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Dynamic evaluation of central venous pressure for fluid responsiveness assessment in spontaneous breathing dogs
Critical Carevolume 11, Article number: P11 (2007)
Variations in intrathoracic pressure interfere with venous return and cardiac output (CO). Inspiratory fall in central venous pressure (CVP) traces (ifCVP) during spontaneous breathing have been recommended for cardiovascular fluid responsiveness (CFR) evaluation. We recently described the usefulness of CVP wave amplitude variation (pressoric vena cava collapsibility index, Cvci) during mechanical ventilation for CFR estimation in critically ill patients. There are no data about the Cvci evaluation during spontaneous breathing.
To test the hypothesis that Cvci can be used for CFR evaluation during spontaneous ventilation.
In six male, anesthetized, intubated and spontaneous breathing dogs, CO measurements and CVP waves were registered through a Swan–Ganz catheter while the mean arterial pressure (MAP) was measured through an intraarterial catheter.
After baseline measurements a graded hemorrhage was performed in 10% quota until 50% of the estimated volemia. The total shed blood volume was then re-infused in the same quota. Measurements of the heart rate (HR), CO, MAP, CVP, ifCVP, and Cvci are performed in every bleeding and re-infusion step. The Cvci was calculated with the following formula: Cvci(%) = [(CVPPexp - CVPPins)/CVPPexp] × 100, using the inspiratory (CVPPins) and expiratory central venous pulse pressure (CVPPexp). ifCVP = CVP measured in the 'a' wave base at expiration minus CVP measured in the 'a' wave base at inspiration. Correlations among the CO and other variables were performed using the Spearman coefficient test.
See Table 1. The correlations encountered were: CO and SvO2 (r = 0.94, P < 0.001); CO and Cvci (r = 0.61, P < 0.04); and CO and ifCVP (r = -0.02, P < 0.9).
We conclude that a pressoric vena cava collapsibility index may be used to detect cardiovascular fluid responsiveness during spontaneous ventilation.