2020 were included. All patients underwent various venous pressure measurements and balloon-occluded compression hepatic venography during the TIPS operation. Agreements were evaluated by Pearson’s correlation and the Bland–Altman method. Disagreements were assessed by paired t tests. ResultsThe correlation coefficient (r) values (P < 0.001) between the HVPG and the PPG of the early (151 patients, 32.8 %), middle (73 patients, 15.8 %), late (46 patients, 10.0 %), portal vein (151 patients, 32.8 %), and no lateral branch development groups (40 patients, 8.7 %) were 0.373, 0.487, 0.569, 0.690, and 0.575, respectively; the determination coefficient (R2) values were 0.139, 0.238, 0.323, 0.475, and 0.330, respectively. According to the Bland–Altman method, agreement was the greatest in the portal vein development group, with the 95 % limits of agreement (95 % LoA, mean differences ± 1.96 SD) being the smallest. The differences were statistically significant (P < 0.05). ConclusionThe correlation between the HVPG and the PPG is the worst in early lateral branch development, followed by middle development, and the influence of lateral branches becomes significantly reduced in late development. Hepatic venous collateral formation is a vital factor for underestimation of the HVPG, which is the most accurate predictor of PPG in patients with portal vein development. Patients with no collateral channel development in the hepatic vein have a higher HVPG than PPG, which is an important reason for overestimation of the HVPG.

Optimization of central venous pressure during the perioperative period is associated with improved prognosis of high-risk operation patients

BackgroundWhile central venous pressure (CVP) measurement is used to guide fluid management for high-risk surgical patients during the perioperative period, its relationship to patient prognosis is unknown. MethodsThis single-center, retrospective observational study enrolled patients undergoing high-risk surgery from February 1, 2014 to November 31, 2020, who were admitted to the surgical intensive care unit (ICU) directly after surgery. Patients were divided into the following three groups according to the first CVP measurement (CVP1) after admission to the ICU: low, CVP1 <8 mmHg; moderate, 8 mmHg≤ CVP1 ≤ 12 mmHg; and high, CVP1 >12 mmHg. Perioperative fluid balance, 28-day mortality, length of stay in the ICU, and hospitalization and surgical complications were compared across groups. ResultsOf the 775 high-risk surgical patients enrolled in the study, 228 were included in the analysis. Median (interquartile range) positive fluid balance during surgery was lowest in the low CVP1 group and highest in the high CVP1 group (low CVP1: 770 [410, 1205] mL; moderate CVP1: 1070 [685, 1500] mL; high CVP1: 1570 [1008, 2000] mL; all P <0.001). The volume of positive fluid balance during the perioperative period was correlated with CVP1 (r=0.336, P <0.001). The partial arterial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO2) ratio was significantly lower in the high CVP1 group than in the low and moderate CVP1 groups (low CVP1: 400.0 [299.5, 443.3] mmHg; moderate CVP1: 362.5 [330.0, 434.9] mmHg; high CVP1: 335.3 [254.0, 363.5] mmHg; all P <0.001). The incidence of postoperative acute kidney injury (AKI) was lowest in the moderate CVP1 group (low CVP1: 9.2%; moderate CVP1: 2.7%; high CVP1: 16.0%; P=0.007). The proportion of patients receiving renal replacement therapy was highest in the high CVP1 group (low CVP1: 1.5%; moderate CVP1: 0.9%; high CVP1: 10.0%; P=0.014). Logistic regression analysis showed that intraoperative hypotension and CVP1 >12 mmHg were risk factors for AKI within 72 h after surgery (adjusted odds ratio[aOR]=3.875, 95% confidence interval[CI]: 1.378–10.900, P=0.010 and aOR=1.147, 95%CI: 1.006–1.309, P=0.041). ConclusionsCVP that is either too high or too low increases the incidence of postoperative AKI. Sequential fluid therapy based on CVP after patients are transferred to the ICU post-surgery does not reduce the risk of organ dysfunction caused by an excessive amount of intraoperative fluid. However, CVP can be used as a safety limit indicator for perioperative fluid management in high-risk surgical patients.

