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Critical Care

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

Keywords

Public HealthPearson CorrelationEmergency MedicineUrinary BladderInferior Vena

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, Athens, Greece
(2)
Athens University School of Nursing, ICU, Athens Trauma Hospital KAT, Athens, Greece

Copyright

© BioMed Central Ltd 2003

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