Intensive Care Medicine

, Volume 42, Issue 3, pp 324–332 | Cite as

Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness

Systematic Review

Abstract

Purpose

Central venous pressure (CVP) has been shown to have poor predictive value for fluid responsiveness in critically ill patients. We aimed to re-evaluate this in a larger sample subgrouped by baseline CVP values.

Methods

In April 2015, we systematically searched and included all clinical studies evaluating the value of CVP in predicting fluid responsiveness. We contacted investigators for patient data sets. We subgrouped data as lower (<8 mmHg), intermediate (8–12 mmHg) and higher (>12 mmHg) baseline CVP.

Results

We included 51 studies; in the majority, mean/median CVP values were in the intermediate range (8–12 mmHg) in both fluid responders and non-responders. In an analysis of patient data sets (n = 1148) from 22 studies, the area under the receiver operating curve was above 0.50 in the <8 mmHg CVP group [0.57 (95 % CI 0.52–0.62)] in contrast to the 8–12 mmHg and >12 mmHg CVP groups in which the lower 95 % CI crossed 0.50. We identified some positive and negative predictive value for fluid responsiveness for specific low and high values of CVP, respectively, but none of the predictive values were above 66 % for any CVPs from 0 to 20 mmHg. There were less data on higher CVPs, in particular >15 mmHg, making the estimates on predictive values less precise for higher CVP.

Conclusions

Most studies evaluating fluid responsiveness reported mean/median CVP values in the intermediate range of 8–12 mmHg both in responders and non-responders. In a re-analysis of 1148 patient data sets, specific lower and higher CVP values had some positive and negative predictive value for fluid responsiveness, respectively, but predictive values were low for all specific CVP values assessed.

Keywords

Central venous pressure Critical illness Fluid therapy Haemodynamics Intensive care 

Supplementary material

134_2015_4168_MOESM1_ESM.docx (21 mb)
Supplementary material 1 (DOCX 21478 kb)

