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Intensive Care Medicine

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01-11-2007 | Original

Use of bladder pressure to correct for the effect of expiratory muscle activity on central venous pressure

Authors: Ahmad S. Qureshi, Robert S. Shapiro, James W. Leatherman

Published in: Intensive Care Medicine | Issue 11/2007

Abstract

Objective

To assess whether subtracting the expiratory change in intra-abdominal (bladder) pressure (ΔIAP) from central venous pressure (CVP) provides a reliable estimate of transmural CVP in spontaneously breathing patients with expiratory muscle activity.

Design and setting

Prospective observational study in a medical ICU.

Patients

Twenty-four spontaneously breathing patients with central venous and bladder catheters: 18 with no clinical evidence of active expiration (group 1) and 6 with active expiration (group 2).

Interventions

Patients in group 1 were coached to change their breathing pattern to one of active expiration for several breaths; those in group 2 were asked to sip water through a straw to briefly interrupt active expiration.

Measurements and results

During active expiration end-expiratory CVP (uncorrected CVP) and ΔIAP were measured; ΔIAP was subtracted from uncorrected CVP to obtain corrected CVP. End-expiratory CVP during relaxed breathing (best CVP) was assumed to represent the best estimate of transmural CVP. The absolute difference between corrected CVP and best CVP was much less than the difference between uncorrected CVP and best CVP (2.3 ± 2.0 vs. 12.5 ± 4.7 mmHg).

Conclusions

In patients with active expiration, subtracting ΔIAP from end-expiratory CVP yields a more reliable (and lower) estimate of transmural CVP than does the uncorrected CVP value.

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Title: Use of bladder pressure to correct for the effect of expiratory muscle activity on central venous pressure
Authors: Ahmad S. Qureshi
Robert S. Shapiro
James W. Leatherman
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 11/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0841-6

At a glance: The STEP trials

Springer Medicine

Use of bladder pressure to correct for the effect of expiratory muscle activity on central venous pressure

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

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