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Hemodynamic profiles for peripheral venous pressure (PVP) and central venous pressure (CVP) in all 15 cases. Pressures and time intervals are as labeled in each panel. All 1026 data measurement intervals are displayed. Patient and surgery characteristics are abbreviated in each, and appear in detail in Table 1.
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Neurosurgical patients undergoing either craniotomy or complex spine surgery are subject to wide variations in blood volume and vascular tone. The ratio of these variables yields a pressure that is traditionally measured at the superior vena cava and referred to as "central venous pressure" (CVP). We have investigated an alternative to...
Contexts in source publication
Context 1
... PVP and CVP tracings for each of the 15 cases are displayed in Figure 2. In most cases, an offset (PVP CVP) is evident, but the degree of offset tended to remain relatively constant throughout each case. ...
Context 2
... 2 displays statistical tests of correlation for individual cases, as well as the overall correlation from 1026 paired mea- surements (r 0.82). Tests of correlation for cases with large estimated blood loss (1000 mL; r 0.885), and large CVP variability (sd CVP 2; r 0.923) revealed essentially the same result as is visually evident from Figure 2: where CVP trends changed rapidly, so did PVP trends, and in synchrony with each other. The mean CVP value in these patients was 10 mm Hg and the mean PVP value was 13 mm Hg, with an overall difference of 3 mm Hg. ...
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Citations
... Several studies conducted on surgical patients have reported a strong linear correlation between PVP and central venous pressure. [4][5][6][7][8][9][10][11][12][13] Recent studies have also demonstrated a robust association between PVP and RAP or central venous pressure obtained through right heart catheterization (RHC) in patients with heart failure (HF), cardiac transplant, Fontan circulation, and patients with left ventricular (LV) assist device. [14][15][16][17][18][19] PVP has been shown to have superior predictive capabilities for RAP compared with conventional bedside examinations, including physical examinations, laboratory tests, and imaging modalities. ...
Background
Peripheral venous pressure (PVP) has been shown to be a reliable surrogate for right atrial pressure in assessing congestion in patients with heart failure (HF). Liver fibrosis markers and scores can be useful in assessing organ injury in patients with acute HF. This study aimed to investigate the association of liver fibrosis markers and scores with PVP in patients with acute HF.
Methods and Results
The 7S domain of the collagen type IV N‐terminal propeptide (P4NP 7S), aspartate aminotransferase‐to‐platelet ratio index, fibrosis‐4, and nonalcoholic fatty liver disease fibrosis score were determined along with PVP measurements before discharge in 229 patients with acute HF. The strongest correlation with PVP was found for P4NP 7S (Pearson r =0.40). Patients with high P4NP 7S levels (≥median [6.2 ng/mL]) had an increased risk of cardiovascular death or HF hospitalization (adjusted hazard ratio [HR], 1.80 [95% CI, 1.09–3.04], P =0.02). The concomitant high PVP (≥mean [8 mm Hg])/high P4NP 7S group, in contrast to the high PVP/low P4NP 7S or low PVP/high P4NP 7S group, had a significant risk relative to the low PVP/low P4NP 7S group for cardiovascular death or HF hospitalization (adjusted HR, 2.63 [95% CI, 1.43–5.05], P =0.002). A sustained elevation in PVP for 1 month postdischarge was associated with a persistent increase in P4NP 7S.
Conclusions
The study demonstrated the relationship between the liver fibrosis marker P4NP 7S and congestion. PVP and P4NP 7S could be useful for assessing congestion‐related organ injury and predicting prognosis in patients with acute HF.
... m s -1 , 41 and a mean pressure of 10mmHg (1333.22 Pa) 42,43 . The fluidic platform is a 1 mm-tall channel of square section, in which the microdevice is positioned at the center as presented in Fig. 2a. ...
Circulating tumour cells (CTCs) correlate by their number to the lethal potential of the tumour and can be characterized in terms of molecular properties. The repeated isolation of living CTCs has now appeared as an unavoidable step towards their use as biomarkers in clinical routine. We introduce a 3D stealthy microdevice adapted to the in vivo capture of CTCs in the venous blood flow, on the basis of their physical characteristics, size and rigidity. Embedded in a fluidic bench mimicking an artificial arm vein, it readily captured human prostate cancer cells spiked into donor blood down to a concentration of 1000 cells mL‐1. The isolation of cancer cells in venous circulation was validated in an animal model in vivo. These results open new avenues to the characterization of CTCs in prognosis, personalization of treatments and follow‐up, not only as a research tool, but also for repeated monitoring in clinical practice.