Central Venous Catheter Malposition into the Left Internal Mammary Vein in Patient with Coagulation Disorder and Safe Removal: A Case Report

A 61-year-old male patient with underlying diseases of hypertension and alcoholic liver cirrhosis was hospitalized for liver transplantation due to advanced liver cirrhosis. In preparation for liver transplant surgery, a multi-lumen access catheter and Swan-ganz catheter are inserted into the right internal jugular vein. And another central venous catheter is inserted into the subclavian vein for central venous pressure measurement and drug administration. There was no abnormal resistance of the guide wire or catheter that the operator could feel during the insertion process, and there was no abnormality in the function of the catheter. But the postoperative chest image showed that the left subclavian central vein catheter was malpositioned. Through venography at the angiography room, it was confirmed that the central venous catheter was inserted into the left internal mammary vein. Since the patient with coagulation disorder, special attention was required to remove the catheter. In addition, due to the location of the internal mammary vein, it was expected that it would be difficult to compress for hemostasis after removal of the catheter. Therefore, it was necessary to check the patient's coagulation test to determine the appropriate time of the catheter removal and cooperation of the radiologist.

How is the practice of nurses in preventing infection of central venous catheters in hospitalized patients?-Nurse knowledge and attitudes

Central venous catheter (CVC) is an action that is often performed in treatment. There are several indications for the installation of a central venous catheter, ranging from measurement of central venous pressure (CVP), chemotherapy to parenteral nutrition. Central venous catheter wound care that is not carried out according to the procedure can cause various complications, one of which is infection. The incidence of sepsis due to central venous catheter placement is a significant cause of morbidity and mortality for patients. All nurses are required to have good skills and attitudes in the practice of implementing central venous catheter wound care in accordance with the procedure. Objective: This study aims to analyze the relationship between knowledge and attitudes of nurses regarding wound care to nurses practice in preventing wound infections in patients with central venous catheters. Methods: The design of this study was cross sectional using a descriptive correlational design. This research was conducted in July 2020. The number of samples involved in this study were 69 nurses with Diploma III educational qualifications in the inpatient ward of Dharmais Cancer Hospital. Data analysis using chi-square. Results: Bivariate analysis showed a value of p&lt;0.05 for nurses knowledge and attitudes regarding central venous catheter wound care on nurse practice in preventing central venous catheter infection. Conclusion: there is a relationship between the level of knowledge and attitudes of nurses in wound care to the practice of nurses in preventing wound infections in patients with central venous catheters in hospital inpatient rooms.&#x0D; Keywords: Nursing knowledge, attitude, practice, infection prevention, central venous catheter.

Shear wave dispersion to assess liver disease progression in Fontan-associated liver disease.

AimWe aimed to analyze the dispersion slope (DS) using shear wave dispersion (SWD) in patients with Fontan-associated liver disease (FALD) and to investigate its utility as a biomarker of disease progression.MethodsThis cross-sectional study enrolled 27 adults with FALD who underwent SWD, two-dimensional shear wave elastography (2D-SWE), transthoracic echocardiography, cardiac catheterization, or abdominal computed tomography (CT) from April 2019 to April 2021. According to CT findings, patients were divided into two groups: significant fibrosis and non-significant fibrosis.ResultsThe median DS in the control (n = 10), non-significant fibrosis (n = 12), and significant fibrosis (n = 15) was 9.35, 12.55, and 17.64 (m/s)/kHz, respectively. The significant fibrosis group showed a significantly higher DS than non-significant fibrosis group (P = 0.003). DS showed a significant correlation with central venous pressure (r = 0.532, P = 0.017) and liver stiffness measurements using 2D-SWE (r = 0.581, P = 0.002). The areas under the receiver operating characteristic curve for the diagnosis of significant fibrosis were 0.903 and 0.734 for SWD and 2D-SWE, respectively (P = 0.043).ConclusionsDS measured by SWD reflects the severity of liver damage in patients with FALD. SWE may be valuable for the therapeutic management of patients with FALD.

