title: Non invasive evaluation of central venous pressure using echocardiography in the intensive care--specific features of patients with right ventricular enlargement and chronic exacerbated pulmonary disease.
abstract: OBJECTIVE
  To determine the possibility of non-invasive estimation of central venous pressure (CVP) through inferior vena cava (IVC) analysis, using transthoracic echocardiography (TTE).
  
  
  METHODS
  A prospective 3-year study.
  
  
  METHODS
  A 16-bed medical/surgical Intensive Care Unit (ICU).
  
  
  METHODS
  Patients admitted to the ICU were enrolled. CVP measurement and TTE (determining cardiac chambers dimension and left ventricular shortening fraction) with IVC analysis (maximum dimension and IVC index) were performed simultaneously. Parametric and non-parametric statistical analysis was performed to establish correlations between variables.
  
  
  RESULTS
  560 patients were admitted to the study, including 477 in whom IVC was analysed, aging 62.2 +/- 17.3 years, a mean ICU stay 11.9 +/- 18.7 days, a APA- CHE II score 23.9 +/- 8.9 and a SAPS II score 55.7 +/- 20.4. Through linear regression analysis CVP was influenced by IVC index (p=0.001), IVC maximum dimension (p=0.013) and presence of mechanical ventilation (p=0.002). A statistically significant correlation was found between the following parameters: an IVC index < 25% and a CVP > 13 mmHg; an IVC index and a CVP 26%-50%; an IVC index > 51% and CVP < 7 mmHg; an IVC maximum dimension > 20mm and a CVP > 13 mmHg; an IVC maximum dimension < 10 mmHg and CVP < 7 mmHg. Patients with right ventricle enlargement presented a lack of agreement between IVC maximum dimension and CVP > 7 mmHg was observed, and in patients with chronic respiratory failure (who presented a high prevalence of right ventricular enlargement) a lack of agreement between IVC index > 50% and CVP < 7 mmHg was also observed.
  
  
  CONCLUSIONS
  IVC analysis is a possible way to non-invasively estimate CVP in a medical /surgical ICU. However, patients with right ventricular enlargement and admitted with chronic respiratory failure present a lack of agreement between IVC parameters and low values of CVP. IVC dimension is a marker of chronic disease and IVC index correlated better with CVP.
authors.affiliation: Intensive Care Unit, Hospital de Curry Cabral, Rua de Beneficência 8, 1069-166 Lisbon, Portugal. pmarcelino@fm.ul.pt
authors.forename: Paulo
authors.initials: P
authors.lastname: Marcelino
authors.forename: Alexandra
authors.initials: A
authors.lastname: Borba
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Fernandes
authors.forename: Susana
authors.initials: S
authors.lastname: Marum
authors.forename: Nuno
authors.initials: N
authors.lastname: Germano
authors.forename: M Rio G
authors.initials: MR
authors.lastname: Lopes
mesh_terms: D001795:Blood Pressure Determination / Q000379:methods*; D002496:Central Venous Pressure; D002908:Chronic Disease; D003422:Critical Care; D004452:Echocardiography; D005260:Female; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000503:physiopathology*; D008171:Lung Diseases / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies