Central Venous Catheters in the ICU

US-guided CV cannulation (Saugel)

Preventing Complications of Central Venous Catheterization — NEJM http://www.nejm.org/doi/full/10.1056/NEJMra011883#.V_OduHslmqI.twitter

Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization:
http://www.cochrane.org/CD006962/ANAESTH_ultrasound-guidance-versus-anatomical-landmarks-for-internal-jugular-vein-catheterization

Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization: http://www.cochrane.org/CD011447/ANAESTH_ultrasound-guidance-versus-anatomical-landmarks-for-subclavian-or-femoral-vein-catheterization

Use of ultrasound guidance for central venous catheterization: a national survey of intensivists and hospitalists: https://www.ncbi.nlm.nih.gov/pubmed/27491563

Practice of ultrasound-guided central venous catheter technique by the French intensivists: a survey from the BoReal study group: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-016-0177-x

 

CVP measurement issues (Magder)

CVP can be thought as “preload” or as “outflow pressure”

CVP does not tell you blood volume

CVP does not allow you to reliably predict fluid responsiveness

Measurement is zeroed at the level of the stopclock

The value is taken at the bottom of the ‘a’ wave at end expiration

 

CVP intepretation issues (De Backer)

 

Can ScvO2 replace ScO2 (Scheeren)

SvO2 to monitor resuscitation of septic patients: let’s just understand the basic physiology – https://ccforum.biomedcentral.com/articles/10.1186/cc10491

Measurement of central venous saturations can be measured continuously or intermittently

Mixed- vs Central- venous saturations are comparable, normal central lower by 2-3% in health

Mixed venous oxygen saturation cannot be estimated by central venous oxygen saturation in septic shock: http://icmjournal.esicm.org/Journals/abstract.html?doi=10.1007/s00134-006-0270-y

Can femoral saturation SfO2 replace ScvO2?

pCO2 gap – how to use (Teboul)

review: http://lifeinthefastlane.com/ccc/pco2-gap/

Vallet B, Pinsky MR, Cecconi M. Resuscitation of patients with septic shock: please “mind the gap”! – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732761/

Vallet B, Teboul JL, Cain S, Curtis S. Venoarterial CO2 difference during regional ischemic or hypoxic hypoxia. J Appl Physiol. 2000;89:1317–1321.  PubMed PMID: 11007564

Combination of arterial lactate levels and venous-arterial CO2 to arterial-venous O2 content difference ratio as markers of resuscitation in patients with septic shock https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414929/