Correlation between Ultrasound Measurements of Internal Jugular Venous Diameter and Central Venous Pressure Measurements as a Follow up Tool in Severe Sepsis

Correlation between Ultrasound Measurements of Internal Jugular Venous Diameter and Central Venous Pressure Measurements as a Follow up Tool in Severe Sepsis

Transverse Sinus Stenting Reverses Medically Refractory Idiopathic Intracranial Hypertension.

To characterise the ophthalmic indications for, and ophthalmic efficacy of, transverse sinus stenting in adults with medically refractory idiopathic intracranial hypertension. A retrospective cohort study was undertaken on a single-author database of 226 successive patients with confirmed idiopathic intracranial hypertension (IIH). A total of 32 patients were identified who received a transverse sinus stent for medically refractory disease. This which was defined as visual threat and/or intolerance of maximal medical therapy. Patients with medically refractory disease proceeded to stenting, if found to have a significant transverse sinus stenosis gradient at catheter venography. Visual threat was quantified via the degree of papilledema on optical coherence tomography of the retinal nerve fibre layer, and via the visual field mean deviation. CSF opening pressure at lumbar puncture and cerebral venous sinus pressure measurements from catheter venography were correlated with the ophthalmic data, noting also intolerance of maximal medical therapy. Complications of stenting were fully assessed. Medically refractory IIH was found in 18% of the total cohort of IIH patients. 90% of those with medically refractory disease had a significant transverse sinus stenosis pressure gradient, and 80% proceeded to stenting. The intervention eliminated papilledema in 96% of stented patients, and allowed 81% to cease acetazolamide. The need for a further procedure was low at 6%, and the safety profile was favourable. Medically refractory disease in IIH is common (18%), and nearly always associated with a significant transverse sinus stenosis pressure gradient (90%). Endovascular stenting of the stenosis deserves wider uptake as a highly effective, safe, and usually definitive treatment. It safeguards vision by eliminating papilledema (96%), and allows most patients to cease acetazolamide (81%). By analogy with glaucoma, if acetazolamide is the prostaglandin of IIH and CSF diversion the emergency glaucoma filter, stenting is the minimally invasive glaucoma surgery.

Jugular Venous Pressure Measurement Is Accurate When Performed By Attending Physicians On Internal Medicine Wards

<h3>Introduction</h3> Jugular venous pressure (JVP) is a widely used estimate of central venous pressure (CVP). It is unclear how accurate JVP measurement is by physicians in different stages of clinical practice. We investigated the accuracy of JVP measurement across different levels of medical training by comparing JVP measurements to the peripheral venous pressure (PVP) measurement, which has been shown to have a high degree of correlation to CVP measurements. <h3>Hypothesis</h3> JVP will be better correlated with CVP when measured by physicians of higher level of clinical training. <h3>Methods</h3> A prospective, cross-sectional study in which 82 participants (13 third or fourth-year medical students, 26 interns, 21 residents, and 22 attending internal medicine physicians) measured JVP in patients admitted for acute decompensated heart failure (ADHF) to the general medicine ward. JVP measurements were compared to the PVP measured from a peripheral intravenous catheter by standard technique. <h3>Results</h3> Forty-five patients were enrolled with a mean age of 69±14 years, mean body mass index (BMI) of 31±9 kg/m², mean ejection fraction (EF) of 47±20%, and mean B-type natriuretic peptide (BNP) of 1242±1161 pg/ml. Mean JVP was 8.6 (4-18) cmH₂O for medical students, 8.7 (4-16) cmH₂O for interns, 9.1 (5-20) cmH₂O for residents, and 9.2 (4-15) cmH₂O for attending physicians. Mean PVP was 8.7 (1-20) mmHg. The JVP and CVP were found to have a moderate correlation (r=0.42, p=0.005) for attending physicians and a low correlation for medical students or residents. High-degree correlation among attending physicians was noted in patients with EF < 50% (r=0.60, p=0.009), BMI < 30 (r=0.55, p=0.008) and BNP > 1000 (r=0.56, p=0.01). <h3>Conclusions</h3> JVP is a reliable estimation of volume status in those admitted with ADHF when examined by an attending-level internal medicine physician, specifically in patients with a low BMI, low EF, and a high BNP.

