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Central venous pressure as an adjunct to flow-guided volume optimisation after induction of general anaesthesia
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Abstract
Background: Although the central venous pressure (CVP) is often used as a guide to volume status in major surgery
and intensive care, fluid therapy should be guided by the response of the stroke volume (SV) to a fluid bolus. The
present study evaluates whether the central venous pressure (CVP) can serve as an adjunct to decisions of whether
or not fluid should be infused.
Methods: Stroke volume (SV) and stroke volume variation (SVV) was monitored with FloTrac/Vigileo and the CVP
were measured in 80 patients just before general anaesthesia was induced (baseline) and then, before each of three
successive bolus infusions of 3 mL kg-1 of 6% hydroxyethyl starch 130/0.4. A patient showed fluid responsiveness and
was denoted a “responder” if SV increased by ≥10% from the bolus infusion.
Results: The CVP was higher in non-responders (mean 7.2 mm Hg) than in responders (mean 5.8 mm Hg, P <
0.0001). In non-responders but not in responders, the absence or presence of a rise in CVP improved the prediction
of whether the patient would show fluid responsiveness during the next fluid bolus. For example, if no rise in CVP
occurred the chance was 48% of subsequent fluid responsiveness, while this chance was only 9% for those who had
an increase in CVP (P < 0.004). There was only a fair concordance between fluid responsiveness as indicated by SV
and SVV (Cohen´s kappa 0.28).
Conclusions: A low CVP suggests that the patient is lower on the Frank-Starling curve than indicated by SV as measured by FloTrac/Vigileo.
Abstract
Background: Although the central venous pressure (CVP) is often used as a guide to volume status in major surgery
and intensive care, fluid therapy should be guided by the response of the stroke volume (SV) to a fluid bolus. The
present study evaluates whether the central venous pressure (CVP) can serve as an adjunct to decisions of whether
or not fluid should be infused.
Methods: Stroke volume (SV) and stroke volume variation (SVV) was monitored with FloTrac/Vigileo and the CVP
were measured in 80 patients just before general anaesthesia was induced (baseline) and then, before each of three
successive bolus infusions of 3 mL kg-1 of 6% hydroxyethyl starch 130/0.4. A patient showed fluid responsiveness and
was denoted a “responder” if SV increased by ≥10% from the bolus infusion.
Results: The CVP was higher in non-responders (mean 7.2 mm Hg) than in responders (mean 5.8 mm Hg, P <
0.0001). In non-responders but not in responders, the absence or presence of a rise in CVP improved the prediction
of whether the patient would show fluid responsiveness during the next fluid bolus. For example, if no rise in CVP
occurred the chance was 48% of subsequent fluid responsiveness, while this chance was only 9% for those who had
an increase in CVP (P < 0.004). There was only a fair concordance between fluid responsiveness as indicated by SV
and SVV (Cohen´s kappa 0.28).
Conclusions: A low CVP suggests that the patient is lower on the Frank-Starling curve than indicated by SV as measured by FloTrac/Vigileo.
Keywords
central venous pressure; fluid therapy; fluid responsiveness; general anesthesia; stroke volume; stroke volume variation
Supplementary Files (4)
About this articleTitle
Central venous pressure as an adjunct to flow-guided volume optimisation after induction of general anaesthesia
Journal
Anaesthesiology Intensive Therapy
Issue
Pages
110-115
Published online
2015-10-26
DOI
10.5603/AIT.a2015.0066
Pubmed
Bibliographic record
Anaesthesiol Intensive Ther 2016;48(2):110-115.
Keywords
central venous pressure
fluid therapy
fluid responsiveness
general anesthesia
stroke volume
stroke volume variation
Authors
Robert G. Hahn
Rui He
Yuhong Li