I think it depends. Early in a resuscitation, there may be more value, especially if you haven't yet differentiated the patient into septic versus cardiogenic shock. (Of course echo would be better). But if you give a patient who is hypotensive 1 hour after arriving to the ED 2 Liters of normal saline and their CVP is 4, I think that is helpful. 3 hours later after giving 6 more L of NS and blood and it is 7-13, then it is clearly pretty unhelpful.

In the era of minimal invasive (PICCO-cath, FlowTrac) or non-invasive (Echo,NICOM,PLR...)tools with a better predictive value to fluid responsiveness CVP should not be relevant. Too many influences like PEEP-Ventilation, elevated abdominal pressure, tricuspidal regurgiation and many more complicate an adequate interpretation.

I never use CVP to direct fluid management, plenty of evidence that it predicts fluid responsiveness no better that the flip of a coin. However, CVP variance in a spontaneuosly breathing patient is of value. Since most of my patients are mechanically ventilated I only find the CVP a useful marker for cardiac tamponade or abnormal anatomy in my cardiac surgery patients. Paul Marik was correct last year when he stated, in a nice review, that there is little reason to monitor CVP in the OR and ICU. However this comment was directed purely at fluid management. I think CVP targeted therapy only remains in the Sepsis guidelines because of River's et al, lack of a good widely available alternative for spontaneuosly breathing patients and the fear that removing it from the guidelines will lead to another era of inadequate fluid resuscitation.

Quotation: indeed, there have only been two studies published in the world literature that demonstrate “some relationship” between the CVP and intravascular volume; both of these studies were conducted in standing horses. Paul E Marik, Xavier Monnet, Jean-Louis Teboul. Hemodynamic parameters to guide fluid therapy .Annals of Intensive Care 2011, 1:1

I have found that plethysmographic variance index (PVI) has a high sensitivity and specifity for fluid responsiveness which is a non-invasive measurement and readily as well as continuously obtained.

Whereas, as others, i used in the 90's CVP for fluid management,

NOW, in view of the poor relationship between CVP and the rigt ventricular end diastolic volume which may not reflect the preload reserve, CVP SHOULD NOT BE ANY MORE USED to evaluate the need or not of fluid therapy.

Be careful, plethysmographic wave forms are poorly predictive of volume responsiveness in spontaneous brething activity

In my opinion, the main reasons why advanced monitoring varables ( PPV, SVV...) are not used as much as we would like are poor accesibility and high price.

Here I present a good alternative. With our smartphone.

Consultar Capstesia App Anestesia - https://play.google.com/store/apps/details?id=com.simu.capstesia

ProCESS results are probably the definitive answer to CVP as a non useful parameter to monitor fluid management.

Interesting..

Dear colleagues!

There is no better hemodynamic indicator as CVP in determining the body's volemic status, if interpreted correctly. All researchers mistakenly consider CVP a reflection of the body's volemic status.

The fact is that with the help of CVP, the body regulates the inflow of blood to the heart to compensate for abnormalities (a decrease or increase in the volume of circulating blood (VCB)) in critical patients.

In addition to CVP, other hemodynamic parameters are needed to determine the VCB and tactics of infusion therapy in critical patients: diastolic pressure, "white spot" symptom, diuresis, and accounting for changes in these parameters after intravenous infusion. At the same time, there is no need to use (complex, labor-consuming, not safe, invasive, and so on) hemodynamic monitoring methods.

I enclose (in a separate file) the results of my research, please read and express your opinion on this issue. I will be happy to answer any questions that arise after reading the article.

Sorry for the bad English (Google translator is to blame). Respectfully Dzhumberi

    For correspondence: Kiladze Dzhumberi Georgievich, St. Petersburg City Children's Health Institution Hospital number 2 st. Maria Magdalene ", 199053, St. Petersburg. E-mail: [email protected] E-mail: [email protected] tel.: + 7 965 761 99 79 Skype: Djumbery

CVP is not usefull to know the volemic status. This situation, is deeply know yet.

The real knoledge about the funtional relation betwen volemic and vessels status is non invase hemodinámic monitor. Also is the best way to protect the glycocalix.

Dear Ghazi Aldehayat !

For more than 40 years I have been involved in emergency surgery and used hemodynamic parameters: CVP, white spot symptom, diastolic pressure, diuresis and taking into account changes in these parameters after intravenous infusions. This allowed not only the correct management of fluid therapy, but also helped in the diagnosis of acute surgical pathology. They helped to diagnose not only blood loss, but whether bleeding continues or not, and what is its intensity. As for the article you mentioned above: it is human nature to make mistakes. I studied retrospectively hemodynamic parameters in critical patients.

As it turned out, the change in hemodynamic parameters in critical conditions (including CVP) is directed by the body to correct hemodynamic disorders (optimizations of blood inflow to the heart) in critical situations for the patient. Therefore, they do not correlate with the volume of circulating blood. All researchers mistakenly seek this correlation and therefore get "paradoxical" results, although there is no paradox.

I will send you the results of my work (in a separate file), if you read carefully everything will fall into place. The entire article is for surgeons, in red - for resuscitators. I don't know much English, I translate a translator through Google, so excuse me. I will answer any questions that arise after reading the article. I look forward to your opinion on this matter.

respectfully Dzhumberi

    For correspondence: Kiladze Dzhumberi Georgievich, St. Petersburg City Children's Health Institution Hospital number 2 st. Maria Magdalene ", 199053, St. Petersburg. E-mail: [email protected] E-mail: [email protected] tel.: + 7 965 761 99 79 Skype: Djumbery