An Unusual Cause of Superior Vena Cava Stenosis

<h3>Introduction</h3> An unusual cause of superior vena cava stenosis following heart transplantation. <h3>Case Report</h3> A sixty-five year old female underwent orthotopic heart transplantation for chemotherapy-induced cardiomyopathy after treatment for breast cancer in 2008. She required peripheral veno-arterial extracorporeal membrane oxygenation for primary graft dysfunction immediately post-transplantation. Venous access proved challenging due to a combination of implantable defibrillator therapy (extracted at transplant) and left sided mastectomy with lymph node clearance. Attempts at floating a pulmonary artery catheter were unsuccessful. Three days later she developed clinical signs of superior vena cava (SVC) obstruction, with head and upper limb oedema and elevated central venous pressure at 25mmHg. Echocardiography showed a moderate pericardial effusion but no tamponade and an underfilled right heart. Venography confirmed stenosis of the SVC during contrast injection, and measurement of central venous pressures demonstrated a pressure gradient of >4mmHg across the narrowing, with dampening of the pressure waveform distally (Figures). Surgical exploration of the SVC anastomosis site identified a haematoma causing external venous compression. Evacuation of the haematoma resulted in full resolution of symptoms. <h3>Summary</h3> Superior vena cava stenosis is an uncommon complication following heart transplantation, characterized by elevated central venous pressures and upper body oedema. Venography and direct intravenous pressure measurements are diagnostic. Surgical exploration or revision of the anastomosis may be indicated.

Effective Sphygmomanometer Based Non-invasive Central Venous Pressure Measurement In Hospitalized Heart Failure Patients

<h3>Background</h3> : Central venous pressure (CVP) estimation is vital in treating patients with heart failure (HF) exacerbation, with the measurement being routinely performed via physical examinations, which can frequently be difficult to obtain. This difficulty is further compounded in the age of expanding telemedicine, limiting the physicians' ability to care for HF patients remotely. A simple and accurate non-invasive measurement of CVP is needed. Recently a non-invasive device using a sphygmomanometer pump and oscillometric method to measure enclosed-zone CVP (ezCVP^TM) was developed (Nihon Kohden, Corp., Japan) and was found to accurately predict invasively measured CVP. However, whether ezCVP correlates with the clinical outcome or can be used to guide clinical management is unknown. We conducted a pilot study to assess its clinical utility of this novel technology in managing hospitalized patients with a primary diagnosis of HF exacerbation. <h3>Methods</h3> : Patients admitted to the HF inpatient service were enrolled. Both HF with reduced ejection fraction and preserved ejection fraction were included. Major exclusion criteria included patients in atrial fibrillation, on inotrope, on renal replacement therapy, or have severe tricuspid valve regurgitation. Daily measurement of ezCVP was performed and values were converted to CVP_NI (CVP non-invasive) as previously described. The treatment team was blinded from the CVP_NI values. We correlated the CVP_NI values with the hospital course and parameters such as weight and renal function. Finally, we compared the length of hospital stay between patients who had high or low admission CVP_NI values. <h3>Results</h3> : 22 patients were enrolled in this pilot study, and overall the patients' CVP_NI value decreased as they received diuresis. 8 patients had CVP_NI below the detection limit of ∼2 mmHg (shown as "0") upon admission and remained unchanged. The CVP_NI values upon discharge were overall low (mean +/- SD: 5 +/- 7, median 0). 3 patients had an increase in CVP_NI at discharge, 2 of them had worsening HF and were transitioned to comfort care and therefore the increase in CVP_NI was clinically consistent. The patients with low CVP_NI values upon admission had a shorter length of hospital stay compared to patients with higher CVP_NI values. <h3>Conclusion</h3> : CVP_NI correlated with the clinical course of HF patients receiving diuresis. Admission CVP_NI value was also predictive in overall length of stay in the hospital. This pilot study showed the feasibility and utility of using CVP_NI measurement as part of inpatient HF care. A larger study to confirm these findings is needed.