... Peripheral venous catheter (PVC) which is easy to place and free of complications is indicated wherever Internal Jugular vein (IJV) cannulation is not possible due to inaccessible neck. Literature revealed that venous pressure measured from PVCs closely related to pressure measured by central venous catheter (CVC) both intraoperatively and patients on ventilator in ICU [2][3][4][5]. ...
... Similar results were reported perioperatively by Amar et al and Munis et al [2,6]. The increase in gradient of CVP and PVP was reported by Amar et al was much higher, however in that study a fluid challenge of 2 liters was given which explains greater increase in absolute values of CVP and PVP than our study. ...
Background: Venous pressure can be measured by placing Central venous catheter (CVC) and Peripheral venous catheter (PVC). Venous pressure recording obtained from CVC is called central venous pressure (CVP) and that obtained from PVC is called peripheral venous pressure (PVP). PVC is easy to place and free of complication and sometimes preferable in some cases. CVC though used commonly is not free from complications. We investigate the feasibility and accuracy of measuring PVP and precise correlation between PVP and CVP. Methods: In this prospective, observational study, a total of 2522 readings of CVP and PVP were obtained from 60 patients in varying positions before and after 500 ml of fluid challenge intraoperatively. Results: Throughout the study period, PVP persistently showed a positive trend with a significantly higher value than CVP (P < 0.001). Correlation for the entire data showed a significant consistency of CVP-PVP difference [r = 0.89 (95% CI: 0.87 to 0.90); p<0.0001)]. Tests of correlation revealed that whenever CVP trends changed rapidly so did PVP trends, and in synchrony with each other. The results revealed strong correlation between CVP and PVP (r 2 =0.79). Conclusion: Our study suggests that CVP and PVP change similarly due to changes in intravascular volume in a given patient. The CVP-PVP gradient is not similar between patients; therefore it is not possible to predict CVP from PVP unless the gradient in the individual patient is known beforehand.
... We have investigated an alternative to Central Venous Pressure by measuring the peripheral venous pressure. Peripheral venous pressure trends paralleled Central Venous Pressure trends (1) . A portion of the hemodynamic risk is due to surgery and they may not be due to changes in cardiac function, relative blood volume, vascular tone, effect of anesthetics and mechanical ventilation. ...
... 6,7 Efficient management of hypovolemia from these causes is also aided by CVP monitoring. Literature search revealed only two studies in neurosurgical patients operated for craniotomy, 8,9 one of which is very small in which the authors compared CVP and PVP in eight patients only and showed good correlation between the two measurements. ...
... Our results are in line with the previous studies on this aspect of two pressure measurements. [8][9][10][11][12][13][14] Since, peripheral veins have valves that may interrupt the continuous column of blood, are thin walled, and may be thus more easily subjected to compression and occlusion, use of PVP instead of CVP was not widely accepted in the past. 15 To avoid any compression of the peripheral vein, we used peripheral access in right cephalic vein and the blood pressure cuff was attached on the other arm. ...
... From all the above evidences, it can be safely concluded that irrespective of the diagnosis, age, sex, site, and size of insertion of the peripheral cannula, CVP and PVP correlate with each other. We observed that this relationship between CVP and PVP is not disturbed even during hemodynamic changes from blood loss; rather this correlation improves under such circumstances as was also observed by Munis et al. 8 Given that the changes in CVP and PVP are strongly correlated, predictable and consistent over time, the trends in PVP may be useful for monitoring the intravascular volume status and fluid management. ...
Background and Objectives Central venous pressure (CVP) and peripheral venous pressure (PVP) are strongly correlated during various surgeries. This study was designed to examine the consistency of CVP–PVP relationships in circumstances of rapidly fluctuating hemodynamics in neurosurgical patients. Prime objective of this study was to determine if PVP can be an effective alternative to invasive CVP for assessing volume status during neurosurgical procedures when expertise, equipment, and patient’s condition contraindicate invasive monitoring.
Subjects and Methods After the approval by the Institutional Ethics Committee, CVP and PVP were measured in 50 neurosurgical patients of the American Society of Anesthesiologists grade I and II operated in supine position. Paired measurements of CVP and PVP were made every 20 minutes, from the starting of anesthesia until the end of surgery; however, in situations of hemodynamic instability, the readings were taken every 5 minutes of interval.
Results The study showed a strong correlation between CVP and PVP (Pearson’s correlation coefficient between CVP and PVP, r = 0.89; 95% CI: 0.81–0.93; p < 0.001). Mean CVP was 5.7 ± 0.8 mm of Hg, mean PVP was 10.4 ± 0.6 mm of Hg, and bias between CVP and PVP was 4.7 ± 0.4 (95% CI: − 4.61 to − 4.83). The Bland–Altman analysis showed that limit of agreement to be 4.0 to 5.5 mm of Hg.
