Cite this post as:
Scott Weingart, MD FCCM. What Will it Take to Kill off CVP?. EMCrit Blog. Published on July 27, 2013. Accessed on January 20th 2025. Available at [https://emcrit.org/emcrit/kill-off-cvp/ ].
Financial Disclosures:
The course director, Dr. Scott D. Weingart MD FCCM, reports no relevant financial relationships with ineligible companies. This episode’s speaker(s) report no relevant financial relationships with ineligible companies unless listed above.
CME Review
Original Release: July 27, 2013
Date of Most Recent Review: Jul 1, 2024
Termination Date: Jul 1, 2027
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An EGDT algorithm that does not use it….
Rather than focus on the inadequacy of CVP to predict fluid responsiveness (which many seem to be equating with its complete uselessness as a biophysical parameter – e.g. suggestions of “killing” cvp or recommending it be abandoned completely to guide fluid resus), why not put the emphasis on investigating it (or respiratory-associated change in CVP) to predict fluid tolerance? I’m not convinced that we should be abandoning it completely – perhaps we just need to change our use and interpretation of the parameter.
Many thanks for all of your hard work,
-todd
Todd, The reason is it doesn’t bring much to the table compared to other modalities like actual CO monitors (invasive and non-invasive) that are accurate or ultrasound, which is completely non-invasive. That being said, I agree it would be great if someone did a big and well wrought study on resp-variation of cvp for fluid assessment.
Dr. Marik’s position reminds me of the multiple choice answer on a test that uses the word “never” or “always” – this of course is ‘never’ the correct answer. And so, in defense of the CVP, I like it. I like as much data as I can get my hands on and that includes CVP. Now, I may not understand what the number means (stiff heart?, fluid up? too much PEEP?) but here’s the thing: the CVP gives me a ‘real’ number. It is a column of fluid running from the central venous circulation to a pressure transducer. If I… Read more »
I particulary have a love-hate relationship with CVP and I will try to explain myself: CVP is a poor predictor of fluid-responsiveness. Nobody can tell the opposite. Using CVP to decide whether a patient requires fluids or not is just like flipping a coin on the air. However, I can still see my fellows using CVP for that purpose or teaching about the usefulness of CVP for fluid therapy. In that way, I hate CVP. On the contrary, I’m totally in love with CVP as one of the venous-return determinants. CVP, as is, as a intravascular pressure, is one of… Read more »
Yep, that about sums it up. If the pt has a line, I hook up the CVP. It has value if you know how to use it–just as you elaborate.
I’ve heard great lengths about the disutility of CVP for determining fluid responsiveness in the early management of the septic patient. Does it have a role in trending the response to volume resuscitation? If not, what are the variables that confound this use of CVP?
Links to answers to this question would suffice, if they exist. Thank you!