Table 1 The pros and cons of central venous pressure (CVP) for fluid management

Measurements

Easy to measure

Errors in measurements

Minimal apparatus

Influence of mechanical ventilation

Cheap

Influence of abdominal pressure

CVP for fluid responsiveness

The predictive value of extreme CVP values (CVP < 6–8 mmHg and CVP > 12–15 mmHg) is satisfactory [7, 8]

The predictive value for fluid responsiveness is lower with CVP than with dynamic indices

CVP as a safety value

During a fluid challenge, a given CVP value can be used as a safety value

This safety value should be individually determined as there is no predefined safe upper level of CVP

CVP as a target value

In circulatory failure, this population-based approach may be used to ensure that the majority of the patients achieve a satisfactory hemodynamic goal

In circulatory failure, a significant number of patients may be submitted to excessive fluid administration whereas other patients may require additional fluid administration

In patients without indices of hypoperfusion, this approach is not recommended as it could lead to unnecessary fluid administration [19]

Influence of mechanical ventilation

The CVP represents the back pressure of all extrathoracic organs

The CVP may fail to reflect intravascular pressure during mechanical ventilation

CVP can be used to evaluate the response to fluids

An increase in CVP indicates an increase in preload

The increase in CVP indicates the increase in preload but does not indicate the response to fluids; in fluid responders the increase in CVP should be minimal (with a large increase in cardiac output) while in nonresponders the increase in CVP is larger

An absence of change in CVP during fluid administration indicates that insufficient fluids were administered to manipulate preload