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Do not abandon monitoring the central venous pressure during fluid resuscitation of septic shock patients

  • Jihad Mallat
  • Benjamin John Reddi
Correspondence

Initial correspondence from Dr. Mallat

Dear Editor,

With great interest, we read the article by Reddi et al. [1], but are uncomfortable with their conclusions. In a post hoc analysis of the Australasian Resuscitation In Sepsis Evaluation (ARISE) trial [2], they found no meaningful relationships between the changes in central venous pressure (delta-CVP) and intravenous fluid administration (FA) and the changes in mean arterial pressure (delta-MAP) and delta-CVP during the first 6 h of resuscitation in septic shock patients [1].

The authors used an epidemiological tool to examine a physiological question. CVP is determined by the interaction of cardiac function and return function (Fig.  1) and so does not reflect the intravascular volume status. Thus, changes in CVP during FA should always be analyzed together with changes in cardiac output (CO). Minimal changes in CVP along with increases in CO indicate fluid responsiveness, whereas large increases in CVP with minimal changes in CO...

Notes

Compliance with ethical standards

Conflicts of interest

The author declares that he has no conflict of interest.

References

  1. 1.
    Reddi B, Finnis M, Udy AA, Maiden M, Delaney A, Bellomo R et al (2018) The relationship between the change in central venous pressure and intravenous fluid volume in patients presenting to the emergency department with septic shock. Intensive Care Med 44:1591–1592 CrossRefGoogle Scholar
  2. 2.
    Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ et al (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371(16):1496–1506CrossRefGoogle Scholar
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    Pierrakos C, Velissaris D, Scolletta S, Heenen S, De Backer D, Vincent JL (2012) Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock? Intensive Care Med 38(3):422–428CrossRefGoogle Scholar
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    Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41(2):580–637CrossRefGoogle Scholar
  5. 5.
    Reddi BA, Carpenter RH (2005) Venous excess: a new approach to cardiovascular control and its teaching. J Appl Physiol 98(1):356–364CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Department of Critical Care Medicine, Critical Care InstituteCleveland Clinic Abu DhabiAbu DhabiUnited Arab Emirates
  2. 2.Department of Anesthesiology and Critical Care MedicineCentre Hospitalier du Dr. Schaffner de LensLensFrance
  3. 3.Royal Adelaide HospitalAdelaideAustralia

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