Comparison of different techniques of central venous pressure measurement in mechanically ventilated critically ill patients

Background. Several techniques exist for measuring central venous pressure (CVP) but little information is available about the accuracy of each method. The aim of this study was to compare different methods of CVP measurements in mechanically ventilated patients. Methods. CVP was measured in mechanically ventilated patients without spontaneous breathing using four different techniques: 1) end expiratory CVP measurement at the base of the" c" wave (CVP), chosen as the reference method; 2) CVP measurement from the monitor averaging CVP over the cardiac and respiratory cycles (CVP); 3) CVP measurement after a transient withdrawing of mechanical ventilation (CVP); 4) CVP measurement corrected for the transmitted respiratory pressure induced by intrinsic PEEP (calculated CVP: CVP). Bias, precision, limits of agreement, and proportions of outliers (difference > 2 mm Hg) were determined. Results. Among 61 included patients, 103 CVP assessments were performed. CVP bias [-0.87 (1.06) mm Hg] was significantly different from those of CVP [1.42 (1.07), P < 0.001 and CVP (1.04 (1.29), P < 0.001]. The limits of agreement of CVP [-2.96 to 1.21 mm Hg] were not significantly different to those of CVP (-1.49 to 3.57 mm Hg, P = 0.39) and CVP (-0.68 to 3.53 mm Hg, P = 0.31). The proportion of outliers was not significantly different between CVP (n = 5, 5%) and CVP (n = 9, 9%, P = 0.27) but was greater with CVP (n = 16, 15%, P = 0.01). Conclusions. In mechanically ventilated patients, CVP is a reliable method for assessing CVP. Taking into account transmitted respiratory pressures, CVP had a higher proportion of outliers and precision than CVP