measured central venous pressure and physician administration of intravenous fluids

Measured Central Venous Pressure and Physician Administration of

Intravenous Fluids

Todd Belok

PI: Neal Handly, MD

Hahnemann University Hospital, Emergency Department

Hypothesis• Low (< 8mmHg) measured central venous pressure of

hypotensive non-trauma patients correlates with the decision by physicians to administer intravenous fluids.

Purpose• To determine if using the Venus 1000 will alter physician

behavior using low CVP level and fluid administration as variables

Overview of Hemodynamics

• Renin-Angiotensin system

• Cardiac Output = Heart Rate x Stroke Volume

• Systemic vascular resistance= (MAP-CVP)/CO

• Shock: Inadequate perfusion/oxygenation

Mohit Goyal, Rabindranath

Tagore Medical College

Uscom Ltd.

Ohm’s Law

Dr. Sam George, Anesthesia and Intensive Care, Guajarat Cancer and Research Institute (GCRI)

What is Central Venous Pressure?

• Measurement of blood pressure within the right atrium and vena cava

• Ability of the heart to pump blood to the lungs• High CVP is an important marker of right heart failure b/c of ⊕

pulmonary vascular resistance

• CVP ≈ Venous return to the right side of the heart

Use of CVP in the ED/Intensive Care Setting for hemodynamic stability

• “Structured early goal-directed resuscitation”

• CVP readings help in the general management of shock through improving…

• O2 saturation

• Cardiac Output*

• Blood Pressure*

• Regional blood flow*

• Septic shock and CVP• “Golden” 6 hours for hemodynamic stabilization before specific

antibiotics

Central Venous Pressure and Cardiac Output

• With no vascular resistance Cardiac Output=Venous Return and MAP=CVP

• Use fluid resuscitation, vasopressors, and inotropic agents to increase cardiac output and blood pressure

SVR=(MAP-CVP)/CO

CVP and CO: Volume resuscitation

Josh Farkas, MD, Pulmonary and Critical Care Medicine, University of Vermont

CVP and CO: Vasopressor Therapy

Josh Farkas, MD, Pulmonary and Critical Care Medicine, University of Vermont

CVP and CO: Inotropic therapy

Josh Farkas, MD, Pulmonary and Critical Care Medicine, University of Vermont

Central Venous Pressure and Blood Pressure

• Systemic vascular resistance=(MAP-CVP)/CO

• If BP improves after fluid administration, issue could be decreased preload

• If BP does not improve after fluids, then problem could be contractility

• Use CVP to guide whether volume expansion is appropriate

• Importance in suggesting reasons for low blood pressure• Low CVP (<8cm H2O) suggests low BP is b/c of low blood volume

Central Venous Pressure and Regional blood flow

• Regional blood flow=Pressure1-Pressure2/Resistance

• Increase MAP to decrease CVP

• 2013 Netherlands study: CVP > 12 mmHg correlated with reduced microvascular blood flow in sepsis

• Renal blood flow particularly at risk

Septic Shock and CVP

• Use fluid resuscitation, vasopressors, inotropic therapy, and corticosteroids (severe sepsis only) to increase cardiac output and during the first 6 hrs maintain…

• CVP 8-12 mmHg

• MAP ≥ 65 mmHg

• Urine output ≥ .5 mL·kg·hr

• Superior vena cava O2 saturation 70% or mixed venous 65%

• Blood cultures

• Source control

Measuring CVP traditionally involves intravenous catheterization

• Risks of…• infection, embolism, compartment syndrome, necrosis of vascular

tissue, thrombophlebitis, and more

NREMT academy Fibroid Center of MD

Mespere’s Venus 1000

Mespere Life Sciences Inc.

Implications for the future

• Increase screening/continuous monitoring for patients at risk of developing shock

• Increase point-of-care testing in the prehospital setting

American Medical Academy Nova Biomedical