Central Venous Pressure Measurement Is Associated With Improved Outcomes in Patients With or at Risk for Acute Respiratory Distress Syndrome: An Analysis of the Medical Information Mart for Intensive Care IV Database.

BackgroundCentral venous pressure (CVP) monitoring is widely used in the intensive care unit (ICU). However, the formal utility of CVP measurement to altering patient outcomes among ICU patients with or at risk for acute respiratory distress syndrome (ARDS) has never been investigated. Our study aimed to explore the association of CVP measurement with 28-day mortality specifically in that population.MethodsThis study was based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were divided into CVP and no CVP groups according to whether they had CVP measurement within 24 h of admission to the ICU. The primary outcome was 28-day mortality. Multivariate regression was used to elucidate the association between CVP measurement and 28-day mortality, and propensity score matching (PSM) and propensity score-based overlap weighting (OW) were employed to verify the stability of our results.ResultsA total of 10,198 patients with or at risk for ARDS were included in our study, of which 4,647 patients (45.6%) belonged to the CVP group. Multivariate logistic regression showed that the early measurement of CVP was independently associated with lower 28-day mortality (OR: 0.49; 95% CI: 0.42–0.57; p < 0.001). This association remained robust after PSM and OW (both p < 0.001). Patients in the CVP group had shorter ICU stay, lower in-hospital mortality, more fluid on day 1 and higher clearance of blood lactate than those in the no CVP group.ConclusionEarly CVP measurement is associated with an improvement in 28-day mortality among a general population of critically ill patients with or at risk for ARDS.

Portable ultrasound assessment of jugular venous pressure is an accurate method for estimating volaemic status in patients with cardiac disease

PurposeThe objective of this study was to determine whether ultrasound-measured jugular venous pressure (U-JVP) could accurately estimate central venous pressure (CVP).MethodsThis prospective, diagnostic, single-centre study was performed at the Cardiac Intensive Care Unit of the Northern General Hospital, Sheffield, UK. Post-cardiac surgery patients were recruited from January to May 2019. The investigators were blinded to the central venous pressure when measuring the jugular venous pressure. U-JVP and direct CVP were measured simultaneously. Measurements were taken whilst the patient was ventilated and then repeated when the patient was extubated, providing non-ventilated readings.ResultsOne-hundred and fourteen consecutive participants with a male predominance of 71% and mean age of 65 ± 12 years were included in the analysis. Bland–Altman plots revealed that U-JVP marginally overestimated CVP by 0.91 mmHg (95% limits of agreement were −2.936 to 4.754) in ventilated patients and by 0.11 mmHg (95% limits of agreement between −2.481 and 2.695) in non-ventilated patients. Reasonable sensitivity and specificity of ultrasound-measured jugular venous pressure was achieved for low and high central venous pressure in both ventilated and non-ventilated patients.ConclusionU-JVP accurately estimates cardiac filling pressure and fluid status in patients after cardiac surgery, irrespective of their ventilatory status. Jugular venous pressure measurement by insonation is a reliable technique that can be taught to medical students and other health professionals to non-invasively estimate central venous pressure and may be useful for assessment of volaemic status in patients with heart failure.Trial registrationClinicalTrials.gov public (identifier NCT03815188).Graphical abstract