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LETTER TO THE EDITOR
Year : 2020  |  Volume : 2  |  Issue : 3  |  Page : 66

Patients Admitted to the Intensive Care Unit Should Receive Central Venous Pressure Monitoring: We Should Personalize Our Approach


Department of ICU, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium

Date of Submission01-Jul-2020
Date of Acceptance20-Aug-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Patrick M Honore
Department of ICU, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 41020 Brussels
Belgium
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DOI: 10.4103/jtccm.jtccm_10_20

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How to cite this article:
Honore PM, Mugisha A, Kugener L, Redant S, Attou R, Gallerani A, Bels DD. Patients Admitted to the Intensive Care Unit Should Receive Central Venous Pressure Monitoring: We Should Personalize Our Approach. J Transl Crit Care Med 2020;2:66

How to cite this URL:
Honore PM, Mugisha A, Kugener L, Redant S, Attou R, Gallerani A, Bels DD. Patients Admitted to the Intensive Care Unit Should Receive Central Venous Pressure Monitoring: We Should Personalize Our Approach. J Transl Crit Care Med [serial online] 2020 [cited 2021 Nov 30];2:66. Available from: http://www.tccmjournal.com/text.asp?2020/2/3/66/305793



Dear Editor,

We read with great interest the recent article by Chen et al. who suggest that almost all patients undergoing major surgery, as well as patients admitted to the intensive care unit (ICU), will receive central venous pressure (CVP) monitoring.[1] We would like to somewhat moderate this enthusiasm. Not only is it not necessary to insert a central venous catheter (CVC) in all ICU patients, doing so would expose patients to the numerous possible risks of the procedure.[2] Rather, we should utilize CVC monitoring in at-risk groups of patients who are most likely to benefit from it, including cardiac surgery, heart failure, cardiorenal syndrome, mechanical ventilation, intra-abdominal hypertension, sepsis, and patients who receive a significant amount of fluids.[3] Outside of those important groups, many ICU patients can be more than adequately treated without the insertion of a CVC.[3] Chen et al. also report that their meta-analysis found that each 1 mmHg increase in CVP increases the odds of acute kidney injury in critically ill adult patients.[1] Again, we would like to plea for an individualized approach regarding the management of CVP and efforts to decrease it. Patients with acute heart failure and a CVP <10 cmH2 O have been found to be more likely to develop worsening renal function within the first 24 h than those presenting with a CVP >15 cmH2 O.[4] This does not imply that a higher CVP must be targeted in this population, but rather that a volume “deficit” due to excessive fluid restriction or elimination should be absolutely avoided. Any decision to lower CVP should be individualized. Improving lung–right heart interactions that sustain an elevated CVP in heart failure and cardiorenal syndrome appears to be more efficacious than reducing intravascular volume, when feasible.[5] In conclusion, at this time, no exact definition of “lowest possible CVP” can be given except that it should be a CVP that ensures adequate cardiac output and preserves organ perfusion, with a particular focus on the importance of the arteriovenous pressure gradient. In different patient populations, and even in cohorts of similar patients with different disease stages, the optimal CVP level will vary and thus a personalized approach is essential.

Author's contributions

PMH, SR, and DDB designed the article. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript.

Acknowledgments

We would like to thank Dr. Melissa Jackson for critical review of the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chen CY, Zhou Y, Wang P, Qi EY, Gu WJ. Elevated central venous pressure is associated with increased mortality and acute kidney injury in critically ill patients: A meta-analysis. Crit Care 2020;24:80.  Back to cited text no. 1
    
2.
Chen X, Wang X, Honore PM, Spapen HD, Liu D. Renal failure in critically ill patients, beware of applying (central venous) pressure on the kidney. Ann Intensive Care 2018;8:91.  Back to cited text no. 2
    
3.
Shibata W, Sohara M, Wu R, Kobayashi K, Yagi S, Yaguchi K et al. Incidence and outcomes of central venous catheter-related blood stream infection in patients with inflammatory bowel disease in routine clinical practice setting. Inflamm Bowel Dis 2017;23:2042-7.  Back to cited text no. 3
    
4.
Uthoff H, Breidthardt T, Klima T, Aschwanden M, Arenja N, Socrates T, et al. Central venous pressure and impaired renal function in patients with acute heart failure. Eur J Heart Fail 2011;13:432-9.  Back to cited text no. 4
    
5.
Guazzi M, Gatto P, Giusti G, Pizzamiglio F, Previtali I, Vignati C, et al. Pathophysiology of cardiorenal syndrome in decompensated heart failure: Role of lung-right heart-kidney interaction. Int J Cardiol 2013;169:379-84.  Back to cited text no. 5
    




 

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