scholarly journals The Relation Between Common Carotid Artery Diameter and Central Venous Pressure for Assessment of Intravascular Fluid Status after Major Surgeries; an Observational Study

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Samaa A Kasem Rashwan ◽  
Ashraf Abd Elmawgood Bassiouny ◽  
Ahmed A Badawy ◽  
Ahmed Rabea Mohammed
Keyword(s):  
Carotid Artery ◽  
Central Venous Pressure ◽  
Common Carotid Artery ◽  
Venous Pressure ◽  
Fluid Challenge ◽  
Fluid Administration ◽  
Adult Patients ◽  
P Value ◽  
Central Venous ◽  
Spontaneously Breathing

Objectives: The current study aimed to find the relation between the changes in the common carotid artery (CCA) diameter and the central venous pressure (CVP) in response to a fluid challenge in spontaneously breathing adult patients. Methods: This study included 65 adult patients aged 20 - 60 years who were admitted to the surgical ICU. The CCA diameter and CVP were measured before and after fluid challenge, and the percentage of increase in the CCA diameter and CVP were calculated. The correlation was assessed between changes in the CVP and CCA diameter. Results: The CCA diameter before fluid administration had a significant strong positive correlation to the CVP (r = 0.8, P value < 0.001); the increase in the CCA diameter after fluid administration had a significant moderate positive correlation with the increase in the CVP (r = 0.4, P value < 0.001). The percentage of increase in CCA diameters was positively correlated to the percentage of increase in CVP (r = 0.589, P value = 0.001) following fluid administration. However, the Receiver Operating Characteristic (ROC) analysis was an invalid test (area under curve 0.513, P value = 0.885). Conclusions: After major surgeries, the change in the CCA diameter was positively correlated with the change in the CVP values in response to fluid administration in the spontaneously breathing adult patients, but the cut-off limit cannot be reached.

scholarly journals Respiratory variation of inferior vena cava diameter and central venous pressure in ventilated and non-ventilated children in fluid refractory septic shock: an observational study

2019 ◽  
Vol 6 (5) ◽  
pp. 1947
Author(s):  
Mohd Kashif Ali ◽  
Eeman Naim
Keyword(s):  
Septic Shock ◽  
Inferior Vena Cava ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Central Venous ◽  
Mechanically Ventilated ◽  
Spontaneously Breathing ◽  
Ventilated Patients

Background: Ultrasound guided fluid assessment in management of septic shock has come up as an adjunct to the current gold standard Central Venous Pressure monitoring. This study was designed to observe the respiro-phasic variation of IVC diameter (RV-IVCD) in invasively mechanically ventilated and spontaneously breathing paediatric patients of fluid refractory septic shock.Methods: This was a prospective observational study done at Paediatric intensive Care Unit (PICU) in Paediatric ward of Jawaharlal Nehru Medical College and Hospital (JNMCH) from February 2016 to June 2017. 107 consecutive patients between 1 year to 16 years age who were in shock despite 40ml/kg of fluid administration were included. Inferior Vena Cava (IVC) diameters were measured at end-expiration and end inspiration and the IVC collapsibility index was calculated. Simultaneously Central Venous Pressure (CVP) was recorded. Both values were obtained in ventilated and non-ventilated patients. Data was analysed to determine to look for the profile of RV-IVCD and CVP in ventilated and non-ventilated cases.Results: Out of 107 patients, 91 were on invasive mechanical ventilation and 16 patients were spontaneously breathing. There was a strong negative correlation between central venous pressure (CVP) and inferior vena cava collapsibility (RV-IVCD) in both spontaneously breathing (-0.810) and mechanically ventilated patients (-0.700). Negative correlation was significant in both study groups in CVP <8 mmHg and only in spontaneously breathing patients in CVP 8-12 mmHg range. IVC collapsibility showed a decreasing trend with rising CVP in both spontaneously breathing and mechanically ventilated patients.Conclusion: Ultrasonography guided IVCCI appears to be a valuable index in assessing fluid status in both spontaneously breathing and mechanically ventilated septic shock patients. However, more data is required from the paediatric population so as to define it as standard of practice.

scholarly journals Measurement of Inferior Ven Cava Collapsibility Index and Its Correlation to Central Venous Pressure in Adult Critically Ill Patients a Prospective Observational Study

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Inferior Vena Cava ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Volume Status ◽  
P Value ◽  
Central Venous ◽  
Collapsibility Index ◽  
Status Assessment

