Central Venous Pressure/Right Atrial Pressure: The Origin

I’m working on a talk where I take a trip through memory lane regarding resuscitation. We were all trained to use central venous pressure or right atrial pressure (CVP or RAP) to guide resuscitation and it remains on the Surviving Sepsis guidelines today. This post is about the origin of central venous pressure.

Where does the measurement of central venous pressure come from?
To my knowledge, this was the first study where they placed a probe in the RA of 25 pts and noted the effects during hypovolemia and the post-op period. Needless to say, this study would never be published today given its lack of transparency regarding the subjects, endpoints, procedures being performed, methodology, etc.

It is my opinion that, although this was great for 1959 and the subsequent years because it was a step in the right direction, using this study as a foundation and a justification for using CVP is a bit of a stretch. CVP does have some uses but we all need to know it’s limitations. It does not fit the build for the definition of fluid responsiveness. There have been many who have criticized it to bits. I tend to agree with them.
A hat tip to the authors for being pioneers.
Hope this clears up the origin of central venous pressure.

This paper is cited in my lecture titled “Resuscitation and Fluid Responsiveness”. You can see all the citations to this paper HERE. It’s a fun rabbit hole to go down. In addition, I break down the second study that I was able to find published in 1962 (with links to the article) HERE.

HUGHES RE, MAGOVERN GJ. The relationship between right atrial pressure and blood volume. AMA Arch Surg. 1959;79(2):238‐243. doi:10.1001/archsurg.1959.04320080074009
Link to Abstract

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