References

  1. 1.
    Perner A, De Backer D (2014) Understanding hypovolaemia. Intensive Care Med 40:613–615CrossRefPubMedGoogle Scholar
  2. 2.
    Marik PE, Cavallazzi R, Vasu T, Hirani A (2009) Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 37:2642–2647CrossRefPubMedGoogle Scholar
  3. 3.
    Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA (2011) Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 39:259–265CrossRefPubMedGoogle Scholar
  4. 4.
    Cecconi M, Hofer C, Teboul JL, Pettila V, Wilkman E, Molnar Z, Della Rocca G, Aldecoa C, Artigas A, Jog S, Sander M, Spies C, Lefrant JY, De Backer D (2015) Fluid challenges in intensive care: the FENICE study: a global inception cohort study. Intensive Care Med 41:1529–1537Google Scholar
  5. 5.
    Sondergaard S, Parkin G, Aneman A (2015) Central venous pressure: we need to bring clinical use into physiological context. Acta Anaesthesiol Scand 59:552–560CrossRefPubMedGoogle Scholar
  6. 6.
    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228CrossRefPubMedGoogle Scholar
  7. 7.
    Marik PE, Baram M, Vahid B (2008) Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 134:172–178CrossRefPubMedGoogle Scholar
  8. 8.
    Marik PE, Cavallazzi R (2013) Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med 41:1774–1781CrossRefPubMedGoogle Scholar
  9. 9.
    Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, Jaeschke R, Mebazaa A, Pinsky MR, Teboul JL, Vincent JL, Rhodes A (2014) Consensus on circulatory shock and hemodynamic monitoring. Task Force of the European Society of Intensive Care Medicine. Intensive Care Med 40:1795–1815PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377CrossRefPubMedGoogle Scholar
  11. 11.
    Wetterslev M, Haase N, Johansen RR, Perner A (2013) Predicting fluid responsiveness with transthoracic echocardiography is not yet evidence based. Acta Anaesthesiol Scand 57:692–697CrossRefPubMedGoogle Scholar
  12. 12.
    Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome JL, Jardin F, Vieillard-Baron A (2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 30:1740–1746PubMedGoogle Scholar
  13. 13.
    Belloni L, Pisano A, Natale A, Piccirillo MR, Piazza L, Ismeno G, De Martino G (2008) Assessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter. J Cardiothorac Vasc Anesth 22:243–248CrossRefPubMedGoogle Scholar
  14. 14.
    Berkenstadt H, Margalit N, Hadani M, Friedman Z, Segal E, Villa Y, Perel A (2001) Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg 92:984–989CrossRefPubMedGoogle Scholar
  15. 15.
    Biais M, Nouette-Gaulain K, Cottenceau V, Revel P, Sztark F (2008) Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation. Br J Anaesth 101:761–768CrossRefPubMedGoogle Scholar
  16. 16.
    Broch O, Bein B, Gruenewald M, Hocker J, Schottler J, Meybohm P, Steinfath M, Renner J (2011) Accuracy of the pleth variability index to predict fluid responsiveness depends on the perfusion index. Acta Anaesthesiol Scand 55:686–693CrossRefPubMedGoogle Scholar
  17. 17.
    Broch O, Renner J, Gruenewald M, Meybohm P, Hocker J, Schottler J, Steinfath M, Bein B (2012) Variation of left ventricular outflow tract velocity and global end-diastolic volume index reliably predict fluid responsiveness in cardiac surgery patients. J Crit Care 27:325.e7–325.e13CrossRefGoogle Scholar
  18. 18.
    Cannesson M, Attof Y, Rosamel P, Desebbe O, Joseph P, Metton O, Bastien O, Lehot JJ (2007) Respiratory variations in pulse oximetry plethysmographic waveform amplitude to predict fluid responsiveness in the operating room. Anesthesiology 106:1105–1111CrossRefPubMedGoogle Scholar
  19. 19.
    Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, Tavernier B (2011) Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach. Anesthesiology 115:231–241CrossRefPubMedGoogle Scholar
  20. 20.
    Cannesson M, Musard H, Desebbe O, Boucau C, Simon R, Henaine R, Lehot JJ (2009) The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients. Anesth Analg 108:513–517CrossRefPubMedGoogle Scholar