Fluid therapy is an essential component part management of critically ill patients. Proper estimation of the amount of needed fluids is of great importance due to the well-established adverse effects of marked negative and positive fluids balance. Central venous pressure has been widely used by ICU physicians for volume status assessment. Several methods have been postulated for volume status assessment, among which is the inferior vena cava collapsibility index. As the inferior vena cava is a thin-walled capacitance vessel that adjusts to the body’s volume status by changing its diameter depending on the total body fluid volume. Giving the fact that bed-side ultrasonographic measurement of inferior vena cava diameters is an available, non-invasive, reproducible and quiet easy-to-learn technique, it can provide a safe and quiet reliable replacement of central venous pressure measurement for assessment of volume status assessment. The aim of this study was to find statistical correlation between central venous pressure and caval index, as a step towards validating the above mentioned replacement. 86 critically ill patients from ICU population were enrolled. Simultaneous measurements of central venous pressure and inferior vena cava collapsibility index were observed and recorded on four sessions. Patients were also grouped based on their mode of ventilation and central venous pressure values in order to compare the strength of correlation between various populations. The results showed that Inferior vena cava collapsibility index has significant inverse correlation with CVP value (r= -85, p value ˂0.001 at 95% CI) and it better correlated with mean arterial blood pressure and lactate clearance as compared to central venous pressure. However it correlated better with CVP in spontaneously breathing patients (r= -0.86, p value ˂0.001) than in mechanically ventilated patients (r= -0.84, p value ˂0.001). Inferior vena cava collapsibility index has shown to correlate better with CVP value in lower values (˂ 10 cmH2O) (r= -0.8, p value ˂0.001) than in higher values (≥ 10 cmH2O) (r= -0.6, p value ˂0.001). In addition, an inferior vena caval collapsibility index cut-off value of 29% was shown to discriminate between CVP values ˂10 cmH2O and values ≥10 cmH2O with high Sensitivity (88.6%) and specificity (80.4%). In conclusion, inferior vena cava collapsibility index has a strong inverse relationship with central venous pressure which is more pronounced at low central venous pressure values. Point-of-care ultrasonographically-measured inferior vena cava collapsibility index is very likely to be a good alternative to central venous pressure measurement with a high degree of precision and reproducibility. However, Wide scale studies are needed to validate its use in different patient populations.

Therapeutic goals of fluid resuscitation

2016 ◽  
Author(s):  
Bashar S. Staitieh ◽  
Greg S. Martin
Keyword(s):  
Cardiac Output ◽  
Fluid Responsiveness ◽  
Venous Pressure ◽  
Systolic Pressure ◽  
Fluid Challenge ◽  
Tissue Perfusion ◽  
Pressure Variation ◽  
Fluid Administration ◽  
Waveform Analysis ◽  
Central Venous

Optimizing tissue perfusion by administering intravenous fluids presents a special challenge to the intensive care unit (ICU) clinician. Recent studies have drastically altered how we assess a patient’s fluid responsiveness, particularly with regard to upstream surrogates of tissue perfusion. Central venous pressure and pulmonary capillary wedge pressure have been found to be inaccurate markers of fluid responsiveness and have given way to methods such as cardiac output as assessed by echocardiography and the various forms of arterial waveform analysis. These newer techniques, such as stroke volume variation, systolic pressure variation, and pulse pressure variation, have been found to better delineate which patients will respond to a fluid challenge with an increase in cardiac output, and which will not. In addition, traditional methods of assessing the consequences of excessive fluid administration, such as pulmonary oedema and the non-anion gap acidosis of saline administration, have given way to more sophisticated measurements of extravascular lung water, now available at the bedside. Downstream markers of tissue perfusion, such as base deficit, central venous oxygen saturations, and lactic acid, continue to be useful in particular clinical settings, but are all relatively non-specific markers, and are therefore difficult to use as resuscitation targets for ICU patients in general. Finally, recent data on septic shock and ARDS have demonstrated the importance of conservative fluid strategies, while data in surgical populations have emphasized the need for judicious fluid administration and attention to the balance of blood products used in resuscitation efforts.

OPTIMAL CENTRAL VENOUS PRESSURE IN FLUID CHALLENGE IN SEVERE SEPSIS AND SEPTIC SHOCK.

2005 ◽  
Vol 33 ◽  
pp. A166
Author(s):  
Bogdan N Dobrin ◽  
Giulia Soldati ◽  
Marc Van Nuffelen ◽  
Jean-Louis Vincent
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Fluid Challenge ◽  
Central Venous ◽  
Sepsis And Septic Shock

Central venous pressure and blood loss during intraoperative goal-directed fluid administration

2008 ◽  
Vol 25 (Sup 44) ◽  
pp. 68
Author(s):  
K. Maierhofer ◽  
R. Rozum ◽  
H. Hetz ◽  
E. Fleischmann ◽  
B. Kabon
Keyword(s):  
Blood Loss ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Fluid Administration ◽  
Central Venous
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