Influence of tissue pressure on central venous pressure/peripheral venous pressure correlation: An experimental report

Abstract

Abstract:

BACKGROUND: Peripheral venous pressure (PVP) has been shown to correlate with central venous pressure (CVP) in a number of reports. Few studies, however, have explored the relationship between tissue pressure (TP) and PVP/CVP correlation.
METHODS: PVP and CVP were simultaneously recorded in a bench-top model of the venous circulation of the upper limb and in a single human volunteer after undergoing graded manipulation of tissue pressure surrounding the intervening venous conduit. Measures of correlation were determined below and above a point wherein absolute CVP exceeded TP.
RESULTS: Greater correlation was observed between PVP and CVP when CVP exceeded TP in both models. Linear regression slope was 0.975 (95% CI: 0.959-0.990); r² 0.998 above tissue pressure 10 cmH₂O vs. 0.393 (95% CI: 0.360-0.426); and r² 0.972 below 10 cmH₂O at a flow rate of 2000 mL/h in the in vitro model. Linear regression slope was 0.839 (95% CI: 0.754-0.925); r² 0.933 above tissue pressure 10 mmHg vs. slope 0.238 (95% CI: -0.052-0.528); and r²0.276 in the en vivo model.
CONCLUSION: PVP more accurately reflects CVP when absolute CVP values exceed tissue pressure.

Key words: Peripheral venous pressure, Central venous pressure, Tissue pressure

Martyn G Harvey, Grant Cave. Influence of tissue pressure on central venous pressure/peripheral venous pressure correlation: An experimental report[J]. World Journal of Emergency Medicine, 2011, 2(2): 93-98.

Figures/Tables 6

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References 15

1	Schummer W. Central venous pressure. Validity, informative value and correct measurement. Anaesthesist 2009; 58:499-505. pmid: 19458975
2	Donahue S, Wood J, Patel B, Quinn J. Correlation of sonographic measurements of the internal jugular vein with central venous pressure. Am J Emerg Med 2009; 27:851-855. pmid: 19683116
3	Baumann U, Marquis C, Stoupis C, Willenberg T, Takala J, Jakob S. Estimation of central venous pressure by ultrasound. Resuscitation 2005; 64:193-199. pmid: 15680529
4	Ward KR, Tiba MH, Barbee RW, Ivatury RR, Arrowood JA, Spiess BD, et al. A new noninvasive method to determine central venous pressure. Resuscitation 2006; 70:238-246. doi: 10.1016/j.resuscitation.2005.12.013 pmid: 16820258
5	Thalhammer C, Aschwanden M, Odermatt A, Baumann UA, Imfeld S, Bilecen D, et al. Noninvasive central venous pressure measurement by controlled compression sonography at the forearm. J Am Coll cardiol 2007; 50:1584-1589. pmid: 17936158
6	Hoftman N, Braunfeld M, Hoftman G, Mahajan A. Peripheral venous pressure as a predictor of central venous pressure during orthotopic liver transplantation. J Clin Anesthesia 2006; 18:251-255.
7	Tugrul M, Camci E, Pembeci K, Al-Darsani A, Telci L. Relationship between peripheral and central venous pressures in different patient positions, catheter sizes, and insertion sites. J Cardiothorac Vasc Anesth 2004; 18:446-450. pmid: 15365925
8	Memtsoudis SG, Jules-Elysse K, Girardi FP, Buschiazzo V, Maalouf D, Sama AA, et al. Correlation between centrally versus peripherally transduced venous pressure in prone patients undergoing posterior spine surgery. Spine 2008; 33:643-647.
9	Choi SJ, Gwak MS, Ko JS, Kim GS, Kim TH, Ahn H, et al. Can peripheral venous pressure be an alternative to central venous pressure during right hepatectomy in living donors? Liver Transpl 2007; 13:1414-1421. pmid: 17902127
10	Anter A, Bondok R. Peripheral venous pressure is an alternative to central venous pressure in paediatric surgical patients. J Neurosurg Anesth 2005; 17:91-96.
11	Desjardins R, Denault AY, Bélisle S, Carrier M, Babin D, Lévesque S, et al. Can peripheral venous pressure be interchangeable with central venous pressure in patients undergoing cardiac surgery? Intensive Care Med 2004; 30:627-632. doi: 10.1007/s00134-003-2052-0 pmid: 14600810
12	Cave G, Harvey M. The difference between peripheral venous pressure and central venous pressure (CVP) decreases with increasing CVP. Eur J Anaesthesiol 2008; 25:1037-1040. pmid: 18561873
13	Wells H, Youmans J, Miller D. Tissue pressure (intracutaenous, subcutaneous and intramuscular) as related to venous pressure, capillary filtration, and other factors. J Clin Invest 1938; 17:489. pmid: 16694596
14	Trzebicki J, Flakiewicz E, Nowakowski P, Kosieradzki M, Lisik W, Chmura A. Is external jugular pressure a good predictor of volume status in kidney graft recipients? Transplant Proc 2009; 41:3033-3035. doi: 10.1016/j.transproceed.2009.08.025 pmid: 19857669
15	Leonard A, Allsager C, Parker J, Swami A, Thompson J. Comparison of central venous and external jugular venous pressures during repair of proximal femoral fracture. Br J Anaesth 2008; 101:166-170. pmid: 18515269

Tissue pressure (TP)	Slope (≤TP)	Slope (>TP)	Goodness of fit[r²] (≤TP & >TP)
0 cmH₂O (1000 mL/h)	0.994 (0.986 to 1.003)		0.999
10 cmH₂O (1000 mL/h)	0.556 (0.489 to 0.623)	0.975 (0.959 to 0.990)	0.972 & 0.999
20 cmH₂O (1000 mL/h)	0.430 (0.402 to 0.458)	0.873 (0.813 to 0.933)	0.982 & 0.993
0 cmH₂O (2000 mL/h)	0.945 (0.922 to 0.969)		0.999
10 cmH₂O (2000 mL/h)	0.393 (0.360 to 0.426)	0.975 (0.959 to 0.990)	0.972 & 0.998
20 cmH₂O (2000 mL/h)	0.299 (0.267 to 0.330)	0.873 (0.813 to 0.933)	0.982 & 0.996

Tissue pressure (TP)	Slope (≤TP)	Slope (>TP)	Goodness of fit[r²] (≤TP & >TP)
Native (6 mmHg)	0.821 (0.779 to 0.863)		0.978
10 mmHg	0.238 (-0.052 to 0.528)	0.839 (0.754 to 0.925)	0.276 & 0.933
20 mmHg	0.272 (0.094 to 0.449)	0.776 (0.532 to 1.021)	0.338 & 0.870