Association Between Central Venous Pressure Measurement and Outcomes in Critically Ill Patients with Severe Coma

Overview

Journal Eur J Med Res

Publisher Biomed Central

Specialty General Medicine

Date 2023 Jan 18

PMID 36653881

Authors

Xin Tong

Xin Feng

Chuanzhi Duan

Aihua Liu

Affiliations

Soon will be listed here.

Abstract

Background: The use of central venous pressure (CVP) measurements among (intensive care unit) ICU patients with severe coma has been questioned. This study aimed to investigate the application value of CVP in this population.

Methods: Data stored in the ICU Collaborative Research Database (eICU-CRD) and Medical Information Mart for Intensive Care III (MIMIC-III) database were reviewed. Critically ill patients with a Glasgow Coma Scale (GCS) score of 3-8 were included. The primary outcome was the in-hospital mortality rate. The statistical approaches used included multivariable Cox regression, propensity score matching (PSM), inverse probability treatment weighting (IPTW), stabilized IPTW, and restricted cubic splines (RCS) to ensure the robustness of our findings.

Results: In total, 7386 patients were included in the study. Early CVP measurement was independently associated with in-hospital mortality [hazard ratio, 0.63; p < 0.001] in patients with severe-to-moderate coma. This result was robust in the PSM, sIPTW, and IPTW cohorts. For all patients with CVP measurements, the RCS curves showed that the risk of in-hospital mortality increased as the initial CVP time was delayed. In addition, early CVP measurement was significantly associated with lower ICU mortality, 28-day mortality, and 365-day mortality and a significantly higher number of ventilator-free days.

Conclusion: Early CVP measurement could improve clinical outcomes in critically ill patients with severe coma.

References

Ostermann M, Liu K, Kashani K . Fluid Management in Acute Kidney Injury. Chest. 2019; 156(3):594-603. DOI: 10.1016/j.chest.2019.04.004. View

Goldberger A, Amaral L, Glass L, Hausdorff J, Ivanov P, Mark R . PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals. Circulation. 2000; 101(23):E215-20. DOI: 10.1161/01.cir.101.23.e215. View

Pinsky M, Kellum J, Bellomo R . Central venous pressure is a stopping rule, not a target of fluid resuscitation. Crit Care Resusc. 2014; 16(4):245-6. View

Yang Y, Ma J, Zhao L . High central venous pressure is associated with acute kidney injury and mortality in patients underwent cardiopulmonary bypass surgery. J Crit Care. 2018; 48:211-215. DOI: 10.1016/j.jcrc.2018.08.034. View

Vasilevskis E, Chandrasekhar R, Holtze C, Graves J, Speroff T, Girard T . The Cost of ICU Delirium and Coma in the Intensive Care Unit Patient. Med Care. 2018; 56(10):890-897. PMC: 6200340. DOI: 10.1097/MLR.0000000000000975. View

Vanmassenhove J, Kielstein J, Jorres A, Van Biesen W . Management of patients at risk of acute kidney injury. Lancet. 2017; 389(10084):2139-2151. DOI: 10.1016/S0140-6736(17)31329-6. View

Wang X, Chen H, Liu D, Zhang Q, Su L . The correlation between CVP-derived parameters and the prognosis of critically ill patients. J Crit Care. 2017; 40:257-264. DOI: 10.1016/j.jcrc.2017.03.011. View

Mehta R, Chinthapalli K . Glasgow coma scale explained. BMJ. 2019; 365:l1296. DOI: 10.1136/bmj.l1296. View

Johnson A, Pollard T, Shen L, Lehman L, Feng M, Ghassemi M . MIMIC-III, a freely accessible critical care database. Sci Data. 2016; 3:160035. PMC: 4878278. DOI: 10.1038/sdata.2016.35. View

10.

McMillan T, Wilson L, Ponsford J, Levin H, Teasdale G, Bond M . The Glasgow Outcome Scale - 40 years of application and refinement. Nat Rev Neurol. 2016; 12(8):477-85. DOI: 10.1038/nrneurol.2016.89. View

11.

Chen H, Zhu Z, Zhao C, Guo Y, Chen D, Wei Y . Central venous pressure measurement is associated with improved outcomes in septic patients: an analysis of the MIMIC-III database. Crit Care. 2020; 24(1):433. PMC: 7358999. DOI: 10.1186/s13054-020-03109-9. View

12.

Junrungsee S, Suwannikom K, Tiyaprasertkul W, Lapisatepun W, Chotirosniramit A, Sandhu T . Efficacy and safety of infrahepatic inferior vena cava clamping under controlled central venous pressure for reducing blood loss during hepatectomy: A randomized controlled trial. J Hepatobiliary Pancreat Sci. 2021; 28(7):604-616. DOI: 10.1002/jhbp.969. View

13.

Claassen J . Coma science: intensive care as the new frontier. Intensive Care Med. 2019; 46(1):97-101. PMC: 7881805. DOI: 10.1007/s00134-019-05820-w. View

14.

Semler M, Wheeler A, Thompson B, Bernard G, Wiedemann H, Rice T . Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome. Crit Care Med. 2016; 44(4):782-9. PMC: 4792704. DOI: 10.1097/CCM.0000000000001555. View

15.

Eskesen T, Wetterslev M, Perner A . Systematic review including re-analyses of 1148 individual data sets of central venous pressure as a predictor of fluid responsiveness. Intensive Care Med. 2015; 42(3):324-332. DOI: 10.1007/s00134-015-4168-4. View

16.

Pollard T, Johnson A, Raffa J, Celi L, Mark R, Badawi O . The eICU Collaborative Research Database, a freely available multi-center database for critical care research. Sci Data. 2018; 5:180178. PMC: 6132188. DOI: 10.1038/sdata.2018.178. View

17.

Kellum J, Lameire N . Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 17(1):204. PMC: 4057151. DOI: 10.1186/cc11454. View

18.

Schiefenhovel F, Trauzeddel R, Sander M, Heringlake M, Groesdonk H, Grubitzsch H . High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality. J Clin Med. 2021; 10(17). PMC: 8432196. DOI: 10.3390/jcm10173945. View

19.

Tang R, Peng J, Wang D . Central Venous Pressure Measurement Is Associated With Improved Outcomes in Patients With or at Risk for Acute Respiratory Distress Syndrome: An Analysis of the Medical Information Mart for Intensive Care IV Database. Front Med (Lausanne). 2022; 9:858838. PMC: 8995425. DOI: 10.3389/fmed.2022.858838. View

20.

Hughes R, Magovern G . The relationship between right atrial pressure and blood volume. AMA Arch Surg. 1959; 79(2):238-43. DOI: 10.1001/archsurg.1959.04320080074009. View