measured central venous pressure and physician administration of intravenous fluids
TRANSCRIPT
![Page 1: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/1.jpg)
Measured Central Venous Pressure and Physician Administration of
Intravenous Fluids
Todd Belok
PI: Neal Handly, MD
Hahnemann University Hospital, Emergency Department
![Page 2: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/2.jpg)
Hypothesis• Low (< 8mmHg) measured central venous pressure of
hypotensive non-trauma patients correlates with the decision by physicians to administer intravenous fluids.
Purpose• To determine if using the Venus 1000 will alter physician
behavior using low CVP level and fluid administration as variables
![Page 3: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/3.jpg)
Overview of Hemodynamics
• Renin-Angiotensin system
• Cardiac Output = Heart Rate x Stroke Volume
• Systemic vascular resistance= (MAP-CVP)/CO
• Shock: Inadequate perfusion/oxygenation
Mohit Goyal, Rabindranath
Tagore Medical College
![Page 4: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/4.jpg)
Uscom Ltd.
Ohm’s Law
![Page 5: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/5.jpg)
Dr. Sam George, Anesthesia and Intensive Care, Guajarat Cancer and Research Institute (GCRI)
![Page 6: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/6.jpg)
What is Central Venous Pressure?
• Measurement of blood pressure within the right atrium and vena cava
• Ability of the heart to pump blood to the lungs• High CVP is an important marker of right heart failure b/c of ⊕
pulmonary vascular resistance
• CVP ≈ Venous return to the right side of the heart
![Page 7: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/7.jpg)
Use of CVP in the ED/Intensive Care Setting for hemodynamic stability
• “Structured early goal-directed resuscitation”
• CVP readings help in the general management of shock through improving…
• O2 saturation
• Cardiac Output*
• Blood Pressure*
• Regional blood flow*
• Septic shock and CVP• “Golden” 6 hours for hemodynamic stabilization before specific
antibiotics
![Page 8: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/8.jpg)
Central Venous Pressure and Cardiac Output
• With no vascular resistance Cardiac Output=Venous Return and MAP=CVP
• Use fluid resuscitation, vasopressors, and inotropic agents to increase cardiac output and blood pressure
SVR=(MAP-CVP)/CO
![Page 9: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/9.jpg)
CVP and CO: Volume resuscitation
Josh Farkas, MD, Pulmonary and Critical Care Medicine, University of Vermont
![Page 10: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/10.jpg)
CVP and CO: Vasopressor Therapy
Josh Farkas, MD, Pulmonary and Critical Care Medicine, University of Vermont
![Page 11: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/11.jpg)
CVP and CO: Inotropic therapy
Josh Farkas, MD, Pulmonary and Critical Care Medicine, University of Vermont
![Page 12: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/12.jpg)
Central Venous Pressure and Blood Pressure
• Systemic vascular resistance=(MAP-CVP)/CO
• If BP improves after fluid administration, issue could be decreased preload
• If BP does not improve after fluids, then problem could be contractility
• Use CVP to guide whether volume expansion is appropriate
• Importance in suggesting reasons for low blood pressure• Low CVP (<8cm H2O) suggests low BP is b/c of low blood volume
![Page 13: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/13.jpg)
Central Venous Pressure and Regional blood flow
• Regional blood flow=Pressure1-Pressure2/Resistance
• Increase MAP to decrease CVP
• 2013 Netherlands study: CVP > 12 mmHg correlated with reduced microvascular blood flow in sepsis
• Renal blood flow particularly at risk
![Page 14: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/14.jpg)
Septic Shock and CVP
• Use fluid resuscitation, vasopressors, inotropic therapy, and corticosteroids (severe sepsis only) to increase cardiac output and during the first 6 hrs maintain…
• CVP 8-12 mmHg
• MAP ≥ 65 mmHg
• Urine output ≥ .5 mL·kg·hr
• Superior vena cava O2 saturation 70% or mixed venous 65%
• Blood cultures
• Source control
![Page 15: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/15.jpg)
Measuring CVP traditionally involves intravenous catheterization
• Risks of…• infection, embolism, compartment syndrome, necrosis of vascular
tissue, thrombophlebitis, and more
NREMT academy Fibroid Center of MD
![Page 16: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/16.jpg)
Mespere’s Venus 1000
Mespere Life Sciences Inc.
![Page 17: Measured Central Venous Pressure and Physician Administration of Intravenous Fluids](https://reader031.vdocuments.us/reader031/viewer/2022022415/58ed17c31a28aba76d8b45a5/html5/thumbnails/17.jpg)
Implications for the future
• Increase screening/continuous monitoring for patients at risk of developing shock
• Increase point-of-care testing in the prehospital setting
American Medical Academy Nova Biomedical