Central Venous Pressure and fluid responsiveness

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Since Rivers’s publication of Early Goal Directed Therapy (EGDT) at the turn of the century clinicians have talked about aggressive resuscitation for septic shock. One of the goals underpinning this technique is the insertion of a central line with targeted goals of CVP and central venous oxygen saturations.

This model of care for patients with septic shock had an NNT of 6 to save a life which is pretty phenomenal! Try to think of another therapy that has been proven to have such a dramatic effect on patients……

So why is it that most of you reading this won’t have followed EGDT in your patients with septic shock? How heavily should this guilt be weighing on your shoulders?

Over the past few months the treatment of septic shock has hit the journal headlines, firstly with the Process Trial and latterly the Arise Trial. These studies looked at EGDT vs alternative treatment strategies (both structured and completely at the discretion of the treating clinician). If you’re not familiar with the papers be sure to have a listen to those podcasts before listening to this episode. Keep a look out for the third paper due for publication this year on the same topic; the Promise trial.

In essence the results of the 2 trials were surprising and leave you wondering where EGDT belongs, it has undoubtedly informed our practice over the last decade but hasn’t been universally implemented. We need to break down the individual goals from EGDT and assess their utility in treating our patients in resus, specifically with septic shock.

Our previous podcast on lactate clearance looked at the idea of exchanging the goal of central venous oxygen sats for lactate clearance. In this episode we take a look at the use of CVP as a goal, specifically in the assessment of fluid responsiveness in the shocked patient.

Have a listen and get in touch with your thoughts!

Simon

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