Fernandez Edward G, Green Thomas P, Sweeney Michael
Pediatric Critical Care, Marshfield Clinic and St. Joseph's Hospital, Marshfield, WI 54449, USA.
Pediatr Crit Care Med. 2004 Jan;5(1):14-8. doi: 10.1097/01.PCC.0000102383.07075.97.
To assess the value of low inferior vena caval (LIVC) catheters for estimating central venous pressure in pediatric intensive care patients and to assess influences of intra-abdominal pressures and mean airway pressure on these measurements.
Prospective cohort of consecutive patients.
Pediatric intensive care unit.
Thirty patients ranging in age (18, 0-1 yrs; four, 1-3 yrs; four, 3-10 yrs; four, > or =10 yrs).
Interventions included catheterizations via internal jugular, subclavian, and common femoral veins, as well as direct right atrial catheterization during surgery; arterial catheter placement; airway pressure monitoring during mechanical ventilation; indirect intra-abdominal pressure monitoring via bladder catheter pressure readings; and arterial and central venous blood gas analysis. LIVC vein catheters were placed below the origin of the renal veins.
LIVC pressure was highly correlated with central venous pressure (n=30, r2=.965, p=.0001). LIVC pressure did not correlate with intra-abdominal pressure (n=18, r2=.000). Mean airway pressure did not correlate with central venous pressure (n=11, r2=.106). The pH of LIVC blood was similar to that of central venous blood (n=18, r2=.941, p=.0001). PCO2 values of inferior vena cava and central venous blood correlated (r2=.945, p=.0001). However, agreement between inferior vena cava and central venous PO2 and oxyhemoglobin saturation was poor (PO2, r2=.066; oxyhemoglobin saturation, r2=.000).
LIVC catheters whose tips lie below the origin of the renal veins predict central venous pressure in pediatric intensive care unit patients. Intra-abdominal pressure and mean airway pressure do not affect this relationship, within the wide range of values for these variables included in this study. Blood samples drawn from femoral venous catheters can be used to monitor acid-base balance and partial pressure of carbon dioxide.
评估低位下腔静脉（LIVC）导管在儿科重症监护患者中估计中心静脉压的价值，并评估腹腔内压力和平均气道压力对这些测量值的影响。
连续患者的前瞻性队列研究。
儿科重症监护病房。
30例患者，年龄范围为（18例，0 - 1岁；4例，1 - 3岁；4例，3 - 10岁；4例，≥10岁）。
干预包括经颈内静脉、锁骨下静脉和股总静脉进行导管插入术，以及在手术期间进行直接右心房导管插入术；动脉导管放置；机械通气期间的气道压力监测；通过膀胱导管压力读数进行间接腹腔内压力监测；以及动脉和中心静脉血气分析。LIVC静脉导管放置在肾静脉起源以下。
LIVC压力与中心静脉压高度相关（n = 30，r2 = 0.965，p = 0.0001）。LIVC压力与腹腔内压力不相关（n = 18，r2 = 0.000）。平均气道压力与中心静脉压不相关（n = 11，r2 = 0.106）。LIVC血液的pH值与中心静脉血液的pH值相似（n = 18，r2 = 0.941, p = 0.0001）。下腔静脉和中心静脉血液的PCO2值相关（r2 = 0.945，p = 0.0001）。然而，下腔静脉和中心静脉的PO2以及氧合血红蛋白饱和度之间的一致性较差（PO2，r2 = 0.066；氧合血红蛋白饱和度，r2 = 0.000）。
尖端位于肾静脉起源以下的LIVC导管可预测儿科重症监护病房患者的中心静脉压。在本研究纳入的这些变量的广泛值范围内，腹腔内压力和平均气道压力不影响这种关系。从股静脉导管抽取的血样可用于监测酸碱平衡和二氧化碳分压。
