Abstract
Background: The appropriate range of central venous pressure (CVP) in sepsis patients remains controversial. The aim of this study was to investigate the optimal CVP range in sepsis and septic shock patients admitted to intensive care unit.Methods: We performed a retrospective study with adult sepsis patients with CVP records based on the eICU Collaborative Research Database. Cases were divided into three groups according to mean CVP level during ICU stay: low (< 8 mmHg), normal (8–12 mmHg), and high (> 12 mmHg). Baseline characteristics and clinical outcomes of three groups were compared. Multivariable logistic regression was used to assess the relationship between different CVP levels (by equal interval of 4 mmHg) and in-hospital death risk. Results: 5302 sepsis patients were included in this study. Lactate level, serum creatinine, proportion of mechanical ventilation and dialysis were significantly higher in high CVP group compared to normal CVP group (2.6 [1.6,3.4] vs 2.2 [1.4,2.9] mmol/L; 1.5 [1,2.4] vs 1.2 [0.8,2] mg/dL; 52.2% vs 48.2%; 14.6% vs 9.7%; p < 0.05, respectively). In addition, high CVP group tended to have higher ICU mortality (24.8% vs 15.9%, p < 0.05) and hospital mortality (32.2% vs 22.4%, p < 0.05). The logistic regression analyses revealed that, in sepsis patients, CVP range of 12-16 mmHg, 16-20 mmHg and > 20 mmHg was related to increased in-hospital death risk compared to 8-12 mmHg level (OR: 1.349, 2.287, 3.210, respectively; 95% CI: 1.161–1.568, 1.897–2.757, 2.403–4.290, respectively); there were no significant differences between 0-4 mmHg, 4-8 mmHg and 8-12 mmHg levels regarding in-hospital death risk. Whereas in septic shock patients, CVP level of 0-4 mmHg, 12-16 mmHg, 16-20 mmHg and > 20 mmHg all contributed to increased in-hospital death risk (OR: 1.914, 1.652, 3.305, 3.554, respectively; 95% CI: 1.165–3.146, 1.299–2.101, 2.444–4.47, 2.233–5.654, respectively).Conclusions: High CVP level (> 12 mmHg) was related to worse clinical outcomes in both sepsis and septic shock patients; while very low CVP level (< 4 mmHg) in septic shock patients was also harmful. More strict fluid administration was essential in septic shock population.
Inverted U-Shaped Relationship between Central Venous Pressure and Intra-Abdominal Pressure in the Early Phase of Severe Acute Pancreatitis: A Retrospective Study
