Central Venous Pressure as a Predictor of Fluid Responsiveness: Is This All You Need?

Fluid administration during and after surgery is a fundamental strategy for maintaining hemodynamic stability. Technology offers different strategies for hemodynamic monitoring and decision making about fluids administration. In particular patients may be divided into fluid-responding patients and non-fluid-responding patients. Central venous pressure, measured by a central venous catheter, is a basic measure of right heart preload, and many trials defined it as a non-trustable parameter, with many biases and confounding factors, such as mechanical ventilation and intrathoracic pressure. Nevertheless, many authors describe how a simple value like the Central venous pressure may be useful in hemodynamic monitoring during and after cardiac surgery, although it is not the best available. Moreover the results of a recent survey performed in cardiothoracic intensive care units in Italy, reported how central venous pressure was the easiest and the most frequently used parameter for the monitoring of fluid therapy. Given this state of the art, Central venous pressure seems to be the most criticized but, due to its feasibility and availability, it is still the most used parameter for the evaluation of preload and for the prediction of fluid responsiveness in operating room and Intensive Care Unit.