Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
Crit Care Med. 2013 Jul;41(7):1774-81. doi: 10.1097/CCM.0b013e31828a25fd.
Despite a previous meta-analysis that concluded that central venous pressure should not be used to make clinical decisions regarding fluid management, central venous pressure continues to be recommended for this purpose.
To perform an updated meta-analysis incorporating recent studies that investigated indices predictive of fluid responsiveness. A priori subgroup analysis was planned according to the location where the study was performed (ICU or operating room).
MEDLINE, EMBASE, Cochrane Register of Controlled Trials, and citation review of relevant primary and review articles.
Clinical trials that reported the correlation coefficient or area under the receiver operating characteristic curve (AUC) between the central venous pressure and change in cardiac performance following an intervention that altered cardiac preload. From 191 articles screened, 43 studies met our inclusion criteria and were included for data extraction. The studies included human adult subjects, and included healthy controls (n = 1) and ICU (n = 22) and operating room (n = 20) patients.
Data were abstracted on study characteristics, patient population, baseline central venous pressure, the correlation coefficient, and/or the AUC between central venous pressure and change in stroke volume index/cardiac index and the percentage of fluid responders. Meta-analytic techniques were used to summarize the data.
Overall 57% ± 13% of patients were fluid responders. The summary AUC was 0.56 (95% CI, 0.54-0.58) with no heterogenicity between studies. The summary AUC was 0.56 (95% CI, 0.52-0.60) for those studies done in the ICU and 0.56 (95% CI, 0.54-0.58) for those done in the operating room. The summary correlation coefficient between the baseline central venous pressure and change in stroke volume index/cardiac index was 0.18 (95% CI, 0.1-0.25), being 0.28 (95% CI, 0.16-0.40) in the ICU patients, and 0.11 (95% CI, 0.02-0.21) in the operating room patients.
There are no data to support the widespread practice of using central venous pressure to guide fluid therapy. This approach to fluid resuscitation should be abandoned.
尽管之前的荟萃分析得出结论，认为中心静脉压不应用于指导液体管理的临床决策，但仍建议将其用于此目的。
进行更新的荟萃分析，纳入最近研究中心静脉压预测液体反应性的指数。根据研究地点（重症监护病房或手术室）进行了预先设定的亚组分析。
MEDLINE、EMBASE、Cochrane 对照试验注册库和相关原始研究和综述文章的引文检索。
报告了中心静脉压与干预后心脏功能变化之间相关性系数或接受者操作特征曲线（AUC）的临床试验，该干预改变了心脏前负荷。从筛选出的 191 篇文章中，有 43 项研究符合纳入标准并纳入数据提取。这些研究包括成年人类受试者，包括健康对照者（n=1）、重症监护病房（n=22）和手术室（n=20）患者。
对研究特征、患者人群、基线中心静脉压、相关性系数和/或中心静脉压与每搏量指数/心指数变化之间的 AUC 以及液体反应者的百分比进行了数据提取。使用荟萃分析技术对数据进行了总结。
共有 57%±13%的患者为液体反应者。汇总 AUC 为 0.56（95%CI，0.54-0.58），各研究之间无异质性。在重症监护病房进行的研究中，汇总 AUC 为 0.56（95%CI，0.52-0.60），在手术室进行的研究中，汇总 AUC 为 0.56（95%CI，0.54-0.58）。基线中心静脉压与每搏量指数/心指数变化之间的汇总相关性系数为 0.18（95%CI，0.1-0.25），重症监护病房患者为 0.28（95%CI，0.16-0.40），手术室患者为 0.11（95%CI，0.02-0.21）。
没有数据支持广泛使用中心静脉压指导液体治疗的做法。这种液体复苏方法应被摒弃。
