The CVP is Useless (mostly) and Harmful (almost always)
See also lecture on Fluids and hemodynamics
Paul Marik
Intensivist, Researcher, Myth-Buster, Status Quo Destabilizer
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Great stuff! Wisdom!
Compared to CVP, wouldn’t serum Osmo be a better surrogate of volume status to target in sepsis patients who are believed to be volume down? (as well as much less invasive) What are your thoughts on trending the Osmo? Great presentation, I’m shocked to see the continued pervasiveness of its use in the face of all the data against it. Thank you for sharing!
Matthew: Good thought. This has not been studied (as far as I know). However I suspect that multiple factors would affect serum osmo that it would be unreliable.
What if you trended BNP? Obtain an initial baseline measure, and as long as it doesn’t rise, you should (in theory) be in the “good” region of the Starling curve.
Andrew: Good thought. This has been done before and a rising BNP is associated with volume overload. I think this is useful as an adjective measure in fluid management. I suspect that the turn around time may be a bit slow for real time use.
Good topic. CVP is a static marker and because of RA and venous system compliance it isn’t a good marker of fluid responsiveness. However extreme values of CVP could be interesting to consider.
ex : a CVP 10-15 mmHg in an extubated patient = massive hypervolemia, right ventricular failure or cardiac tamponnade.
So it is still useful but one has to consider that only the extreme values are useful and they should always be confirmed by dynamic measures or TTE.
Edvard: Could not agree more. CVP is a poor indicator of volume status; however a high CVP in an non-ventilated patient is usually a sign of RV failure, tamponade , or gross fluid overload, etc.