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      Comparison between noninvasive measurement of central venous pressure using near infrared spectroscopy with an invasive central venous pressure monitoring in cardiac surgical Intensive Care Unit


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          Central venous pressure (CVP) measurement is essential in the management of certain clinical situations, including cardiac failure, volume overload and sepsis. CVP measurement requires catheterization of the central vein which is invasive and may lead to complications. The aim of this study was to evaluate the accuracy of measurement of CVP using a new noninvasive method based on near infrared spectroscopy (NIRS) in a group of cardiac surgical Intensive Care Unit (ICU) patients.


          Thirty patients in cardiac surgical ICU were enrolled in the study who had an in situ central venous catheter (CVC). Sixty measurements were recorded in 1 h for each patient. A total of 1800 values were compared between noninvasive CVP (CVPn) obtained from Mespere VENUS 2000 CVP system and invasive CVP (CVPi) obtained from CVC.


          Strong positive correlation was found between CVPi and CVPn ( R = 0.9272, P < 0.0001). Linear regression equation - CVPi = 0.5404 + 0.8875 × CVPn ( r 2 = 0.86, P < 0.001), Bland–Altman bias plots showed mean difference ± standard deviation and limits of agreement: −0.31 ± 1.36 and − 2.99 to + 2.37 (CVPi–CVPn).


          Noninvasive assessment of the CVP based on NIRS yields readings consistently close to those measured invasively. CVPn may be a clinically useful substitute for CVPi measurements with an advantage of being simple and continuous. It is a promising tool for early management of acute state wherein knowledge of CVP is helpful.

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          Most cited references22

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
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            The limited reliability of physical signs for estimating hemodynamics in chronic heart failure.

            The cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in chronic heart failure, although the relationship between physical signs, increased ventricular filling pressure, and decreased cardiac output has not been established for this population. We prospectively compared physical signs with hemodynamic measurements in 50 patients with known chronic heart failure (ejection fraction, .18 +/- .06). Rales, edema, and elevated mean jugular venous pressure were absent in 18 of 43 patients with pulmonary capillary wedge pressures greater than or equal to 22 mm Hg, for which the combination of these signs had 58% sensitivity and 100% specificity. Proportional pulse pressure correlated well with cardiac index (r = .82), and when less than 25% pulse pressure had 91% sensitivity and 83% specificity for a cardiac index less than 2.2 L/min/m2. In chronic heart failure, reliance on physical signs for elevated ventricular filling pressure might result in inadequate therapy. Conversely, the adequacy of cardiac output is assessed reliably by pulse pressure. Our results facilitate decisions regarding treatment in chronic heart failure.
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              Physical examination of venous pressure: a critical review.

              To explain why investigations of the measurement of central venous pressure (CVP) usually reveal a discrepancy between the clinician's estimate of CVP from physical diagnosis and supine measurement with a catheter. Data from MEDLINE search, personal files, and bibliographies of textbooks on physical diagnosis and cardiology were used. The most important reasons for this disagreement are the failure to standardize the external reference point used by the clinician to indicate "zero" venous pressure and the failure to recognize that venous pressure often depends on the position of the patient during examination. During physical examination clinicians tend to underestimate the CVP, as measured by a catheter in the same patient positioned supine, especially when the measured value is high. This occurs because the venous pressure of patients with heart failure, in contrast to that of healthy individuals, demonstrates an exaggerated postural fall when the patient is in the more upright positions that are necessary to visualize the elevated neck veins. The cause of this postural instability, increased venoconstriction from sympathetic tone, also helps explain two other physical findings of the jugular veins, the abdominojugular test, and Kussmaul's sign. Clinicians should avoid making decisions about degrees of CVP elevation that are imprecise and difficult to reproduce. Instead, they should determine during physical diagnosis merely whether the CVP is elevated. Until further research is done, the best definition of elevated CVP is that of Sir Thomas Lewis-when the top of the external or internal jugular veins is >3 cm of vertical distance above the sternal angle, the CVP is abnormally high.

                Author and article information

                Ann Card Anaesth
                Ann Card Anaesth
                Annals of Cardiac Anaesthesia
                Medknow Publications & Media Pvt Ltd (India )
                Jul-Sep 2016
                : 19
                : 3
                : 405-409
                [1]Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
                Author notes
                Address for correspondence: Dr. P. S. Nagaraja, Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru - 560 069, Karnataka, India. E-mail: docnag10@ 123456gmail.com
                Copyright: © 2016 Annals of Cardiac Anaesthesia

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                Original Article: Janak Mehta Award

                cardiac preload,central venous pressure,near infrared spectroscopy


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