Elevated central venous pressure is associated with impairment of microcirculatory blood flow in sepsis: a hypothesis generating post hoc analysis

NAR Vellinga, Can Ince, C Boerma

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Background: Microcirculatory driving pressure is defined as the difference between post-arteriolar and venular pressure. In previous research, an absence of correlation between mean arterial blood pressure (MAP) and microcirculatory perfusion has been observed. However, the microcirculation may be considered as a low pressure compartment with capillary pressure closer to venous than to arterial pressure. From this perspective, it is conceivable that central venous pressure (CVP) plays a more important role in determination of capillary perfusion. We aimed to explore associations between CVP and microcirculatory perfusion. Methods: We performed a post-hoc analysis of a prospective study in septic patients who were resuscitated according a strict non-CVP guided treatment protocol. Simultaneous measurements of hemodynamics and sublingual Sidestream Dark Field imaging were obtained 0 and 30 minutes after fulfillment of resuscitation goals. Data were examined for differences in microcirculatory variables for CVP <= or > 12 mmHg and its evolution over time, as well as for predictors of a microvascular flow index (MFI) Results: In 70 patients with a mean APACHE II score of 21, 140 simultaneous measurements of CVP and sublingual microcirculation (vessels < 20 mu meter) were obtained. (MFI) and the percentage of perfused small vessels (PPV) were significantly lower in the 'high' CVP (> 12 mmHg) group as compared to patients in the 'low' CVP (<= 12 mmHg) group (1.4 +/- 0.9 vs. 1.9 +/- 0.9, P = 0.006; and 88 +/- 21% vs. 95 +/- 8%, P = 0.006 respectively). Perfusion pressure (MAP-CVP) and cardiac output did not dif Conclusion: We observed a significant association between a higher CVP and impairment of microcirculatory blood flow. Further research is needed to elaborate on our hypothesis generating findings that an elevated CVP may act as an outflow obstruction of organ perfusion.
Original languageUndefined/Unknown
JournalBMC Anesthesiology
Publication statusPublished - 2013

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