Effect of airway pressure on inferior vena cava pressure as a measure of central venous pressure in children

doi:10.1016/S0022-3476(95)70223-7

The Journal of Pediatrics

Volume 126, Issue 6, June 1995, Pages 961-965

Presented in part at the annual meeting of the Society for Pediatric Research, Seattle, Wash., May 1994.

https://doi.org/10.1016/S0022-3476(95)70223-7 Get rights and content

Abstract

We evaluated the effect of elevated airway pressure on the validity of intravascular pressure obtained in the distal inferior vena cava (IVC) as a measure of central venous pressure (CVP) in a group of children receiving mechanical ventilation. The IVC pressure correlated well with CVP in the patients without abdominal distention, but the disparity was wider in those with abdominal distention. Elevated mean airway pressure or positive end-expiratory pressure had no effect on the relationship of IVC to CVP. (J PEDIATR 1995;126:961-5)

Section snippets

METHODS

This study was approved by the appropriate human subject protection committees. The need for informed consent was waived by these institutional review boards. No interventions were done solely for the purpose of the study. All patients had had percutaneous placement of 4F 8 cm double-lumen catheters (Cook Critical Care, Bloomington, Ind.) into a femoral vein and into the SVC through either the internal jugular or subclavian veins. Multiple data points were collected at different levels of

RESULTS

Patients in group 1 ranged from 14 days to 16 years of age (mean, 4.3 years) with PRISM (pediatric risk of mortality) scores of 12 to 48 (mean, 26). Four patients from group 1 received ventilation from a high-frequency oscillator. Three of these patients also had data collected during periods of conventional ventilation. Patients in group 2 ranged from 7 months to 16 years of age (mean, 4.4 years) with PRISM scores of 12 to 42 (mean, 22). Measurements were obtained at 47 levels of PEEP (2 to 12

DISCUSSION

This study compared the effects of PEEP and MAP on the reliability of CVP as measured in the iliac vein in patients with and without abdominal distention. We have shown that high airway pressure (both PEEP and MAP) does not affect this pressure as a valid measure of CVP; the difference was always 3 mm Hg or less in group 1. The two measurements with a difference of 3 mm Hg occurred in one patient early in the study, and we cannot exclude the possibility that this patient was not completely

References (6)

JP Stenzel et al.
Percutaneous femoral venous catheterizations: a prospective study of complications
J PEDIATR
(1989)
RA Berg et al.
Accuracy of central venous pressure monitoring in the intraabdominal vena cava: a canine study
J PEDIATR
(1992)
JP Stenzel et al.
Percutaneous femoral venous catheterization in a pediatric intensive care unit: a survival analysis of complications
Crit Care Med
(1989)

There are more references available in the full text version of this article.

Cited by (16)

Intensivist Use of Hand-Carried Ultrasonography to Measure IVC Collapsibility in Estimating Intravascular Volume Status: Correlations with CVP
2009, Journal of the American College of Surgeons
Citation Excerpt :
Earlier studies of IVC-CI and right atrial pressure in ventilated patients have shown variable results, leading to the preponderance of current evidence suggesting that this relationship is inconsistent in this group.30-33 Another factor that might have weakened the correlation between IVC-CI and CVP in our study is the high prevalence of increased intraabdominal pressures in SICU patients.34 Other factors that affect IVC diameters that might have been present in an unknown number of our patients include elevated pulmonary artery pressures, tricuspid or pulmonic valve disease, and right and left ventricular dysfunction.
Volume status assessment is an important aspect of patient management in the surgical intensive care unit (SICU). Echocardiologist-performed measurement of IVC collapsibility index (IVC-CI) provides useful information about filling pressures, but is limited by its portability, cost, and availability. Intensivist-performed bedside ultrasonography (INBU) examinations have the potential to overcome these impediments. We used INBU to evaluate hemodynamic status of SICU patients, focusing on correlations between IVC-CI and CVP.
Prospective evaluation of hemodynamic status was conducted on a convenience sample of SICU patients with a brief (3 to 10 minutes) INBU examination. INBU examinations were performed by noncardiologists after 3 hours of didactics in interpreting and acquiring two-dimensional and M-mode images, and ≥25 proctored examinations. IVC-CI measurements were compared with invasive CVP values.
Of 124 enrolled patients, 101 had CVP catheters (55 men, mean age 58.3 years, 44.6% intubated). Of these, 18 patients had uninterpretable INBU examinations, leaving 83 patients with both CVP monitoring devices and INBU IVC evaluations. Patients in three IVC-CI ranges (<0.20, 0.20 to 0.60, and >0.60) demonstrated significant decrease in mean CVP as IVC-CI increased (p = 0.023). Although <5% of patients with IVC-CI <0.20 had CVP <7 mmHg, >40% of this group had a CVP >12 mmHg. Conversely, >60% of patients with IVC-CI >0.6 had CVP <7 mmHg.
Measurements of IVC-CI by INBU can provide a useful guide to noninvasive volume status assessment in SICU patients. IVC-CI appears to correlate best with CVP in the setting of low (<0.20) and high (>0.60) collapsibility ranges. Additional studies are needed to confirm and expand on findings of this study.
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Increasing blood volume and cardiac output is one of the most commonly needed intervention in the primary care of traumatized and severely ill patients. Although cardiac filling pressures have severe limitations in assessing the preload, central venous pressure (CVP) is the invasive measure most frequently used in clinical practice for the assessment of volume status and cardiac preload. We combined ultrasound and tissue pressure measurement for non-invasive jugular and brachial venous pressure estimation.
CVP was measured invasively and non-invasively using the new technique in 32 critically ill patients. In six volunteers, increasing PEEP was used for the assessment of changes in non-invasive CVP.
Non-invasive CVP increased linearly with increasing PEEP, independent of the investigator. Median (range) coefficient of variation (CV) for five consecutive measurements performed by three investigators in volunteers was 15% (6–31%), 14% (4–31%), and 21% (8–42%). Absolute differences between the average non-invasive CVP between investigators was 1.7 cm H₂O (0.4–6.6 cm H₂O), and the inter-examiner CVP was high (182%, 40–415%). In patients, invasive CVP was 10 mmHg (5–18 mmHg), and the corresponding non-invasive venous pressures were 8 mmHg (3–14 mmHg, basilic vein, p < 0.01) and 6 mmHg (3–13 mmHg, jugular vein, p < 0.01). The coefficients of variation were 4% (<1%–64%, invasive CVP), 22% (5%–51%, non-invasive basilic vein pressure), and 17% (7%–34%, non-invasive jugular vein pressure).
Ultrasound-based, non-invasive measurement of venous pressure provides a relatively easy method rapid estimation of changes in CVP, although absolute values may differ substantially from invasive CVP and between different investigators.
Establishing normal values of central venous pressure in very low birth weight infants
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^☆: From the Departments of Pediatrics and Anesthesiology, University of California, Los Angeles, and Miller Children's Hospital, Long Beach, California

^☆☆: Reprint requests: Victor C. Baum, MD, Department of Anesthesiology, Box 238, University of Virginia Medical Center, Charlottesville, VA 22908.

^★: 0022-3476/95/$3.00 + 0 9/22/63483

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Effect of airway pressure on inferior vena cava pressure as a measure of central venous pressure in children☆,☆☆,★

Abstract

Section snippets

METHODS

RESULTS

DISCUSSION

J PEDIATR

J PEDIATR

Percutaneous femoral venous catheterization in a pediatric intensive care unit: a survival analysis of complications

Crit Care Med