Our study is using the independent variables of low CVP coupled with hypotension and dependent variable of physician administered fluids to test how the Venus 1000 can alter physician actions in the emergency department setting.

1. Measured Central Venous Pressure
and Physician Administration of
Intravenous Fluids
Todd Belok
PI: Neal Handly, MD
Hahnemann University Hospital, Emergency Department

2. Hypothesis
• Low (< 8mmHg) measured central venous pressure of
hypotensive non-trauma patients correlates with the decision by
physicians to administer intravenous fluids.
Purpose
• To determine if using the Venus 1000 will alter physician
behavior using low CVP level and fluid administration as
variables

3. Overview of Hemodynamics
• Renin-Angiotensin system
• Cardiac Output = Heart Rate x Stroke Volume
• Systemic vascular resistance= (MAP-CVP)/CO
• Shock: Inadequate perfusion/oxygenation
Mohit Goyal, Rabindranath
Tagore Medical College

4. Uscom Ltd.
Ohm’s Law

5. Dr. Sam George, Anesthesia and Intensive Care, Guajarat Cancer and Research Institute (GCRI)

6. What is Central Venous Pressure?
• Measurement of blood pressure within the right atrium
and vena cava
• Ability of the heart to pump blood to the lungs
• High CVP is an important marker of right heart failure b/c of ⊕
pulmonary vascular resistance
• CVP ≈ Venous return to the right side of the heart

7. Use of CVP in the ED/Intensive Care
Setting for hemodynamic stability
• “Structured early goal-directed resuscitation”
• CVP readings help in the general management of shock
through improving…
• O2 saturation
• Cardiac Output*
• Blood Pressure*
• Regional blood flow*
• Septic shock and CVP
• “Golden” 6 hours for hemodynamic stabilization before specific
antibiotics

8. Central Venous Pressure and Cardiac Output
• With no vascular resistance Cardiac Output=Venous Return and
MAP=CVP
• Use fluid resuscitation, vasopressors, and inotropic agents to
increase cardiac output and blood pressure
SVR=(MAP-CVP)/CO

9. CVP and CO: Volume resuscitation
Josh Farkas, MD, Pulmonary and Critical Care Medicine, University of Vermont

10. CVP and CO: Vasopressor Therapy
Josh Farkas, MD, Pulmonary and Critical Care Medicine, University of Vermont

11. CVP and CO: Inotropic therapy
Josh Farkas, MD, Pulmonary and Critical Care Medicine, University of Vermont

12. Central Venous Pressure and Blood
Pressure
• Systemic vascular resistance=(MAP-CVP)/CO
• If BP improves after fluid administration, issue could be
decreased preload
• If BP does not improve after fluids, then problem could be
contractility
• Use CVP to guide whether volume expansion is appropriate
• Importance in suggesting reasons for low blood pressure
• Low CVP (<8cm H2O) suggests low BP is b/c of low blood volume

13. Central Venous Pressure and Regional blood flow
• Regional blood flow=Pressure1-Pressure2/Resistance
• Increase MAP to decrease CVP
• 2013 Netherlands study: CVP > 12 mmHg correlated with
reduced microvascular blood flow in sepsis
• Renal blood flow particularly at risk

14. Septic Shock and CVP
• Use fluid resuscitation, vasopressors, inotropic therapy, and
corticosteroids (severe sepsis only) to increase cardiac output
and during the first 6 hrs maintain…
• CVP 8-12 mmHg
• MAP ≥ 65 mmHg
• Urine output ≥ .5 mL·kg·hr
• Superior vena cava O2 saturation 70% or mixed venous 65%
• Blood cultures
• Source control

15. Measuring CVP traditionally involves
intravenous catheterization
• Risks of…
• infection, embolism, compartment syndrome, necrosis of vascular
tissue, thrombophlebitis, and more
NREMT academy Fibroid Center of MD

16. Mespere’s Venus 1000
Mespere Life Sciences Inc.

17. Implications for the future
• Increase screening/continuous monitoring for patients at risk of
developing shock
• Increase point-of-care testing in the prehospital setting
American Medical Academy Nova Biomedical