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Intensive care is directed towards patients with severe illness or risk of serious outcomes following, for example, surgery. Central venous pressure (CVP) is an important part of the hemodynamic assessment of patients in surgery and the intensive care unit (ICU). CVP is normally measured via a central venous catheter (CVC) inserted through the subclavian or internal jugular vein, with the tip placed at the junction to the right atrium. A pressure tubing is connected to one of the branches of the CVC and then connected to a pressure sensor that sends a digital signal to the monitoring screen where CVP can be read in mmHg. To accurately read CVP, the pressure sensor must be positioned at the level of the right atrium. Different external reference points are used nationally and internationally to locate the correct height for the pressure sensor. This study aims to investigate the most commonly used external reference points for CVP measurement in various body positions compared to CVP measured via a solid state pressure catheter in the right atrium (RAP).
A Millar Mikro-Cath solid state pressure catheter is inserted through one of the medial lines of the CVC and guided in position by the pressure curve and verified in position by ultrasound.
CVP is compared to RAP in supine, semi-recumbent, Trendelenburg and lateral position.
CVP, RAP and arterial pressure is recorded in each session with Biopac Acqnowledge.
In each body position PEEP is raised 5 cmH20 and then lowered 5 cmH20.
Ventilator settings, capillary refill time, perfusion index are collected in each setting and before and after PEEP adjustments.
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| Measure | Description | Time Frame |
|---|---|---|
| Difference in mmHg between Right atrial pressure (RAP) and Central venous pressure (CVP) in supine position | Difference in mmHg between RAP (Millar Micro-Cath) and CVP. | 3 minutes after body position change |
| Difference in mmHg between RAP and CVP in semi-recumbent position | Difference in mmHg between RAP (Millar Micro-Cath) and CVP. | 3 minutes after body position change |
| Difference in mmHg between RAP and CVP in Trendelenburg position | Difference in mmHg between RAP (Millar Micro-Cath) and CVP. | 3 minutes after body position change |
| Difference in mmHg between RAP and CVP in right lateral position | Difference in mmHg between RAP (Millar Micro-Cath) and CVP. | 3 minutes after body position change |
| Difference in mmHg between RAP and CVP in left lateral position | Difference in mmHg between RAP (Millar Micro-Cath) and CVP. | 3 minutes after body position change |
| Measure | Description | Time Frame |
|---|---|---|
| Change in hemodynamic parameters after body position change | Change in CVP (mmHg) | 3 minutes after body position change |
| Change in hemodynamic parameters after PEEP change | Change in RAP (mmHg) |
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Inclusion Criteria:
Exclusion Criteria:
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Critically ill patients, in mechanical ventilation, sedated to RASS -4 or -5 in mechanical ventilation with a 4 or 5 line CVC.
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| Name | Affiliation | Role |
|---|---|---|
| Lotta Johansson, MD | Sahlgrenska University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sahlgrenska University Hospital | Gothenburg | Västra Götaland County | 41345 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42285730 | Derived | Sjodin C, Oras J, Johansson L, Persson P, Olausson S, Holmqvist J, Ille A, Vidovic N, Svensson CJ. Central Venous Pressure Referencing in the Lateral Position: Comparison With Direct Right Atrial Pressure in Mechanically Ventilated ICU Patients. Acta Anaesthesiol Scand. 2026 Jul;70(6):e70280. doi: 10.1111/aas.70280. |
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All excel data that underlie results in publication
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| ID | Term |
|---|---|
| D016638 | Critical Illness |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| 1 minutes after PEEP change |
| Change in hemodynamic parameters after body position change | Change in arterial pressure (mmHg) | 3 minutes after body position change |
| Change in hemodynamic parameters after body position change | Change in perfusion index (%) | 3 minutes after body position change |
| Change in hemodynamic parameters after body position change | Change in capillary refill time change (sek) | 3 minutes after body position change |
| Change in hemodynamic parameters after body position change | Change in RAP (mmHg) | 3 minutes after body position change |
| Change in hemodynamic parameters after PEEP change | Change in CVP (mmHg) | 1 minutes after PEEP change |
| Change in hemodynamic parameters after PEEP change | Change in arterial pressure (mmHg) | 1 minutes after PEEP change |
| Change in hemodynamic parameters after PEEP change | In capillary refill time change (sek) | 1 minutes after PEEP change |
| Change in hemodynamic parameters after PEEP change | Change in perfusion index (%) | 1 minutes after PEEP change |