Perioperative hemodynamic monitoring: Still a place for cardiac filling pressures?

Christian Schmidt, Astrid Ellen Berggreen, Matthias Heringlake*

*Corresponding author for this work


The clinical usefulness of the so-called “static” cardiac filling pressures - central (CVP) and pulmonary-artery-occlusion-pressure (PAOP) – has come into question for guiding hemodynamic therapy due to their poor ability to predict fluid responsiveness in comparison with other monitoring modalities such as transpulmonary thermodilution-derived volumetric measurements, dynamic variables for assessing fluid responsiveness, and the potential risks associated with pulmonary artery catheterization. This contrasts with observations in multiple patient populations showing a clear association between increased CVP and PAOP levels and poor outcomes, probably due to a reduction in effective perfusion pressure (mean arterial pressure minus CVP) and their role as effectiveness parameters of the cardiovascular system. Furthermore, clinical studies have revealed beneficial effects when interpreting CVP and PAOP dynamically and combining them with flow-related hemodynamic variables. Taking into account the additional information derived from bedside CVP and PAOP pulse curve interpretation, cardiac filling pressures remain an important hemodynamic monitoring tool.

Original languageEnglish
JournalBest Practice and Research: Clinical Anaesthesiology
Issue number2
Pages (from-to)155-163
Number of pages9
Publication statusPublished - 06.2019


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