Department of Emergency Medicine, Chonnam National University Hospital, 501757, Gwangju, Republic of Korea.
Am J Emerg Med. 2013 Jan;31(1):240-3. doi: 10.1016/j.ajem.2012.06.034. Epub 2012 Sep 11.
Endovascular cooling using the femoral cooling catheter is widely practiced. Central venous pressure (CVP) monitoring in patients undergoing femoral endovascular cooling may require the placement of another catheter near the right atrium (RA). We sought to estimate the agreement between the CVP recorded from catheters placed in the superior vena caval pressure (SVCP) and the inferior vena caval pressure (IVCP) recorded from the femoral cooling catheter in patients undergoing femoral endovascular cooling.
We enrolled adult cardiac arrest survivors undergoing femoral endovascular cooling. A commercially available central venous catheter was placed in the SVC (superior vena cava) near the RA via subclavian venous access. Both SVCP and IVCP were recorded every 4 hours during therapeutic hypothermia. Arterial pressure, heart rate, peak inspiratory pressure (PIP), and positive end expiratory pressure (PEEP) at the time of vena caval pressure measurements were obtained.
A total of 323 pairs of SVCP and IVCP measurements were collected. The correlation coefficient between SVCP and IVCP was 0.965 (P < .001). The mean difference between SVCP and IVCP was -0.45 mm Hg (SD, 1.27; 95% confidence interval, -0.59 to -0.31 mm Hg). The limits of agreement were -2.94 to 2.05 mm Hg. Vena caval pressures were significantly correlated with airway pressures (peak inspiratory pressure and positive end expiratory pressure), whereas the difference between SVCP and IVCP did not correlate with airway pressures.
Inferior vena caval pressure measured via the femoral cooling catheter showed excellent agreement with CVP recorded from catheters placed in the SVC, which indicates that the femoral cooling catheter can be used for monitoring CVP.
使用股动脉冷却导管进行血管内冷却的方法已得到广泛应用。在接受股动脉血管内冷却的患者中，监测中心静脉压（CVP）可能需要在右心房（RA）附近放置另一个导管。我们旨在评估在接受股动脉血管内冷却的患者中，从股动脉冷却导管记录的下腔静脉压（IVCP）与从放置在上腔静脉（SVC）的导管记录的上腔静脉压（SVCP）之间的一致性。
我们招募了接受股动脉血管内冷却的成年心脏骤停幸存者。通过锁骨下静脉通路，在 SVC （上腔静脉）靠近 RA 的位置放置了一条市售的中心静脉导管。在治疗性低温期间，每 4 小时记录一次 SVCP 和 IVCP。在测量腔静脉压时，记录动脉压、心率、吸气峰压（PIP）和呼气末正压（PEEP）。
共收集了 323 对 SVCP 和 IVCP 测量值。SVCP 与 IVCP 之间的相关系数为 0.965（P <.001）。SVCP 与 IVCP 的平均差值为-0.45mmHg（SD，1.27；95%置信区间，-0.59 至-0.31mmHg）。一致性界限为-2.94 至 2.05mmHg。腔静脉压与气道压（吸气峰压和呼气末正压）显著相关，而 SVCP 与 IVCP 的差值与气道压无关。
从股动脉冷却导管测量的下腔静脉压与放置在 SVC 的导管记录的 CVP 具有极好的一致性，这表明股动脉冷却导管可用于监测 CVP。