  21. 21.
    Cecconi M, Monti G, Hamilton MA, Puntis M, Dawson D, Tuccillo ML, Della Rocca G, Grounds RM, Rhodes A (2012) Efficacy of functional hemodynamic parameters in predicting fluid responsiveness with pulse power analysis in surgical patients. Minerva Anestesiol 78:527–533PubMedGoogle Scholar
  22. 22.
    de Waal EE, Rex S, Kruitwagen CL, Kalkman CJ, Buhre WF (2009) Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions. Crit Care Med 37:510–515CrossRefPubMedGoogle Scholar
  23. 23.
    Desgranges FP, Desebbe O, Ghazouani A, Gilbert K, Keller G, Chiari P, Robin J, Bastien O, Lehot JJ, Cannesson M (2011) Influence of the site of measurement on the ability of plethysmographic variability index to predict fluid responsiveness. Br J Anaesth 107:329–335CrossRefPubMedGoogle Scholar
  24. 24.
    Fischer MO, Pelissier A, Bohadana D, Gerard JL, Hanouz JL, Fellahi JL (2013) Prediction of responsiveness to an intravenous fluid challenge in patients after cardiac surgery with cardiopulmonary bypass: a comparison between arterial pulse pressure variation and digital plethysmographic variability index. J Cardiothorac Vasc Anesth 27:1087–1093CrossRefPubMedGoogle Scholar
  25. 25.
    Geerts BF, Aarts LP, Groeneveld AB, Jansen JR (2011) Predicting cardiac output responses to passive leg raising by a PEEP-induced increase in central venous pressure, in cardiac surgery patients. Br J Anaesth 107:150–156CrossRefPubMedGoogle Scholar
  26. 26.
    Heijmans JH, Ganushak YM, Theunissen MS, Maessen JG, Roekaerts PJ (2010) Predictors of cardiac responsiveness to fluid therapy after cardiac surgery. Acta Anaesthesiol Belg 61:151–158PubMedGoogle Scholar
  27. 27.
    Huang CC, Fu JY, Hu HC, Kao KC, Chen NH, Hsieh MJ, Tsai YH (2008) Prediction of fluid responsiveness in acute respiratory distress syndrome patients ventilated with low tidal volume and high positive end-expiratory pressure. Crit Care Med 36:2810–2816CrossRefPubMedGoogle Scholar
  28. 28.
    Keller G, Sinavsky K, Desebbe O, Lehot JJ (2012) Combination of continuous pulse pressure variation monitoring and cardiac filling pressure to predict fluid responsiveness. J Clin Monit Comput 26:401–405CrossRefPubMedGoogle Scholar
  29. 29.
    Kramer A, Zygun D, Hawes H, Easton P, Ferland A (2004) Pulse pressure variation predicts fluid responsiveness following coronary artery bypass surgery. Chest 126:1563–1568CrossRefPubMedGoogle Scholar
  30. 30.
    Lakhal K, Ehrmann S, Benzekri-Lefevre D, Runge I, Legras A, Dequin PF, Mercier E, Wolff M, Regnier B, Boulain T (2011) Respiratory pulse pressure variation fails to predict fluid responsiveness in acute respiratory distress syndrome. Crit Care 15:R85PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Lakhal K, Ehrmann S, Runge I, Benzekri-Lefevre D, Legras A, Dequin PF, Mercier E, Wolff M, Regnier B, Boulain T (2010) Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness. Intensive Care Med 36:940–948CrossRefPubMedGoogle Scholar
  32. 32.
    Lee JH, Jeon Y, Bahk JH, Gil NS, Kim KB, Hong DM, Kim HJ (2011) Pulse-pressure variation predicts fluid responsiveness during heart displacement for off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth 25:1056–1062CrossRefPubMedGoogle Scholar
  33. 33.
    Lee JH, Kim JT, Yoon SZ, Lim YJ, Jeon Y, Bahk JH, Kim CS (2007) Evaluation of corrected flow time in oesophageal Doppler as a predictor of fluid responsiveness. Br J Anaesth 99:343–348CrossRefPubMedGoogle Scholar
  34. 34.
    Mahjoub Y, Benoit-Fallet H, Airapetian N, Lorne E, Levrard M, Seydi AA, Amennouche N, Slama M, Dupont H (2012) Improvement of left ventricular relaxation as assessed by tissue Doppler imaging in fluid-responsive critically ill septic patients. Intensive Care Med 38:1461–1470CrossRefPubMedGoogle Scholar
  35. 35.
