Central Venous Pressure (CVP): Known Limitations in 1962

To my knowledge, this is the second article looking at central venous pressure (CVP). It was published back in 1962. This paper piggybacks off of, what I believe to be the first paper on CVP that I covered here. Ultimately, I read all these papers as I was creating a lecture that is titled “Resuscitation and Fluid Responsiveness” (citations to that lecture here). One thing to notice is that central venous pressure does have many limitations. We’ve known about these since 1962.

Obtaining a copy of the paper was not easy to do, by the way. When I first got a hold of this paper, I expected it to be a glowing review of central venous pressure measuring and monitoring. Especially since this paper had been cited so often in other works in defense of CVP. I could not have been more wrong.

Limitations for central venous pressure were numerous. The authors were quite honest, in fact, that “proper interpretation is the key”. In addition, they state that “a low central venous pressure may be present with hypovolemia or hypervolemia”. Pretty astute stuff when you see some many clinicians, even nowadays painting a black or white picture off of CVP values on the monitor. The authors address this by saying “it is a mistake to treat the venous pressure and attempt to maintain it at some predetermined level”. As the kids say, shots fired.

Given this knowledge in 1962, it baffles me how it was provided with so much enthusiasm after the Manny Rivers trial on Early-Goal Directed Therapy. Yes, I know it decreased mortality by a great deal. Kudos to the team who put that all together. But if we’re academically honest, we are aware of the special circumstances and limitations that led to those fantastic results. Those results, of course, were not replicated in the PROMISE, PROCESS, and ARISE Trials. I disgress, that’s a conversation for another day.

WILSON JN, GROW JB, DEMONG CV, PREVEDEL AE, OWENS JC. Central venous pressure in optimal blood volume maintenance. Arch Surg. 1962;85:563‐578. doi:10.1001/archsurg.1962.01310040035005
Link to Abstract

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