Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness
- 3.5k Downloads
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.
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.
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.
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.
KeywordsCentral venous pressure Critical illness Fluid therapy Haemodynamics Intensive care
We warmly thank Drs. M. Biais, O. Broch, M. Cecconi, M.O. Fischer, M.I. Monge Garcia, B.F. Geerts, G. Keller, K. Lakhal, M.J. Lanspa, S. Magder, Y. Mahjoub, L. Muller, C.D. Oliveira-Costa, S. Preisman, S. Roy, B. Saugel, R.J. Trof, E. Wilkman and T. Yu for sharing their original data. Without their altruistic help the results of this study would have been less conclusive.
Compliance with ethical standards
Conflicts of interest
None of the authors have potential conflicts of interest.
None of the authors receive funding or financial support.
- 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 41:1529–1537PubMedPubMedCentralGoogle Scholar
- 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 39:165–228PubMedGoogle Scholar
- 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 40:1795–1815PubMedPubMedCentralGoogle Scholar
- 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 22:243–248PubMedGoogle Scholar
- 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 92:984–989Google Scholar
- 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.e13Google Scholar
- 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 27:1087–1093PubMedGoogle Scholar
- 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 36:940–948PubMedGoogle Scholar
- 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 107:607–613PubMedGoogle Scholar
- 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 115:541–547PubMedGoogle Scholar
- 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) 67:773–778Google Scholar
- 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
- 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.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
- 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
- 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 112:681–685PubMedGoogle Scholar