Navegando por Palavras-chave "Central Venous Pressure"

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    Variações Da Pressão Venosa Central Durante A Prova De Volume Têm Valor Limitado Para Guiar A Infusão De Fluidos
    (Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Oliveira, Priscilla Souza De [UNIFESP]; Machado, Flavia Ribeiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: Static values of central venous pressure (CVP) have limitations to guide fluid management although dynamic changes are considered useful. We evaluated if changes in CVP and the baseline cyclic variation in the amplitude of CVP curve (ΔCVP) could discriminate responders from non-responders. Design: Prospective, observational study. Setting: Two mixed intensive care. Patients: Adult patients under mechanical ventilation with acute circulatory failure who received a fluid challenge with crystalloids (Ringer's lactate or sodium chloride 0.9% solution, 500 mL infused over 15 minutes). Measurements and Main Results: We determined the CVP at baseline (CVPT0), its amplitude during respiratory cycle (ΔCVP) and the changes at 5 (ΔCVPT5), 10 (ΔCVPT10) and 15 (ΔCVPT15) minutes during fluid infusion. Fluid responsiveness was defined by a cardiac index increased ≥ 15%. We included 30 patients. There was a significant increase over time in CVP for both groups (0.12 mmHg, SE: 1.36 mmHg, p-value: < 0.001) although with no significant differences in CVP changes between responder and non-responders over time (-0.03 mmHg, SE: 0.03 mmHg, p-value:0.253) and for CVP between groups (-2.73 mmHg, SE: 1.36, p-value = 0.055). The cardiac index did not correlate with the changes in CVP after the fluid challenge (R=-0.25, p value = 0.182). The CVPT0 and the changes after fluid challenge in all three timepoints did not adequately predict fluid responsiveness (CVPT0 - AUC: 0.696 (95%CI: 0.492 - 0.901), ΔCVPT5 - AUC: 0.780 (95%CI:0.572 - 0.988), ΔCVPT10 - AUC: 0.634 (95%CI:0.385 - 0.883), ΔCVPT15 - AUC: 0.684 ((95%CI: 0.453 - 0.915)). The ΔCVP at baseline also had poor performance (AUC: 0.703 (95%CI: 0.500 - 0.907). Conclusions: Dynamic changes in CVP have limited value to guide fluid management. Changes in CVP after fluid infusion and ΔCVP at baseline cannot be used as a marker of fluid responsiveness in patients under mechanical ventilation.