The role for using central venous pressure (CVP) as a measure of volume responsiveness has largely fallen out of favor over the years.1 There are certainly better indices for fluid responsiveness, but don’t be fooled – the CVP isn’t a one trick pony. In fact, a high or rapidly rising CVP should raise a significant concern for impending cardiovascular collapse.
Consider the following differential diagnosis in the patient with an abnormally high or rising CVP ( >10 cm H2O).
Excessive pressures outside of the heart or impediments to venous return (juxta-cardiac pressures)
Cardiac tamponade
Auto PEEP or breath stacking during mechanical ventilation
Tension pneumothorax
Venous return that’s more than the right ventricle can handle
Bottom Line: In a time where the utility of the CVP has been largely dismissed, remember that an abnormal CVP offers great deal of information beyond a simple measure of volume status.
References
Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172-8.
Berlin DA, Bakker J. Starling curves and central venous pressure. Critical Care. 2015;19(1):55.
