Journal: J Clin Monit Comput 22(3):181-182, 2008
Reprint: Liver Transplant Department, Azienda Ospedaliera Universitaria Pisana, Ospedale Cisanello, 56100, Pisa, Italy
Faculty Disclosure: Abstracted by R. Ouellette, who has nothing to disclose.
Despite various criticisms, central venous pressure (CVP) continues to be used for the assessment of volume status in patients undergoing surgery or in the intensive care unit (ICU). Because peripheral venous pressure (PVP) reflects an "upstream" pressure that is coupled to CVP by a continuous blood column, it can be expected to have some correlation with CVP. This study measured PVP and CVP together with the reliability of their relationship during hemodynamic perturbations and portal vein cross-clamp. PVP and CVP values were respectively taken from a peripheral catheter in a forearm vein and the distal port of a triple lumen central venous catheter in the right internal jugular vein; these sites were not used for fluid administration. Venous pressures data pairs were recorded every 10 minutes during surgery and hourly, for 12 hours, during spontaneous breathing in the ICU.
A total of 883 PVP/CVP data pairs, 650 during surgery and 233 in the ICU, were collected and analyzed. The PVP/CVP recording during times of hemodynamic instability were extrapolated and evaluated separately. No clinical management was made on the monitoring of the PVP.
Measurements during surgery included 650 data pairs, PVP 12.2±3.8 mmHg, CVP 11.3±3.7 mmHg, bias –0.9. Measurements during hemodynamic instability and portal vein clamping PVP included 92 data pairs, PVP 6.6±3.3 mmHg and CVP 5.8±3.0 mmHg, bias –0.8. Measurements in the ICU included 233 data pairs, PVP 9.8±2.7 mmHg and CVP 8.5± 2.8 mmHg, bias –1.3.
The data in this study outline that if PVP so closely and dynamically approximated CVP during compli¬cated procedures like that of these patients, even in conditions of hemodynamic instability and portal vein cross-clamp, it could represent an interesting, handy, and reliable "rescue" approach for other procedures where CVP monitoring was impossible, not previously planned or characterized by and unfavorable risks to benefits ratio related to the placement of a central venous catheter. |
