High Central Venous Pressure Associated with Mortality in ICU

B. Lubis

1,3

, P. Amelia

2,3

Department of Anesthesiology, Faculty of Medicine, Universitas Sumatera Utara, Indonesia

Department of Child Health, Faculty of Medicine, Universitas Sumatera Utara, Indonesia

H Adam Malik Central Hospital, Medan, Indonesia

Keywords: Central Venous Pressure, ICU, Mortality.

Abstract: Background : For decades Central venous pressure (CVP) has often been used as a measurement of

hemodynamics, medication and nutrition for critical patients. In Intensive care unit (ICU) we use APACHE

or SOFA score for prediction of mortality. We need a lot of time and procedure to get the prediction. Not

every hospital can apply this APACHE and SOFA in their hospital. Since CVP is widely use in ICU for

monitoring, we can use the value of CVP as predictor mortality. Method : A retrospective study conducted

at H Adam Malik Hospital in Medan. Samples are taken by recording CVP in ICU patients. Patients who have

a high CVP (> 8 mmHg) are recorded and seen whether the patient dies or can leave the ICU. Result : During

the study period, 100 patients were admitted. 52% were male with mean age 48.5±16.5 years old. The overall

mortality of 100 patients was 38%. There was association between high central venous pressure with

mortality in ICU (p=0.004). There is a significant relationship between high CVP and mortality. Conclusion

: High CVP is associated with mortality rates.

1 INTRODUCTION

The mortality rate in critical patients is quite high.

Usually used SOFA, APACHE to assess the patient's

death rate (Armiati, 2014; Bello, 2017; Ozaydin,

2017; Bale, 2013; Jones, 2009).

Clinical assessment

of the severity of illness is an essential component of

medical practice to predict the mortality and

morbidity of critically ill patients, especially in the

intensive care unit (ICU) (Ozaydin, 2017; Bale, 2013;

Jones, 2009; Minne, 2008; Saleh, 2015).

The Acute

Physiology And Chronic Health Evaluation

(APACHE), introduced in 1981, takes into

consideration various parameters, such as

physiological variables, vital signs, urine output, the

neurological score, age and co-morbid conditions,

which may have a significant impact on the outcome

of critically ill patients (Armiati, 2014; Bello, 2017;

Ozaydin, 2017; Bale, 2013; Jones, 2009; Minne,

2008; Saleh, 2015).

The APACHE II, formulated in 1985,estimates

the risk based on the worst variables available within

the first 24 h of admission (Armiati, 2014; Bello,

2017; Ozaydin, 2017; Bale, 2013; Jones, 2009;

Minne, 2008; Saleh, 2015).

The APACHE II is

widely used toquantify the severity of illness in the

ICU, and has been validated in many clinical trials

(Armiati, 2014; Bello, 2017; Ozaydin, 2017; Bale,

2013; Jones, 2009; Minne, 2008; Saleh, 2015).

The

Sequential Organ Failure Assessment (SOFA) uses

simple measurements of major organ functions to

calculate a severity score (Armiati, 2014; Bello, 2017;

Ozaydin, 2017; Bale, 2013; Jones, 2009; Minne,

2008; Saleh, 2015). The scores are calculated 24 h

after admission to the ICU and every 48 h thereafter.

The mean and the highest scores are most predictive

of mortality (Armiati, 2014; Bello, 2017; Ozaydin,

2017; Bale, 2013; Jones, 2009; Minne, 2008; Saleh,

2015). But it takes so much time to complete the

existing data.

CVP is a tool often used in ICU, the value of the

CVP is often interpreted as the adequacy of fluid in

critical patients (Damman, 2009; Boyd, 2011; Long,

2017; Williams, 2014; Eskesen, 2015; Bagshaw,

2008; Malbrain, 2014; Coredemans, 2012). In the

case of an increase in CVP it is usually predicted that

there has been an excess fluid in the patient. whereas

excess fluid is associated with increased mortality.

