Central Venous Pressure and Right Atrial Pressure Measurements in Supine, Semi-recumbent and Trendelenburg Position

Intensive care is directed towards patients with severe illness or risk of serious outcomes following, for example, surgery. Central venous pressure (CVP) is an important part of the hemodynamic assessment of patients in surgery and the intensive care unit (ICU). CVP is normally measured via a central venous catheter (CVC) inserted through the subclavian or internal jugular vein, with the tip placed at the junction to the right atrium. A pressure tubing is connected to one of the branches of the CVC and then connected to a pressure sensor that sends a digital signal to the monitoring screen where CVP can be read in mmHg. To accurately read CVP, the pressure sensor must be positioned at the level of the right atrium. Different external reference points are used nationally and internationally to locate the correct height for the pressure sensor. This study aims to investigate the most commonly used external reference points for CVP measurement in various body positions compared to CVP measured via a solid state pressure catheter in the right atrium (RAP).

Study Overview

• Status: Completed
• Conditions: Critically Ill

Detailed Description

A Millar Mikro-Cath solid state pressure catheter is inserted through one of the medial lines of the CVC and guided in position by the pressure curve and verified in position by ultrasound.

CVP is compared to RAP in supine, semi-recumbent, Trendelenburg and lateral position.

CVP, RAP and arterial pressure is recorded in each session with Biopac Acqnowledge.

In each body position PEEP is raised 5 cmH20 and then lowered 5 cmH20.

Ventilator settings, capillary refill time, perfusion index are collected in each setting and before and after PEEP adjustments.

• Study Type: Observational
• Enrollment (Actual): 16

Contacts and Locations

Study Locations

• Sweden
  • Västra Götaland
    • Göteborg, Västra Götaland, Sweden, 41345
      • Sahlgrenska University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Critically ill patients, in mechanical ventilation, sedated to RASS -4 or -5 in mechanical ventilation with a 4 or 5 line CVC.

Description

Inclusion Criteria:

• Critically ill patients in mechanical ventilation with an arterial line and a four or five lumen CVC.

Exclusion Criteria:

• under 18 years of age
• in a dynamic phase of their illness i.e. ongoing treatment of severe circulatory or respiratory failure
• positive end-expiratory pressure (PEEP) >14 cmH20 or intolerance to change of body position.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference in mmHg between Right atrial pressure (RAP) and Central venous pressure (CVP) in supine position	Difference in mmHg between RAP (Millar Micro-Cath) and CVP.	3 minutes after body position change
Difference in mmHg between RAP and CVP in semi-recumbent position	Difference in mmHg between RAP (Millar Micro-Cath) and CVP.	3 minutes after body position change
Difference in mmHg between RAP and CVP in Trendelenburg position	Difference in mmHg between RAP (Millar Micro-Cath) and CVP.	3 minutes after body position change
Difference in mmHg between RAP and CVP in right lateral position	Difference in mmHg between RAP (Millar Micro-Cath) and CVP.	3 minutes after body position change
Difference in mmHg between RAP and CVP in left lateral position	Difference in mmHg between RAP (Millar Micro-Cath) and CVP.	3 minutes after body position change

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in hemodynamic parameters after body position change	Change in CVP (mmHg)	3 minutes after body position change
Change in hemodynamic parameters after PEEP change	Change in RAP (mmHg)	1 minutes after PEEP change
Change in hemodynamic parameters after body position change	Change in arterial pressure (mmHg)	3 minutes after body position change
Change in hemodynamic parameters after body position change	Change in perfusion index (%)	3 minutes after body position change
Change in hemodynamic parameters after body position change	Change in capillary refill time change (sek)	3 minutes after body position change
Change in hemodynamic parameters after body position change	Change in RAP (mmHg)	3 minutes after body position change
Change in hemodynamic parameters after PEEP change	Change in CVP (mmHg)	1 minutes after PEEP change
Change in hemodynamic parameters after PEEP change	Change in arterial pressure (mmHg)	1 minutes after PEEP change
Change in hemodynamic parameters after PEEP change	In capillary refill time change (sek)	1 minutes after PEEP change
Change in hemodynamic parameters after PEEP change	Change in perfusion index (%)	1 minutes after PEEP change

Collaborators and Investigators

• Sponsor: Vastra Gotaland Region
• Investigators: Principal Investigator: Lotta Johansson, MD, Sahlgrenska University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): November 15, 2023
• Primary Completion (Actual): December 15, 2024
• Study Completion (Actual): December 30, 2024

Study Registration Dates

• First Submitted: April 30, 2024
• First Submitted That Met QC Criteria: November 21, 2024
• First Posted (Actual): November 26, 2024

Study Record Updates

• Last Update Posted (Estimated): May 20, 2025
• Last Update Submitted That Met QC Criteria: May 14, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Critical Illness
• Other Study ID Numbers: CVP/RAP

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All excel data that underlie results in publication
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No