Conclusion This study demonstrated a strong correlation between CVP and PVP. Therefore, PVP monitoring may be a reliable alternative to CVP monitoring during neurosurgery.
... Поскольку все роженицы в операционной или родильном зале имеют установленный периферический венозный катетер, его можно использовать для мониторинга периферического венозного давления как альтернативу мониторинга центрального венозного давления. Между периферическим и центральным венозным давлением наблюдается сильная корреляция при различных типах операций [55][56][57][58][59]. Анализ волны при измерении периферического венозного давления с помощью стандартного внутривенного катетера может обеспечить недорогой, минимально инвазивный мониторинг у паци-ентов с интраоперационной кровопотерей. ...
... PVP reportedly correlates highly with CVP under stable hemodynamic conditions, and the fluctuations in these values occur in parallel. Indeed, the correlation coefficient between them was greater than 0.9 in many previous studies [7][8][9][10]. Conversely, the correlation coefficient between them is much smaller under unstable hemodynamic conditions [11]. ...
... Peripheral venous pressure monitoring is an important alternative to central venous pressure monitoring and is measured by connecting the pressure tubing of the transducer to a peripheral venous catheter. Trends of peripheral venous pressure parallels to that of central venous pressure [5][6][7] . ...
... We recently showed that plasma ET-1 concentration and ET-1 expression in venous ECs acutely increase in response to experimental severe venous congestion (VC) (Colombo et al. 2014). However, in this model, the increase in peripheral venous pressure (PVP) (which typically exceeds central venous pressure by 2-3 mmHg) (Munis et al. 2001;Hadimioglu et al. 2006) was extreme (30 mmHg above baseline levels) and short in duration (75 min), thus not realistically mimicking the hemodynamic conditions of peripheral congestion in HF and CKD patients. It is, therefore, critical to understand if lower levels of VC also lead to increased ET-1 levels and if so how quickly these changes occur, and whether or not they are sustained in the setting of decongestion. ...
Endothelin-1 (ET-1) is a pivotal mediator of vasoconstriction and inflammation in congestive states such as heart failure (HF) and chronic kidney disease (CKD). Whether peripheral venous congestion (VC) increases plasma ET-1 at pressures commonly seen in HF and CKD patients is unknown. We seek to characterize whether peripheral VC promotes time- and dose-dependent increases in plasma ET-1 and whether these changes are sustained after decongestion. We used a randomized, cross-over design in 20 healthy subjects (age 30 ± 7 years). To experimentally model VC, venous pressure was increased to either 15 or 30 mmHg (randomized at first visit) above baseline by inflating a cuff around the subject's dominant arm; the nondominant arm served as a noncongested control. We measured plasma ET-1 at baseline, after 20, 60 and 120 min of VC, and finally at 180 min (60 min after cuff release and decongestion). Plasma ET-1 progressively and significantly increased over 120 min in the congested arm relative to the control arm and to baseline values. This effect was dose-dependent: ET-1 increased by 45% and 100% at VC doses of 15 and 30 mmHg, respectively (P < 0.05), and declined after 60 min of decongestion though remaining significantly elevated compared to baseline. In summary, peripheral VC causes time- and dose-dependent increases in plasma ET-1. Of note, the lower dose of 15 mmHg (more clinically relevant to HF and CKD patients) was sufficient to raise ET-1. These findings support the potentially contributory, not merely consequential, role of VC in the pathophysiology of HF and CKD.
... Peripheral venous pressure (PVP) reflects an "upstream" venous variable that is coupled to CVP by a continuous column of blood. [10] During the 1940s, it was demonstrated that the pressure in the venous system of the upper extremity was only slightly higher than right atrial pressure. The venous return concept originally described by Guyton et al. is based on the existence of a pressure gradient between the periphery and the right atrium. ...
... Such valves are, by definition, open during steady state venous flow, and should therefore not disrupt fluid continuity between the two sites. [10] Peripheral veins are also thin walled and may be more easily subjected to compression and occlusion by the surrounding soft tissues. However, a correlation between CVP and PVP has been reported in both humans and animals under experimental conditions. ...
... Peripheral venous pressure (PVP) monitoring via peripheral intravenous catheter in the arm has been described to be very safe and convenient with the easy accessibility and suggested as a comparable alternative to CVP measurement. [3,10,[12][13][14][15] Given that central cannulation places the patients at risk for arterial puncture, pneumothorax, hemothorax, infection, thrombosis and even death, this alternative, minimally invasive monitor is specially appealing. ...
