CVP and Fluid Responsiveness

• Central venous pressure (CVP) has been used over the last 50 years to assess volume status and fluid responsiveness in critically ill patients.
• Despite widespread practice habit, CVP has not been shown to reliably predict fluid responsiveness in the critically ill.
• In a recent updated meta-analysis, Marik et al reviewed 43 studies, totaling over 1800 patients.
  • 57% of patients were fluid responders
  • The mean CVP was 8.2 mm Hg for fluid responders and 9.5 mm Hg for non-responders
  • For studies performed in ICU patients, the correlation coefficient for CVP and change in cardiac index was just 0.28.
• Bottom line: Current literature does not support the use of CVP as a reliable marker of fluid responsiveness.

References

Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med 2013:41:1774-1781.