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VOLUME 2 , ISSUE 2 ( May-August, 2023 ) > List of Articles


Central Venous Pressure: Just a Blast from the Past or Relevant? A Debate

Bikram K Gupta, Arnavjyoti Das, Vinod Kumar Singh, Gopinath Ramachandran

Keywords : Acute care unit, Bedside monitoring, Central venous pressure, Critical care units, Echocardiography, Fluid responsiveness, Hemodynamic monitor, Ultrasound

Citation Information : Gupta BK, Das A, Singh VK, Ramachandran G. Central Venous Pressure: Just a Blast from the Past or Relevant? A Debate. 2023; 2 (2):89-95.

DOI: 10.5005/jp-journals-10089-0073

License: CC BY-NC 4.0

Published Online: 30-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


  1. Bates Guide to Physical Examination and History Taking. 7th Edition. Philadelphia, Lippincott, 1999.
  2. Roger C, Muller L, Riou B, et al. Comparison of different techniques of central venous pressure measurement in mechanically ventilated critically ill patients. Br J Anaesth 2017;118(2):223–231. DOI: 10.1093/bja/aew386
  3. Guyton AC, Jones CE, Coleman TG. Circulatory Physiology: Cardiac Output and Its Regulation. Philadelphia: Saunders; 1973.
  4. Magder S. Heart-lung interactions in sepsis. In: Dantzker DR, Scharf SM (Eds). Cardiopulmonary Critical Care. Philadelphia: Saunders; 1998. pp. 435–448.
  5. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006;354(21):2213–2224. DOI: 10.1056/NEJMoa061895
  6. Berlin DA, Bakker J. Starling curves and central venous pressure. Crit Care 2015;19(1):55. DOI: 10.1186/s13054-015-0776-1
  7. Chen CY, Zhou Y, Wang P, et al. Elevated central venous pressure is associated with increased mortality and acute kidney injury in critically ill patients: a meta-analysis. Crit Care 2020;24(1):80. DOI: 10.1186/s13054-020-2770-5
  8. Magder S. Central venous pressure: a useful but not so simple measurement. Crit Care Med 2006;34(8):2224–2227. DOI: 10.1097/01.CCM.0000227646.98423.98
  9. Magder S. Cardiac output measurement. In: Tobin MJ (Ed). Principles and Practice of Intensive Care Monitoring. Chicago: McGraw-Hill; 1997. pp. 797–810.
  10. Boulain T, Achard JM, Teboul JL, et al. Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. Chest 2002;121(4):1245–1252. DOI: 10.1378/chest.121.4.1245
  11. Magder S, Erice F, Lagonidis D. Determinants of the ‘y’ descent and its usefulness as a predictor of ventricular filling. J Intensive Care Med 2000;15(5):262–269. DOI: 10.1177/088506660001500505
  12. 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(7):1774–1781. DOI: 10.1097/CCM.0b013e31828a25fd
  13. De Backer and Vincent. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Critical Care 2018;22(1):43. DOI: 10.1186/s13054-018-1959-3
  14. Biais M, Ehrmann S, Mari A, et al. Clinical relevance of pulse pressure variations for predicting fluid responsiveness in mechanically ventilated intensive care unit patients: the grey zone approach. Crit Care 2014;18(6):587. DOI: 10.1186/s13054-014-0587-9
  15. Li DK, Wang XT, Liu DW. Association between elevated central venous pressure and outcomes in critically ill patients. Ann Intensive Care 2017;7(1):83. DOI: 10.1186/s13613-017-0306-1
  16. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354(24):2564–2575. DOI: 10.1056/NEJMoa062200
  17. 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. DOI: 10.3389/fmed.2022.858838
  18. Chen H, Zhu Z, Zhao C, et al. 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. DOI: 10.1186/s13054-020-03109-9
  19. Lanspa MJ, Brown SM, Hirshberg EL, et al. Central venous pressure and shock index predict lack of hemodynamic response to volume expansion in septic shock: a prospective, observational study. J Crit Care 2012;27(6):609–615. DOI: 10.1016/j.jcrc.2012.07.021
  20. References
  21. Berlin DA, Bakker J. Starling curves and central venous pressure. Crit Care 2015;19(1):55. DOI: 10.1186/s13054-015-0776-1
  22. Shah P, Louis MA. Physiology, Central Venous Pressure. Treasure Island (FL): StatPearls Publishing; 2023.
  23. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 2008;134(1):172–178. DOI: 10.1378/chest.07-2331
  24. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345(19):1368–1377. DOI: 10.1056/NEJMoa010307
  25. Osborn TM. Severe sepsis and septic shock trials (ProCESS, ARISE, ProMISe): what is optimal resuscitation? Crit Care Clin 2017;33(2): 323–344. DOI: 10.1016/j.ccc.2016.12.004
  26. Pinsky MR, Kellum JA, Bellomo R. Central venous pressure is a stopping rule, not a target of fluid resuscitation. Crit Care Resusc 2014;16(4):245–246.
  27. Shippy CR, Appel PL, Shoemaker WC. Reliability of clinical monitoring to assess blood volume in critically ill patients. Crit Car Med 1984;12(2):107–112. DOI: 10.1097/00003246-198402000-00005
  28. References
  29. Bellamy MC. Wet, dry or something else? Br J Anaesth 2006;97(6):755–757. DOI: 10.1093/bja/ael290
  30. Henderson WR, Griesdale DE, Walley KR, et al. Clinical review: Guyton - the role of mean circulatory filling pressure and right atrial pressure in controlling cardiac output. Crit Care 2010;14(6):243. DOI: 10.1186/cc9247
  31. Beard DA, Feigl EO. Understanding Guyton's venous return curves. Am J Physiol Heart Circ Physiol 2011;301(3):H629–633. DOI: 10.1152/ajpheart.00228.2011
  32. Levitov A, Marik PE. Echocardiographic assessment of preload responsiveness in critically ill patients. Cardiol Res Pract 2012;2012:819696. DOI: 10.1155/2012/819696
  33. Mackenzie DC, Noble VE. Assessing volume status and fluid responsiveness in the emergency department. Clin Exp Emerg Med 2014;1(2):67–77. DOI: 10.15441/ceem.14.040
  34. Di Nicolò P, Tavazzi G, Nannoni L, et al. Inferior vena cava ultrasonography for volume status evaluation: an intriguing promise never fulfilled. J Clin Med 2023;12(6):2217. DOI: 10.3390/jcm12062217
  35. Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 2009;37(9):2642–2647. DOI: 10.1097/CCM.0b013e3181a590da
  36. Enev R, Krastev P, Abedinov F. Prediction of fluid responsiveness: a review. Biotechnol Biotechnol Equip 2021;35(1):1147–1155. DOI: 10.1080/13102818.2021.1960190
  37. Surviving Sepsis Campaign Guidelines. Crit Care Med 2021.
  38. Kalantari K, Chang JN, Ronco C, et al. Assessment of intravascular volume status and volume responsiveness in critically ill patients. Kidney Int 2013;83(6):1017–1028. DOI: 10.1038/ki.2012.424
  39. Li C, Lin FQ, Fu SK, et al. Stroke volume variation for prediction of fluid responsiveness in patients undergoing gastrointestinal surgery. Int J Med Sci 2013;10(2):148–155. DOI: 10.7150/ijms.5293
  40. Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care 2016;6(1):111. DOI: 10.1186/s13613-016-0216-7
  41. Messina A, Robba C, Calabrò L, et al. Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery. Crit Care 2021;25(1):43. DOI: 10.1186/s13054-021-03464-1
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