    Monge Garcia MI, Gil Cano A, Diaz Monrove JC (2009) Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients. Crit Care 13:R142PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Moretti R, Pizzi B (2010) Inferior vena cava distensibility as a predictor of fluid responsiveness in patients with subarachnoid hemorrhage. Neurocrit Care 13:3–9CrossRefPubMedGoogle Scholar
  37. 37.
    Muller L, Louart G, Bengler C, Fabbro-Peray P, Carr J, Ripart J, de La Coussaye JE, Lefrant JY (2008) The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure: a comparison with central venous pressure. Anesth Analg 107:607–613CrossRefPubMedGoogle Scholar
  38. 38.
    Muller L, Louart G, Bousquet PJ, Candela D, Zoric L, de La Coussaye JE, Jaber S, Lefrant JY (2010) The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness. Intensive Care Med 36:496–503CrossRefPubMedGoogle Scholar
  39. 39.
    Muller L, Toumi M, Bousquet PJ, Riu-Poulenc B, Louart G, Candela D, Zoric L, Suehs C, de La Coussaye JE, Molinari N, Lefrant JY (2011) An increase in aortic blood flow after an infusion of 100 ml colloid over 1 minute can predict fluid responsiveness: the mini-fluid challenge study. Anesthesiology 115:541–547CrossRefPubMedGoogle Scholar
  40. 40.
    Oliveira-Costa CD, Friedman G, Vieira SR, Fialkow L (2012) Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volumes. Clinics (Sao Paulo) 67:773–778CrossRefGoogle Scholar
  41. 41.
    Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL (2007) Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 35:64–68CrossRefPubMedGoogle Scholar
  42. 42.
    Perel A, Minkovich L, Preisman S, Abiad M, Segal E, Coriat P (2005) Assessing fluid-responsiveness by a standardized ventilatory maneuver: the respiratory systolic variation test. Anesth Analg 100:942–945CrossRefPubMedGoogle Scholar
  43. 43.
    Preisman S, Kogan S, Berkenstadt H, Perel A (2005) Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the respiratory systolic variation test and static preload indicators. Br J Anaesth 95:746–755CrossRefPubMedGoogle Scholar
  44. 44.
    Roy S, Couture P, Qizilbash B, Toupin F, Levesque S, Carrier M, Lambert J, Denault AY (2013) Hemodynamic pressure waveform analysis in predicting fluid responsiveness. J Cardiothorac Vasc Anesth 27:676–680CrossRefPubMedGoogle Scholar
  45. 45.
    Shin YH, Ko JS, Gwak MS, Kim GS, Lee JH, Lee SK (2011) Utility of uncalibrated femoral stroke volume variation as a predictor of fluid responsiveness during the anhepatic phase of liver transplantation. Liver Transpl 17:53–59CrossRefPubMedGoogle Scholar
  46. 46.
    Trof RJ, Danad I, Groeneveld AJ (2013) Global end-diastolic volume increases to maintain fluid responsiveness in sepsis-induced systolic dysfunction. BMC Anesthesiol 13:12PubMedCentralCrossRefPubMedGoogle Scholar
  47. 47.
    Trof RJ, Danad I, Reilingh MW, Breukers RM, Groeneveld AB (2011) Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function. Crit Care 15:R73PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Wilkman E, Kuitunen A, Pettila V, Varpula M (2014) Fluid responsiveness predicted by elevation of PEEP in patients with septic shock. Acta Anaesthesiol Scand 58:27–35CrossRefPubMedGoogle Scholar
  49. 49.
    Wyffels PA, Durnez PJ, Helderweirt J, Stockman WM, De Kegel D (2007) Ventilation-induced plethysmographic variations predict fluid responsiveness in ventilated postoperative cardiac surgery patients. Anesth Analg 105:448–452CrossRefPubMedGoogle Scholar
  50. 50.
    Yazigi A, Khoury E, Hlais S, Madi-Jebara S, Haddad F, Hayek G, Jabbour K (2012) Pulse pressure variation predicts fluid responsiveness in elderly patients after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 26:387–390CrossRefPubMedGoogle Scholar
  51. 51.
    Calvin JE, Driedger AA, Sibbald WJ (1981) The hemodynamic effect of rapid fluid infusion in critically ill patients. Surgery 90:61–76PubMedGoogle Scholar
  52. 52.
    Fischer MO, Balaire X, Mauff Le, de Kergal C, Boisselier C, Gerard JL, Hanouz JL, Fellahi JL (2014) The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography. Can J Anaesth 61:19–26CrossRefPubMedGoogle Scholar
