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Br J Anaesth. 2017 Feb;118(2):223-231. doi: 10.1093/bja/aew386.

Comparison of different techniques of central venous pressure measurement in mechanically ventilated critically ill patients.

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Division of Anesthesia Intensive Care Pain and Emergency, Nîmes University Hospital, Place de Professeur Robert Debré, Nîmes, 30029, France.
Faculty of Medicine, Montpellier-Nimes University I, Chemin du Carreau de Lane, Nîmes, 30000, France EA 2992, Chemin du Carreau de Lane, 30000 Nimes, France.
Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
Institute of Cardiometabolism and Nutrition and Department of Emergency medicine and Surgery, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Universités, UPMC Univ Paris 06, UMRS INSERM 1156, Paris, France.
PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier hospital, Montpellier cedex 5, 34295.
Service de Réanimation médicale, Kremlin, Hôpital de Bicêtre, APHP, Le Bicêtre, France.
Division of Anesthesia Intensive Care Pain and Emergency, Nîmes University Hospital, Place de Professeur Robert Debré, Nîmes, 30029, France



Several techniques exist for measuring central venous pressure (CVP) but little information is available about the accuracy of each method. The aim of this study was to compare different methods of CVP measurements in mechanically ventilated patients.


CVP was measured in mechanically ventilated patients without spontaneous breathing using four different techniques: 1) end expiratory CVP measurement at the base of the" c" wave (CVPMEASURED), chosen as the reference method; 2) CVP measurement from the monitor averaging CVP over the cardiac and respiratory cycles (CVPMONITOR); 3) CVP measurement after a transient withdrawing of mechanical ventilation (CVPNADIR); 4) CVP measurement corrected for the transmitted respiratory pressure induced by intrinsic PEEP (calculated CVP: CVPCALCULATED). Bias, precision, limits of agreement, and proportions of outliers (difference > 2 mm Hg) were determined.


Among 61 included patients, 103 CVP assessments were performed. CVPMONITOR bias [-0.87  (1.06) mm Hg] was significantly different from those of CVPCALCULATED [1.42  (1.07), P < 0.001 and CVPNADIR (1.04  (1.29), P < 0.001]. The limits of agreement of CVPMONITOR [-2.96 to 1.21 mm Hg] were not significantly different to those of CVPNADIR (-1.49 to 3.57 mm Hg, P = 0.39) and CVPCALCULATED (-0.68 to 3.53 mm Hg, P = 0.31). The proportion of outliers was not significantly different between CVPMONITOR (n = 5, 5%) and CVPNADIR (n = 9, 9%, P = 0.27) but was greater with CVPCALCULATED (n = 16, 15%, P = 0.01).


In mechanically ventilated patients, CVPMONITOR is a reliable method for assessing CVPMEASURED Taking into account transmitted respiratory pressures, CVPCALCULATED had a higher proportion of outliers and precision than CVPNADIR.


central venous pressure; measurement

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