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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A1679
October 22, 2008 9:00 AM - 11:00 AM Room Hall E2-Area G, |
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| The Relationship between CVP and PCWP in Healthy Individuals | |||||||||||||||||||||||||
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Shigeki Shibata, M.D., Ph.D., Paul Bhella, M.D., Eric Pacini, M.D., Krainski Felix, B.S., Benjamin D. Levine, M.D. Institute for Exercise and Environmental Medicine, Dallas, Texas |
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Background: Monitoring of the pulmonary capillary wedge pressure (PCWP) is used during the perioperative period to maintain blood volume and avoid pulmonary edema. However, pulmonary artery (PA) catheterization involves more risk and cost than monitoring central venous pressures (CVP). Therefore, evaluation of the efficacy of PCWP monitoring vs. CVP monitoring is important from the view of a risk- and cost-benefit ratio. The relationship between CVP and PCWP has never been investigated under varying preloads at supine rest in healthy individuals under experimentally controlled conditions. The purpose of this study was to evaluate the relationship between CVP and PCWP under controlled conditions of increased and decreased preload. Methods: Thirty-four young healthy individuals (Young, age<50) and 13 healthy elderly seniors (Old, age>65 yrs) were recruited. A PA catheter was inserted into the pulmonary artery via the median antecubital vein under fluoroscopic guidance. Mean CVP and PCWP were measured three times at the end of a quiet expiration and averaged. Filling pressures were then reduced with lower body negative pressure (LBNP) sequentially by -15 and -30 mmHg. Repeat measurements were made at each level. After LBNP release, baseline measurements of CVP and PCWP were repeated. Filling pressures were then augmented with acute saline infusion by 15 and 30 ml/kg and repeat measurements were taken. The relationships between CVP and PCWP were assessed at baseline and with increased and decreased preload. These relationships were also examined individually and over our entire population. Results: a) Both Young and Old showed that PCWP was well correlated with CVP in individual data in conditions of increased preload, decreased preload, and over a large range of filling pressures (Table 1).[table1]These results were also confirmed in pooled data (Fig. 1).[figure1]b) The slopes of the regression lines were statistically significantly higher at the increased preload pressures than those at decreased preload pressures in both Young and Old although this difference was very small clinically (Table 1). The slopes were not significantly different between Young and Old (Table 1). All of the slopes were higher than one. Conclusion: CVP is highly correlated with PCWP over a wide range of filling pressures from young to elderly. CVP monitoring can be used as a surrogate for PA catheter to follow changes in filling pressure in healthy individuals. Anesthesiology 2008; 109 A1679 |
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Figure 1
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