Volume 7 Supplement 2

23rd International Symposium on Intensive Care and Emergency Medicine

Open Access

Pressures in the superior and inferior vena cava and intra-abdominal pressure

  • N Markou1,
  • P Myrianthefs2,
  • E Boutzouka2,
  • M Rizos1,
  • D Hroni1,
  • P Evagelopoulou2,
  • H Apostolakos1 and
  • G Baltopoulos2
Critical Care20037(Suppl 2):P180

https://doi.org/10.1186/cc2069

Published: 3 March 2003

Purpose

To investigate the relationship of pressure in the inferior vena cava (Pivc) with a) pressure in the superior vena cava (Psvc), and b) intra-abdominal pressure as measured in the urinary bladder (Pcyst).

Materials and results

A prospective study of 38 mechanically ventilated patients. Simultaneous measurements of Psvc, Pivc and Pcyst (151 sets of measurements) were performed. Measurements were divided in: Group A (Pcyst < 10 mmHg), group B (10 mmHg ≤ Pcyst < 15 mmHg), group C (Pcyst ≥ 15 mmHg). Statistical analysis was performed with the paired t test, Pearson correlation. Results are expressed as mean ± SEM (Table 1).

Table 1

 

Psvc (mmHg)

Pivc (mmHg)

Pcyst (mmHg)

Group A (n = 62)

10.8 ± 0.5

10.93 ± 0.49

6.35 ± 0.26*

Group B (n = 45)

14.44 ± 0.71

14.67 ± 0.58

11.44 ± 0.22*

Group C (n = 43)

16.39 ± 0.72*

18.88 ± 0.69

19.18 ± 0.63

* Difference from Pivc statistically significant (t test, P < 0.05).

There was significant correlation of Psvc and Pivc in groups A and B (group A r = 0.93, group B r = 0.87). In Group C, Pivc correlated (P < 0.01) with both Pcyst (r = 0.78) and Psvc (r = 0.7).

When Pcyst > Psvc, Pivc was higher than Psvc (P < 0.01). Furthermore: a) with Pcyst < 15 mmHg, no significant difference was found between Pcyst and Pivc (P = 0.068) and they were correlated (r = 0.766, P < 0.05). Pressures in the superior and inferior vena cava were also correlated (r = 0.764, P < 0.05). b) With Pcyst ≥ 15 mmHg, Pivc was lower than Pcyst (P < 0.01). It highly correlated with Pcyst (r = 0.85, P < 0.01) and less strongly correlated with Psvc (r = 0.701, P < 0.01).

When Pcyst ≤ Psvc, no difference between Pivc and Psvc was observed. Furthermore: a) with Pcyst < 15 mmHg, Pivc was higher than Pcyst (P < 0.01) and highly correlated with Psvc (r = 0.932, P < 0.01). Pivc also correlated with Pcyst (r = 0.69, P < 0.01). b) With Pcyst ≥ 15 mmHg, Pivc was higher than Pcyst (P < 0.01) and correlated with Psvc (r = 0.74, P < 0.01) and Pcyst (r = 0.789, P < 0.01).

Conclusions

Although Psvc and Pivc are interchangeable in the absence of an increased Pcyst, when Pcyst is high measurements of Pivc are misleading. A Pcyst > Psvc results to a 'waterfall' effect, and Pivc does not accurately reflect Psvc any more.

Authors’ Affiliations

(1)
ICU-B, ICU, Athens Trauma Hospital KAT
(2)
Athens University School of Nursing, ICU, Athens Trauma Hospital KAT

Copyright

© BioMed Central Ltd 2003

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