Clinical trial NCT06705374: Central Venous Pressure and Right Atrial Pressure Measurements in Supine, Semi-recumbent and Trendelenburg Position
Official title: Central Venous Pressure and Right Atrial Pressure Measurements in Supine, Semi-recumbent and Trendelenburg Position
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Critically Ill
Lead sponsor: Vastra Gotaland Region
Sponsor class: OTHER_GOV
First posted: 2024-11-26
Enrollment: 16
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Critically ill patients, in mechanical ventilation, sedated to RASS -4 or -5 in mechanical ventilation with a 4 or 5 line CVC.

Brief summary: Intensive care is directed towards patients with severe illness or risk of serious outcomes following, for example, surgery. Central venous pressure (CVP) is an important part of the hemodynamic assessment of patients in surgery and the intensive care unit (ICU). CVP is normally measured via a central venous catheter (CVC) inserted through the subclavian or internal jugular vein, with the tip placed at the junction to the right atrium. A pressure tubing is connected to one of the branches of the CVC and then connected to a pressure sensor that sends a digital signal to the monitoring screen where CVP can be read in mmHg. To accurately read CVP, the pressure sensor must be positioned at the level of the right atrium. Different external reference points are used nationally and internationally to locate the correct height for the pressure sensor. This study aims to investigate the most commonly used external reference points for CVP measurement in various body positions compared to CVP measured via a solid state pressure catheter in the right atrium (RAP).

Detailed description: A Millar Mikro-Cath solid state pressure catheter is inserted through one of the medial lines of the CVC and guided in position by the pressure curve and verified in position by ultrasound.

CVP is compared to RAP in supine, semi-recumbent, Trendelenburg and lateral position.

CVP, RAP and arterial pressure is recorded in each session with Biopac Acqnowledge.

In each body position PEEP is raised 5 cmH20 and then lowered 5 cmH20.

Ventilator settings, capillary refill time, perfusion index are collected in each setting and before and after PEEP adjustments.

Eligibility criteria: Inclusion Criteria:

* Critically ill patients in mechanical ventilation with an arterial line and a four or five lumen CVC.

Exclusion Criteria:

* under 18 years of age
* in a dynamic phase of their illness i.e. ongoing treatment of severe circulatory or respiratory failure
* positive end-expiratory pressure (PEEP) \>14 cmH20 or intolerance to change of body position.

Primary outcomes:
measure: Difference in mmHg between Right atrial pressure (RAP) and Central venous pressure (CVP) in supine position
timeFrame: 3 minutes after body position change
measure: Difference in mmHg between RAP and CVP in semi-recumbent position
timeFrame: 3 minutes after body position change
measure: Difference in mmHg between RAP and CVP in Trendelenburg position
timeFrame: 3 minutes after body position change
measure: Difference in mmHg between RAP and CVP in right lateral position
timeFrame: 3 minutes after body position change
measure: Difference in mmHg between RAP and CVP in left lateral position
timeFrame: 3 minutes after body position change
Secondary outcomes:
measure: Change in hemodynamic parameters after body position change
timeFrame: 3 minutes after body position change
measure: Change in hemodynamic parameters after PEEP change
timeFrame: 1 minutes after PEEP change
measure: Change in hemodynamic parameters after body position change
timeFrame: 3 minutes after body position change
measure: Change in hemodynamic parameters after body position change
timeFrame: 3 minutes after body position change
measure: Change in hemodynamic parameters after body position change
timeFrame: 3 minutes after body position change
measure: Change in hemodynamic parameters after body position change
timeFrame: 3 minutes after body position change
measure: Change in hemodynamic parameters after PEEP change
timeFrame: 1 minutes after PEEP change
measure: Change in hemodynamic parameters after PEEP change
timeFrame: 1 minutes after PEEP change
measure: Change in hemodynamic parameters after PEEP change
timeFrame: 1 minutes after PEEP change
measure: Change in hemodynamic parameters after PEEP change
timeFrame: 1 minutes after PEEP change
Other outcomes:
Locations:
city: Göteborg
country: Sweden
facility: Sahlgrenska University Hospital
state: Västra Götaland
Study officials:
affiliation: Sahlgrenska University Hospital
name: Lotta Johansson, MD
role: PRINCIPAL_INVESTIGATOR
References: