Accuracy of Mean Value of Central Venous Pressure from Monitor Digital Display: Influence of Amplitude of Central Venous Pressure during Respiration

Background

A simple measurement of central venous pressure (CVP)-mean by the digital monitor display has become increasingly popular. However, the agreement between CVP-mean and CVP-end (a standard method of CVP measurement by analyzing the waveform at end-expiration) is not well determined. This study was designed to identify the relationship between CVP-mean and CVP-end in critically ill patients and to introduce a new parameter of CVP amplitude (ΔCVP= CVPmax – CVPmin) during the respiratory period to identify the agreement/disagreement between CVP-mean and CVP-end.

Methods

In total, 291 patients were included in the study. CVP-mean and CVP-end were obtained simultaneously from each patient. CVP measurement difference (| CVP-mean – CVP-end |) was defined as the difference between CVP-mean and CVP-end. The ΔCVP was calculated as the difference between the peak (CVPmax) and the nadir value (CVPmin) during the respiratory cycle, which was automatically recorded on the monitor screen. Subjects with | CVP-mean – CVP-end | ≥ 2 mmHg were divided into the inconsistent group, while subjects with | CVP-mean – CVP-end | < 2 mmHg were divided into the consistent group.

Results

ΔCVP was significantly higher in the inconsistent group [7.17(2.77) vs.5.24(2.18), p<0.001] than that in the consistent group. There was a significantly positive relationship between ΔCVP and | CVP-mean – CVP-end | (r=0.283, p <0.0001). Bland-Altman plot showed the bias was -0.61 mmHg with a wide 95% limit of agreement (–3.34, 2.10) of CVP-end and CVP-mean. The area under the receiver operating characteristic curves (AUC) of ΔCVP for predicting | CVP-mean – CVP-end | ≥ 2 mmHg was 0.709. With a high diagnostic specificity, using ΔCVP<3 to detect | CVP-mean – CVP-end | lower than 2mmHg (consistent measurement) resulted in a sensitivity of 22.37% and a specificity of 93.06%. Using ΔCVP>8 to detect | CVP-mean – CVP-end | >8 mmHg (inconsistent measurement) resulted in a sensitivity of 31.94% and a specificity of 91.32%.

Conclusions

Conclusions CVP-end and CVP-mean have statistical discrepancies in specific clinical scenarios. ΔCVP during the respiratory period is related to the variation of the two CVP methods. A high ΔCVP indicates a poor agreement between these two methods, whereas a low ΔCVP indicates a good agreement between these two methods.