We can use the value of CVP as predictor mortality

(Damman, 2009; Boyd, 2011; Long, 2017; Williams,

2014; Eskesen, 2015; Bagshaw, 2008; Malbrain,

2014; Coredemans, 2012). From several study show

that CVP can be used to predict organ failure such as

kidneys (Damman, 2009; Boyd, 2011; Long, 2017;

Williams, 2014; Eskesen, 2015; Bagshaw, 2008;

Malbrain, 2014; Coredemans, 2012). And kidney

Lubis, B. and Amelia, P.

High Central Venous Pressure Associated with Mortality in ICU.

DOI: 10.5220/0010104109390941

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

939-941

ISBN: 978-989-758-449-7

939

failure is associated with increased mortality. To

predict mortality in the ICU, APACHE or SOFA

scores were used. However, not all hospitals can

measure APACHE and SOFA parameters in each

hospital. Therefore from several studies that have

high CVP also associated with high mortality rates

(Damman, 2009; Boyd, 2011; Long, 2017; Williams,

2014; Eskesen, 2015; Bagshaw, 2008; Malbrain,

2014; Coredemans, 2012). It is expected that a high

CVP can be one way to predict mortality other than

APACHE and SOFA score. And in the future it is

hoped that CVP can become a parameter for doctors

to take medical measures to prevent increased

mortality

2 METHODS

A cross-sectional study was conducted from January

to December 2017 in ICU Adam Malik Hospital

Medan. Patients with age over 18 years admitted to

our ICU were included. The demographic data, CVP

value collected between survivors and nonsurvivors

Data were analyzed using SPSS version 18.0. The

quantitative variable was expressed as means and

standard deviations. The categorical variables were

described by their absolute (n) and relative (%)

frequencies. This study was approved by the Ethics

Committee of the University of North Sumatra

Medical School.

3 RESULTS

During the study period, 100 patients were admitted.

52% were male with mean age 48.5±16.5 years old.

The overall mortality of 100 patients was 38% (Table

1). There was association between high central

venous pressure with mortality in ICU (p=0.004)

(Table 2).

Table 1. Characteristics of subjects

Characteristics

Mean age (SD), months 48.5 (16.5)

Mean weight (SD),

kilograms

57.8 (9.8)

Gender, n (%)

Male

Female

52 (52)

48 (48)

Mortality, n (%)

Yes

38 (38)

62 (62)

CVP, n (%)

Tinggi

Rendah

58 (58)

42 (42)

Table 2. Association between high central venous pressure

and mortality

Central venous

pressure

Mortality P value

Yes

High

Low

0.004

4 DISCUSSION

In this study we get overall mortality of 100 patients

was 38%. There was association between high

central venous pressure with mortality in ICU

(p=0.004). This is consistent with the research from

others (Damman, 2009; Boyd, 2011; Long, 2017;

Williams, 2014). Damman K correlated high CVP

with AKI and mortality. Long Y found that during

the first 24 hours of mechanical ventilation, patients

with high central venous pressure had worse

outcomes. William JB found that patients for every 5

mmHg increase CVP 6 hours postoperative was

strongly associated with in-hospital and 30 day

mortality. This increased mortality may be due to

organ failure such as the kidneys, heart, lungs and

brain (Malbrain, 2014).

High CVP is associated with venous congestion

(Damman, 2009). This congestion may be caused by

edeme tissue which ends with a compartement

(Malbrain, 2014). For example, polycompartments

that occur can cause excessive fluid administration

which makes oxygenation disrupted due to edema

(Malbrain, 2014). High CVP is a sign of the onset of

edema or excess fluid which has an impact on cell

oxygenation and perfusion. We hope that with the

monitoring of each organ such as the heart, lung,

kidney and brain compared to the CVP value can

prove that CVP can represent organ failure that

occurs in the same clinical value as APACHE and

SOFA score.

5 CONCLUSIONS

High central venous pressure is associated with

mortality in ICU patients, and it could be a simple

predictor in addition to APACHE and SOFA score.

ACKNOWLEDGEMENTS

This study received funding from the TALENTA

2018, which is sponsored by the University of

Sumatera Utara.

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

940

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