AUTHOR=Su Longxiang , Pan Pan , Li Dongkai , Zhang Qing , Zhou Xiang , Long Yun , Wang Xiaoting , Liu Dawei 

TITLE=Central Venous Pressure (CVP) Reduction Associated With Higher Cardiac Output (CO) Favors Good Prognosis of Circulatory Shock: A Single-Center, Retrospective Cohort Study

JOURNAL=Frontiers in Medicine

VOLUME=6

YEAR=2019

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2019.00216

DOI=10.3389/fmed.2019.00216

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> The Frank-Starling curve is the basis of hemodynamics. Changes in cardiac output (CO) caused by central venous pressure (CVP) are the most important concerns in the treatment of critically ill patients.</p><p><bold>Objectives:</bold> To explore the use of CVP and its relevant mechanisms with respect to CO in the clinic.</p><p><bold>Methods:</bold> A total of 134 patients with circulatory shock were retrospectively included and analyzed. Hemodynamic data were recorded and analyzed at PICCO initiation and 24 h after PICCO. Data regarding 28-day mortality and renal function were also collected.</p><p><bold>Results:</bold> The patients were divided into a CVP↑+ CO↑ group (<italic>n</italic> = 23), a CVP↑+ CO↓ group (<italic>n</italic> = 29), a CVP↓+ CO↑ group (<italic>n</italic> = 44), and a CVP↓+ CO↓ group (<italic>n</italic> = 38) based on values at PICCO initiation and 24 h after PICCO. <italic>Post- hoc</italic> tests showed that the CVP↓+ CO↑ group had a higher 28-day survival than the other groups [log-rank (Mantel-Cox) = 8.758, 95%, CI, 20.112–23.499, <italic>P</italic> = 0.033]. In terms of hemodynamic characteristics, the CVP↓+ CO↑ group had a lower cardiac function index (CFI) (4.1 ± 1.4/min) and higher extravascular lung water index (EVLWI) (11.0 ± 4.7 ml/kg) at PICCO initiation. This group used more cardiotonic drugs (77.3%, <italic>P</italic> &lt; 0.001) and had a negative fluid balance (−780.4 ± 1720.6 ml/24 h, <italic>P</italic> = 0.018) 24 h after PICCO than the other three groups. Cardiotonic drug use and dehydration treatment were associated with increased CFI (from 4.1 ± 1.4 /min to 4.5 ± 1.3/min, <italic>P</italic> = 0.07) and reduced ELVWI (from 11.0 ± 4.7 ml/kg to 9.0 ± 3.5 ml/kg, <italic>P</italic> = 0.029). Renal function tests showed that SCr and BUN levels in the CVP↓+ CO↑ group were significantly improved (SCr from 197.1 ± 128.9 mmol/L to 154.4 ± 90.8 mmol/L; BUN from 14.3 μmol/L ± 7.3 to 11.6 ± 7.0 μmol/L, <italic>P</italic> &lt; 0.05).</p><p><bold>Conclusions:</bold> Lower CVP was associated with increased CO, which may improve the 28-day prognosis in patients with circulatory shock. Notably, higher CO derived from lower CVP may also contribute to renal function improvement.</p>