Comparative utility of centrally versus peripherally transduced venous pressure monitoring in the perioperative period in spine surgery patients

Relation of Peripheral Venous Pressure to Central Venous Pressure in Patients With Heart Failure, Heart Transplant, and Left Ventricular Assist Device

Peripheral venous pressure (PVP) monitoring is a noninvasive method to assess volume status. We investigated the correlation between PVP and central venous pressure (CVP) in heart failure (HF), heart transplant (HTx), and left ventricular assist device (LVAD) patients undergoing right heart catheterization (RHC). A prospective, cross-sectional study examining PVP in 100 patients from October 2018 to January 2020 was conducted. The analysis included patients undergoing RHC admitted for HF, post-HTx monitoring, or LVAD hemodynamic testing. Sixty percent of patients had HF, 30% were HTx patients, and 10% were LVAD patients. The mean PVP was 9.4 ± 5.3 mm Hg, and the mean CVP was 9.2 ± 5.8 mm Hg. The PVP and CVP were found to be highly correlated (r = 0.93, p < 0.00001). High correlation was also noted when broken down by HF (r = 0.93, p < 0.00001), HTx (r = 0.93, p < 0.00001), and LVAD groups (r = 0.94, p < 0.00005). In conclusion, there is a high degree of correlation between PVP and CVP in HF, HTx, and LVAD patients. PVP measurements can be used as a rapid, reliable, noninvasive estimate of volume status in these patient populations.

A new approach to complicated and noisy physiological waveforms analysis: peripheral venous pressure waveform as an example

We introduce a recently developed nonlinear-type time-frequency analysis tool, synchrosqueezing transform (SST), to quantify complicated and noisy physiological waveform that has time-varying amplitude and frequency. We apply it to analyze a peripheral venous pressure (PVP) signal recorded during a seven hours aortic valve replacement procedure. In addition to showing the captured dynamics, we also quantify how accurately we can estimate the instantaneous heart rate from the PVP signal.

Validation of Peripherally Inserted Central Catheter-Derived Fick Cardiac Outputs in Patients with Heart Failure

The pulmonary artery catheter (PAC) remains the gold standard to calculate Fick cardiac outputs (FCOs) in patients with heart failure admitted to the intensive care unit (ICU). The peripherally inserted central catheter (PICC) provides long-term intravenous access and is used outside the ICU; however, there is scant literature validating venous oxygen saturations (VOSs) from PICC lines. Heart failure patients in the ICU with an existing PAC requiring a PICC line to transition were enrolled. Three blood samples were taken per person (1 at PICC, 1 at central venous pressure [CVP], and 1 at distal PAC). We performed repeated measures analysis of variance, as well as reliability analysis on 31 subjects (77% male, 71% Caucasian, mean ± standard deviation age 60 ± 8 years, 80% on inotropes). The average VOSs were 62 ± 11%, 62 ± 12%, and 61 ± 9% for the PICC line, CVP, and distal port, respectively (p = 0.66); there was excellent reliability (0.79). The median FCOs were 5 [4, 6], 5 [4, 6], and 5 [4, 6] L/min at the PICC, CVP, and distal port, respectively (p = 0.91); there was fair-to-good reliability (0.67). In conclusion, VOS and FCO did not differ by location, on average. Reliable data may be obtained through the PICC line, after evaluation from the PAC. The PICC may provide longer-term hemodynamic assessment while improving patient comfort.

Peripheral Venous Pressure Measurements in Patients With Acute Decompensated Heart Failure (PVP-HF)

BACKGROUND

Accurate assessment of volume status is essential in diagnosis and guidance of decongestive therapy in patients with acute heart failure. We sought to compare peripheral venous pressure (PVP) with central venous pressure (CVP), as well as other invasive hemodynamic measurements, in patients hospitalized with an acute heart failure syndrome.

METHODS AND RESULTS

PVP-HF (Peripheral Venous Pressure Measurements in Patients With Acute Decompensated Heart Failure) was a single-center prospective study, which enrolled patients admitted with acute heart failure, regardless of ejection fraction or disease pathogenesis. PVP and intracardiac pressures were obtained by transducing a peripheral intravenous and pulmonary artery catheter, respectively, after zeroing at the phlebostatic axis. Data were compared using Pearson's correlation coefficient and Bland-Altman plots. A total of 30 patients (median age 64 years, 73% male, 30% ischemic pathogenesis) were enrolled. Mean ejection fraction was 31%, and 60% had moderate or greater right ventricular dysfunction. Median PVP was 9.5 (6-17) mm Hg, CVP was 8.5 (6-18) mm Hg, and pulmonary capillary wedge pressure was 18 (14-21) mm Hg. PVP and CVP were found to be highly correlated (r=0.947), while PVP and pulmonary capillary wedge pressure were found to be moderately correlated (r=0.565). The mean difference between PVP and CVP was 0.4 mm Hg and between PVP and pulmonary capillary wedge pressure was 7.5 mm Hg.

CONCLUSIONS

In patients with acute heart failure syndromes, a simple assessment of PVP demonstrates a high correlation with CVP. These findings suggest that PVP may be useful in the standard bedside clinical assessment of volume status in these patients to help guide decongestive therapy.