Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation
The CVP is Useless (mostly) and Harmful (almost always)
See also lecture on Fluids and hemodynamics
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This Post was by the EMCrit Crew, published 2 weeks ago. We never spam; we hate spammers! Spammers probably work for the Joint Commission.
Hi, my name is Scott Weingart.
I am an ED
Intensivist from New York. Along with my friends, we are attempting to provide and teach Maximally Aggressive Care, Everywhere! From the field to the ICU, EMCrit is about optimal critical care and resuscitation.
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5 Comments on "iSepsis – The CVP is Useless"
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.
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.