Abstract
Purpose
Using peripheral venous pressure (PVP) instead of central venous pressure (CVP) as a volume monitor decreases patient risks and costs, and is convenient. This study was undertaken to determine if PVP predicts CVP in pediatric patients.
Methods
With ethical approval and informed consent, 30 pediatric patients aged neonate to 12 yr requiring a central venous line were studied prospectively in a tertiary care teaching hospital. In the supine position, PVP and CVP were simultaneously transduced. Ninety-six paired recordings of CVP and PVP were made. Correlation and Bland-Altman analysis of agreement of end-expiratory measurements were performed.
Results
The mean (SD; range) CVP was 10.0 mmHg (6.0; −1.0 to 27.0); the mean PVP was 13.7 mmHg (6.3; 0.0 to 33.0); offset (bias) of PVP > CVP was 3.7 mmHg with SD 2.6. The 95% confidence intervals (CI) for the bias were 3.2 to 4.1 mmHg. In the Bland-Altman analysis, lower and upper limits of agreement (LOA; CI in parentheses) were −1.5 (−2.3 to −0.7) and 8.8 (8.1 to 9.6) mmHg. Eight of 96 points were outside the limits of agreement. The correlation of PVP on CVP was r = 0.92,P < 0.0001. For a subset of ten patients (20 simultaneous recordings) withiv atheters proximal to the hand, limits of agreement were better — offset: 3.8 mmHg (± 1.4); lower LOA: 1.2 mmHg (0.25 to 2.1); upper LOA: 6.6 mmHg (5.7 to 7.5).
Conclusion
Peripheral venous pressure measured from aniv catheter in the hand predicts CVP poorly in pediatric patients.
Résumé
Objectif
La tension veineuse périphérique (TVP) est une façon pratique de remplacer la tension veineuse centrale (TVC) comme indicateur de la réplétion volémique, à moindre risque et à meilleur coût. l’objectif de cette étude était de déterminer si la TVP est un bon reflet de la TVC chez les enfants.
Méthode
Après l’approbation du comité d’éthique et l’obtention du consentement, 30 sujets de 0 à 12 ans chez qui un cathéter veineux central était indiqué ont été recrutés de façon prospective dans un hôpital universitaire de soins tertiaires. On a mesuré la TVP et la TVC simultanément en position dorsale à 96 reprises. On a réalisé des analyses de corrélation et de Bland-Altman pour les mesures télé-expiratoires.
Résultats
La TVC moyenne (ET; extrêmes) était de 10,0 mmHg (6,0; −1,0 à 27,0); la TVP était de 13,7 mmHg (6,3; 0,0 à 33,0); la TVP était de 3,7 mmHg (ET 2,6) supérieure à la TVC. Les intervalles de confiance à 95% (IC) pour cet écart (biais) étaient de 3,2 à 4,1 mmHg. Selon l’analyse Bland-Altman, les limites de concordance inférieure et supérieure (LDC; CI entre parenthèses) étaient de −1,5 (−2,3 à −0,7) et 8,8 (8,1 à 9,6) mmHg. Huit des 96 points étaient à l’extérieur des limites de concordance. La corrélation entre PVP et TVC était r = 0,92, P < 0,0001. Dans un sous-groupe de dix patients (20 mesures pairées) avec des cathéters iv plus proximaux que la main, la concordance était meilleure — biais: 3,8 mmHg (± 1,4); LDC inférieure: 1,2 mmHg (0,25 à 2,1); supérieure: 6,6 mmHg (5,7 à 7,5).
Conclusion
La tension veineuse périphérique mesurée à partir d’un cathéter installé sur la main ne reflète pas bien la TVC chez les enfants.
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Leipoldt, C.C.P., McKay, W.P.S., Clunie, M. et al. Peripheral venous pressure predicts central venous pressure poorly in pediatric patients. Can J Anesth 53, 1207–1212 (2006). https://doi.org/10.1007/BF03021582
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DOI: https://doi.org/10.1007/BF03021582