CVP is definitely a good and inexpensive invasive monitoring tool for the management of the fluid therapy. In spite of having some short comings and limitations in some conditions, I suppose it is still the most frequently-used method of fluid management.
If used wisely, it could be an adjunct to fluid management. Herein, I look CVP from the IAP angle: In this view, IAP, abdominal muscle tone, intra-thoracic pressure, etc. may alter the CVP value and have to be considered when evaluating the intravascular volume. Below some references:
http://www.ncbi.nlm.nih.gov/pubmed/8609751?dopt=Citation
http://www.ncbi.nlm.nih.gov/pubmed/16759783
http://www.ncbi.nlm.nih.gov/pubmed/17849097?dopt=Citation
http://www.ncbi.nlm.nih.gov/pubmed/17452925?dopt=Citation
http://www.ncbi.nlm.nih.gov/pubmed/9504572?dopt=Citation
Though we use CVP routinely in our daily practice, there is no evidence to be helpful in monitoring hemodynamic response to fluid challenge as Marik has shown in his review:
http://journal.publications.chestnet.org/data/Journals/CHEST/22074/zcb00708000172.pdf
We are better to manage fluid by cardiac output measurement, echocardiography and pulse pressure variation (PPV) assessment, though there are concerns about PPV:
http://www.ncbi.nlm.nih.gov/pubmed/21705869?dopt=AbstractPlus
In my opinion, we still need CVP catheter in cardiac surgery not only as a central access route but also as a mean to read baseline central pressure to have an estimate of acceptable pressure after cardiopulmonary bypass.
Another really interesting review about non invasive cardiac output monitors
It 's true that many in daily use CVP as an indicator of blood volume, and it is also true that there is no evidence that it is useful as monitoring the hemodynamic response. When I can, but not routine, I use the stoke volume variation (SVV) and / or pulse pressure variation (PPV) and I would ask you what you think of both.
Thanks Giovanni,
I agree with you that SVV , PPV and other dynamic variables are proved to be superior to the static variables like CVP,.I personally use SVV routeinly in liver transplant and find it very useful, however, my aim from the question was to find out the opinions of other peers about the subject.
Most of the time CVP is useless, it is particularly evident when you compare CVP with SVV in a particular clinical scenario.
I have found that PVI (Plethysmographic Variation Index) from the pulse ox is reliable, non-invasive, continuous, and has a high specificty as well as a high sensitivity to fluid volume responsiveness.
Although CVP measurement does have its limitations, I find it useful as a non-intensivist in situations where fluid overlaod may be disastrous. Under such situations, fluid loading can be more rapidly and effectively titrated.
I would like to use dynamic monitoring variables more often (PPV, SVV...) but devices that offer them need also cables, a time to be ready, and besides are very expensive.
I have just known an alternative: Capstesia, an App Android that offers advanced monitoring in our smartphone. In any moment, monitor screen, no cables... and unexpensive. An interesting way to dynamic variables.
It should be recognized that CVP can not any more considered an useful index of volume. Too many pitfalls, few straight certain informations
ProCESS results are probably the definitive answer to CVP as a non useful parameter to monitor fluid management