PURPOSE:To determine the utility of inferior vena caval pressure (Pivc) measured via femoral venous catheter in patients with severe sepsis or septic shock (SS/Shock) who have a contraindication to internal jugular or subclavian vein catheters.
METHODS:IRB approval was obtained for this observational study of subjects with SS/Shock presenting with femoral venous catheters in place to a tertiary MICU. Per Surviving Sepsis Campaign guidelines these subjects should have either an internal jugular or a subclavian central venous catheter placed. Once the central venous pressure (CVP) catheter has been placed, CVP is measured simultaneously with Pivc and bladder pressure. Previous studies have documented an effect of increased intra-abdominal pressure on the Pivc value. Bladder pressure is used as a surrogate of intra-abdominal pressure. Venous oxygen saturation measurements are then performed from both sites.
RESULTS:In subjects with bladder pressures < or = 16 (n=11), the mean CVP is 9.45 +/− 5.7 mmHg and the mean Pivc is 10.73 +/− 5.9 mmHg. The correlation coefficient in these patients is 0.958. In those subjects with bladder pressures > 16 (n=4), the mean CVP is 12.25 mmHg and the mean Pivc is 17.5 mmHg with a correlation coefficient of 0.82. The mean ScVO2 was 72.8% (range 50–91%)and the mean IVC O2 saturation was 69% (range 27–85%).
CONCLUSION:Pivc appears to be a reliable surrogate for CVP in the management of volume resuscitation in patients with SS/Shock and bladder pressures less than 17. In patients with elevated bladder pressures, Pivc overestimates intravascular volume status. The SVO2 from the femoral site does not give an accurate estimate of ScVO2.
CLINICAL IMPLICATIONS:The Surviving Sepsis Guidelines recommend aggressive intravenous fluid resuscitation guided by CVP and ScVO2 measurements. In some patients it is not possible to obtain this measurement. For this subset of patients, it appears that the Pivc may be used as a surrogate for CVP, when the bladder pressure is less than 17mmHg. Our study is ongoing to confirm this possibility.
DISCLOSURE:Jeramy Mosburg, No Financial Disclosure Information; No Product/Research Disclosure Information