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Unexpected Relationship Between Central Venous Pressure (CVP) and Mortality in Patients With Severe Sepsis FREE TO VIEW

Larry Nguyen; Herbert Patrick
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Mercy Suburban Hospital, Philadelphia, PA

Chest. 2014;146(4_MeetingAbstracts):231A. doi:10.1378/chest.1992500
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SESSION TITLE: Sepsis & Septic Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The Surviving Sepsis Campaign (SSC) fosters time-centric guidelines for patients with severe sepsis. Although the timing of interventions have changed from a 6 hour and a 24 hour bundle in 2004 and 2008 to two consecutive 3 hour bundles in 2012, the targets of resuscitation have not changed. After a catheter is placed in the IJ or SC, the unchanged goal for the CVP value is ≥ 8 mm Hg. However, while numerous authors have discussed the insensitivity of the CVP value in mm Hg in predicting fluid responsiveness, studies have been sparse relating CVP value in mm Hg to mortality in patients with severe sepsis. HYPOTHESIS: The CVP value in mm Hg will relate directly to mortality, a more significant outcome measure than fluid responsiveness. We chose to re-examine our prior data for patients with severe sepsis to compare CVP value in mm Hg to mortality.

METHODS: No new data were collected. We retrospectively examined our data on 36 patients published previously in CHEST 2004;126(4, Supplement):863S; Amer J Resp Crit Care Med 2005;(2, Abstract Issue):A42; and CHEST 2006;130(4, Supplement):223S where time to goal for MAP, CVP, and ScvO2 were identified per the 2004 SSC Guideline. Instead of time to goal CVP of ≥ 8 mmHg, we compared CVP in mmHg to mortality. Twenty seven patients had CVP values and 28-day mortality data; 9 patients were excluded secondary to incomplete data.

RESULTS: Of the 27 patients, 15 were alive and 12 deceased by day 28 after the onset of severe sepsis. The CVP in mm Hg values for range, median, mean ± SD in the alive versus the deceased groups were as follows. Alive (mm Hg): 4-22, 12, 12.33 ± 4.32 versus deceased (mm Hg): 8-31, 17, 17.92 ± 6.97. These groups were significantly different by Student's t-test, one tailed, p = 0.016 (p<0.05).

CONCLUSIONS: Our analysis showed a significant relationship of CVP in mm Hg with day 28 mortality. Higher CVP values related to higher mortality. The hypothesis is supported. Weaknesses of this study include small sample size, retrospective design, and a single hospital site. No cause and effect between CVP and mortality can be shown by this study design.

CLINICAL IMPLICATIONS: Despite numerous discussions with emotional arguments and debates whether CVP in mm Hg corresponds to fluid responsiveness, we found that the CVP value in mm Hg, as a single variable, related to day 28 mortality. Researchers retrospectively or prospectively gathering SSC data should check for a similar relationship which, if present, could stimulate new interest in the CVP.

DISCLOSURE: The following authors have nothing to disclose: Larry Nguyen, Herbert Patrick

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