Central venous pressure and plasma arginine vasopressin in man during water immersion combined with changes in blood volume

The determination of the values of central venous pressure has long been used as a guideline for volumetric therapy in the resuscitation of the critical patient, but the performance of such parameter is currently being questioned as an effective measurement of cardiac preload. This has aroused great interest in the search for more accurate parameters to determine cardiac preload and a patient’s blood volume. Goals and Methodology: Based on literature currently available, we aim to discuss the performance of central venous pressure as an effective parameter to determine cardiac preload. Results and Conclusion: Estimating variables such as end-diastolic ventricular area and global end-diastolic volume have a better performance than central venous pressure in determining cardiac preload. Despite the best performance of these devices, central venous pressure is still considered in our setting as the most practical and most commonly available way to assess the patient’s preload. Only dynamic variables such as pulse pressure change are superior in determining an individual’s blood volume.

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Contribution of abdomen and legs to central blood volume expansion in humans during immersion

Journal of Applied Physiology ◽

10.1152/jappl.1997.83.3.695 ◽

1997 ◽

Vol 83 (3) ◽

pp. 695-699 ◽

Cited By ~ 28

Author(s):

Lars Bo Johansen ◽

Thomas Ulrik Skram Jensen ◽

Bettina Pump ◽

Peter Norsk

Keyword(s):

Blood Volume ◽

Volume Expansion ◽

Protein Concentration ◽

Water Immersion ◽

Venous Pressure ◽

Cuff Inflation ◽

Central Blood Volume ◽

Central Venous ◽

Plasma Protein Concentration ◽

Blood Volume Expansion

Johansen, Lars Bo, Thomas Ulrik Skram Jensen, Bettina Pump, and Peter Norsk. Contribution of abdomen and legs to central blood volume expansion in humans during immersion. J. Appl. Physiol. 83(3): 695–699, 1997.—The hypothesis was tested that the abdominal area constitutes an important reservoir for central blood volume expansion (CBVE) during water immersion in humans. Six men underwent 1) water immersion for 30 min (WI), 2) water immersion for 30 min with thigh cuff inflation (250 mmHg) during initial 15 min to exclude legs from contributing to CBVE (WI+Occl), and 3) a seated nonimmersed control with 15 min of thigh cuff inflation (Occl). Plasma protein concentration and hematocrit decreased from 68 ± 1 to 64 ± 1 g/l and from 46.7 ± 0.3 to 45.5 ± 0.4% ( P < 0.05), respectively, during WI but were unchanged during WI+Occl. Left atrial diameter increased from 27 ± 2 to 36 ± 1 mm ( P < 0.05) during WI and increased similarly during WI+Occl from 27 ± 2 to 35 ± 1 mm ( P < 0.05). Central venous pressure increased from −3.7 ± 1.0 to 10.4 ± 0.8 mmHg during WI ( P < 0.05) but only increased to 7.0 ± 0.8 mmHg during WI+Occl ( P < 0.05). In conclusion, the dilution of blood induced by WI to the neck is caused by fluid from the legs, whereas the CBVE is caused mainly by blood from the abdomen.

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Blood Volume, Extracellular Fluid Volume and Central Venous Pressure in Haemorrhagic Shock

Venendruckmessung ◽

10.1007/978-3-642-46149-1_4 ◽

1969 ◽

pp. 28-35

Author(s):

K. Okada ◽

K. Ikeda ◽

S. Tanaka ◽

I. Kataoka ◽

H. Yamamura

Keyword(s):

Central Venous Pressure ◽

Blood Volume ◽

Venous Pressure ◽

Extracellular Fluid ◽

Haemorrhagic Shock ◽

Fluid Volume ◽

Extracellular Fluid Volume ◽

Central Venous

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Cardiorespiratory Status of Erythroblastotic Newborn Infants: III. Intravascular Pressures During the First Hours of Life

PEDIATRICS ◽

10.1542/peds.58.4.484 ◽

1976 ◽

Vol 58 (4) ◽

pp. 484-493

Author(s):

Roderic H. Phibbs ◽

Paul Johnson ◽

Joseph A. Kitterman ◽

George A. Gregory ◽

William H. Tooley ◽

...

Keyword(s):

Central Venous Pressure ◽

Blood Volume ◽

High Pressures ◽

Venous Pressure ◽

Newborn Infants ◽

Hydrops Fetalis ◽

Central Venous ◽

Myocardial Failure ◽

Prematurely Born Infants

We measured aortic and central venous pressures beginning soon after birth in 40 prematurely born infants with moderate or severe erythroblastosis fetalis, including 13 with severe and 10 with mild hydrops fetalis. All but four were asphyxiated at birth and this affected intravascular pressures. Before resuscitation, aortic or central venous pressure or both were elevated in more than one third. All but two of the remaining infants had normal initial pressures. Following resuscitation which relieved acidosis, hypoxia, and anemia, but did not reduce blood volume, the high pressures usually fell to normal and occasionally to subnormal levels, normal pressures fell to subnormal in almost one half, and those with initial subnormal pressures remained hypotensive. In all, 40% were hypotensive after resuscitation; treatment with blood volume expanders consistently returned these pressures to normal. Only two of the 13 severely hydropic infants and none of the mildly hydropic had findings indicative of hypervolemia and myocardial failure which persisted after treatment of asphyxia.

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Reflex-Mediated Reduction in Human Cerebral Blood Volume

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/sj.jcbfm.9600015 ◽

2005 ◽

Vol 25 (1) ◽

pp. 136-143 ◽

Cited By ~ 27

Author(s):

Timothy D Wilson ◽

J Kevin Shoemaker ◽

R Kozak ◽

T-Y Lee ◽

Adrian W Gelb

Keyword(s):

Central Venous Pressure ◽

Blood Volume ◽

Cerebral Blood Volume ◽

Lower Body Negative Pressure ◽

Mean Transit Time ◽

Venous Pressure ◽

Cold Pressor Test ◽

Cold Pressor ◽

Lower Body ◽

Central Venous

Adrenergic nerves innervate the human cerebrovasculature, yet the functional role of neurogenic influences on cerebral hemodynamics remains speculative. In the current study, regional cerebrovascular responses to sympathoexcitatory reflexes were evaluated. In eight volunteers, contrast-enhanced computed tomography was performed at baseline, –40 mmHg lower body negative pressure (LBNP), and a cold pressor test (CPT). Cerebral blood volume (CBV), mean transit time (MTT), and cerebral blood flow (CBF) were evaluated in cortical gray matter (GM), white matter (WM), and basal ganglia/thalamus (BGT) regions. Lower body negative pressure resulted in tachycardia and decreased central venous pressure while mean arterial pressure was maintained. Cold pressor test resulted in increased mean arterial pressure concomitant with tachycardia but no change in central venous pressure. Neither reflex altered end-tidal carbon dioxide. Cerebral blood volume was reduced in GM during both LBNP and CPT ( P<0.05) but was unchanged in WM and BGT. Mean transit time was reduced in WM and GM during CPT ( P<0.05). Cerebral blood flow was only modestly affected with either reflex ( P<0.07). The combined reductions in GM CBV (˜ –25%) and MTT, both with and without any change in central venous pressure, with small CBF changes (˜ –11%), suggest that active venoconstriction contributed to the volume changes. These data demonstrate that CBV is reduced during engagement of sympathoexcitatory reflexes and that these cerebrovascular changes are heterogeneously distributed.

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