  53. 53.
    Hu B, Xiang H, Liang H, Yu L, Xu T, Yang JH, Du ZH, Li JG (2013) Assessment effect of central venous pressure in fluid resuscitation in the patients with shock: a multi-center retrospective research. Chin Med J (Engl) 126:1844–1849Google Scholar
  54. 54.
    Magder S, Bafaqeeh F (2007) The clinical role of central venous pressure measurements. J Intensive Care Med 22:44–51CrossRefPubMedGoogle Scholar
  55. 55.
    Saugel B, Kirsche SV, Hapfelmeier A, Phillip V, Schultheiss C, Schmid RM, Huber W (2013) Prediction of fluid responsiveness in patients admitted to the medical intensive care unit. J Crit Care 28:537.e531–537.e539Google Scholar
  56. 56.
    Sturgess DJ, Pascoe RL, Scalia G, Venkatesh B (2010) A comparison of transcutaneous Doppler corrected flow time, b-type natriuretic peptide and central venous pressure as predictors of fluid responsiveness in septic shock: a preliminary evaluation. Anaesth Intensive Care 38:336–341PubMedGoogle Scholar
  57. 57.
    Thiel SW, Kollef MH, Isakow W (2009) Non-invasive stroke volume measurement and passive leg raising predict volume responsiveness in medical ICU patients: an observational cohort study. Crit Care 13:R111PubMedCentralCrossRefPubMedGoogle Scholar
  58. 58.
    Velissaris D, Pierrakos C, Scolletta S, De Backer D, Vincent JL (2011) High mixed venous oxygen saturation levels do not exclude fluid responsiveness in critically ill septic patients. Crit Care 15:R177PubMedCentralCrossRefPubMedGoogle Scholar
  59. 59.
    Yu T, Pan C, Guo FM, Yang Y, Qiu HB (2013) Changes in arterial blood pressure induced by passive leg raising predict hypotension during the induction of sedation in critically ill patients without severe cardiac dysfunction. Chin Med J (Engl) 126:2445–2450Google Scholar
  60. 60.
    Monge Garcia MI, Gil Cano A, Diaz Monrove JC (2009) Arterial pressure changes during the valsalva maneuver to predict fluid responsiveness in spontaneously breathing patients. Intensive Care Med 35:77–84CrossRefPubMedGoogle Scholar
  61. 61.
    Cecconi M, Aya HD, Geisen M, Ebm C, Fletcher N, Grounds RM, Rhodes A (2013) Changes in the mean systemic filling pressure during a fluid challenge in postsurgical intensive care patients. Intensive Care Med 39:1299–1305CrossRefPubMedGoogle Scholar
  62. 62.
    Lanspa MJ, Brown SM, Hirshberg EL, Jones JP, Grissom CK (2012) Central venous pressure and shock index predict lack of hemodynamic response to volume expansion in septic shock: a prospective, observational study. J Crit Care 27:609–615PubMedCentralCrossRefPubMedGoogle Scholar
  63. 63.
    Hamzaoui O, Monnet X, Teboul JL (2015) Evolving concepts of hemodynamic monitoring for critically ill patients. Indian J Crit Care Med 19:220–226PubMedCentralCrossRefPubMedGoogle Scholar
  64. 64.
    Mahjoub Y, Lejeune V, Muller L, Perbet S, Zieleskiewicz L, Bart F, Veber B, Paugam-Burtz C, Jaber S, Ayham A, Zogheib E, Lasocki S, Vieillard-Baron A, Quintard H, Joannes-Boyau O, Plantefeve G, Montravers P, Duperret S, Lakhdari M, Ammenouche N, Lorne E, Slama M, Dupont H (2014) Evaluation of pulse pressure variation validity criteria in critically ill patients: a prospective observational multicentre point-prevalence study. Br J Anaesth 112:681–685CrossRefPubMedGoogle Scholar
  65. 65.
    Marik PE, Lemson J (2014) Fluid responsiveness: an evolution of our understanding. Br J Anaesth 112:617–620CrossRefPubMedGoogle Scholar
  66. 66.
    Berlin DA, Bakker J (2014) Understanding venous return. Intensive Care Med 40:1564–1566CrossRefPubMedGoogle Scholar
  67. 67.
    Perner A, Vieillard-Baron A, Bakker J (2015) Fluid resuscitation in ICU patients: quo vadis? Intensive Care Med 41:1667–1669CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  1. 1.Department of Intensive CareCopenhagen University Hospital, RigshospitaletCopenhagenDenmark

Personalised recommendations