From the Guidelines
A CVP reading of 15 mmHg is slightly above the recommended target range of 8 to 12 mmHg, but may be acceptable in certain situations, such as mechanical ventilation or pre-existing decreased ventricular compliance, where a higher target CVP of 12 to 15 mmHg is recommended 1.
Clinical Interpretation
CVP stands for Central Venous Pressure, and a reading of 15 mmHg indicates elevated pressure in the central veins near the heart. Normal CVP typically ranges from 2-8 mmHg, so a value of 15 mmHg suggests volume overload or right heart dysfunction. This elevated pressure may indicate conditions such as heart failure, pulmonary hypertension, cardiac tamponade, or fluid overload.
Management Considerations
In clinical practice, a CVP of 15 requires prompt evaluation and management, which might include:
- Diuretics like furosemide (20-40mg IV)
- Fluid restriction
- Treatment of the underlying cause CVP is measured through a central venous catheter placed in the superior vena cava or right atrium, providing valuable information about right heart filling pressures and helping guide fluid management decisions. However, CVP should always be interpreted alongside other clinical parameters such as blood pressure, heart rate, urine output, and the patient's overall clinical condition rather than as an isolated value 1.
Resuscitation Goals
According to the Surviving Sepsis Campaign protocol, resuscitation goals include:
- Central venous pressure (CVP) of 8 to 12 mm Hg, with a higher target CVP of 12 to 15 mm Hg recommended in certain situations
- Mean arterial pressure of greater than or equal to 65 mm Hg
- Urine output of greater than or equal to 0.5 mL/kg per hour
- Central venous (superior vena cava) oxygen saturation (ScvO2) of greater than or equal to 70% or mixed venous oxygen saturation (SvO2) of greater than or equal to 65% 1
From the Research
Central Venous Pressure (CVP) Explanation
- Central Venous Pressure (CVP) is an estimate of right atrial pressure, used to assess cardiac preload and volume status in critically ill patients 2.
- CVP measurements are relatively easy to obtain, but may be difficult to interpret due to the complex relationship between CVP, cardiac output, and the vascular system 2.
- A CVP of > 10 mm Hg is considered high, and the probability of an increase in cardiac output with volume infusion is low 3.
CVP Measurement and Interpretation
- CVP is determined by the interaction between cardiac function and venous return 2.
- The interpretation of CVP needs to be considered in conjunction with an assessment of cardiac output 3.
- A CVP of 15 mm Hg would be considered elevated, indicating potential right-sided heart failure or volume overload 2, 3.
Clinical Implications
- Elevated CVP values, such as 15 mm Hg, may indicate a low probability for cardiac output to increase with a volume infusion 3.
- In patients with chronic heart failure, high daily doses of furosemide have been associated with increased mortality, but CVP is not directly related to furosemide dose 4.
- CVP measurements should be used in conjunction with other clinical parameters, such as cardiac output and volume status, to guide fluid resuscitation and hemodynamic support 5, 6.