Does Raising the Central Venous Pressure (CVP) in Treating Shock with Fluids Induce Volumetric Overload Shocks (VOS)? by Ahmed N Ghanem in ACR - Lupine Publishers
The answer to the heading question is an affirmative yes! Not only persistence to elevate the central venous pressure (CVP) but also pulmonary capillary wedge pressure (PCWP) is among the fundamental commonly practiced but most misleading reasons for overzealous fluid infusion in managing haemodynamic shock of poly-trauma victims and inducing volumetric overload shock (VOS). The generally received practice on raising CVP and PCWP to level of 18-22 cm water in the management of shock as well as in acutely ill patients is a misconception [1]. All physiology textbooks testify that the normal CVP is 0 and ranges between -7 to +7 cm water measured at middle auxilary line- the level of right atrium on supine posture [2]. The best advice here is that we should imitate nature exactly if we can’t understand how it truly works. Raising CVP to such high level vastly increases filtration force at capillaries inducing VOS and causing oedema of the multiple vital organ dysfunction/ failure (MVOD/F) as detailed in the articles [3,4]- Lupine Publishers.
https://lupinepublishers.com/cardiology-journal/fulltext/does-raising-the-central-venous-pressure-cvp-in-treating-shock-with-fluids-induce-volumetric-overload-shocks-vos.ID.000121.php
https://lupinepublishers.com/cardiology-journal/pdf/ACR.MS.ID.000121.pdf
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