Evaluation of external reference levels for central venous pressure measurements of severely obese patients in the supine position

Abstract

Purpose

A proper reference level is important for measuring intracardiac pressures, especially for parameters with small normal values such as central venous pressure (CVP). Although several external zero reference levels (eZRLs) have been proposed for non-obese patients, none has been reported for severely obese patients. The aim of this study was to investigate an appropriate eZRL for CVP measurements of severely obese patients.

Methods

Chest computed tomography images of 65 patients with body mass index (BMI) ≥ 35 kg/m² were retrospectively reviewed. The anteroposterior thoracic diameter and height of the mid-right atrium (RA) were measured. Four reported eZRLs for CVP measurements (midthoracic level, two-thirds and four-fifths of the thoracic diameter above table level, and 5 cm below the anterior thorax) were examined for error when predicting the midpoint of the RA.

Results

The median BMI was 36.9 kg/m² [interquartile range (IQR), 36.0–39.2]. There was a significant difference in the calculated errors for the midpoint of the RA among the four eZRLs (Kruskal–Wallis test, P < 0.001). Two-thirds of the thoracic diameter above table level was the most accurate reference level for CVP measurement (Steel–Dwass post hoc analysis, P < 0.001). The Bland–Altman plot showed acceptable agreement for clinical use (mean difference, − 7 mm; 95% limit of agreement, − 23 to 9 mm).

Conclusion

The most accurate eZRL for CVP measurements of severely obese patients in the supine position was two-thirds of the thoracic diameter above table level. This result is consistent with that of a previous report of non-obese patients.

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Oropharyngeal squamous cell carcinoma induces an innate systemic inflammation, affected by the size of the tumour and the lymph node spread

Clinical Otolaryngology, EarlyView.


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Resonance frequency analysis in bone‐anchored hearing aids: Patient demographics and an approach to assess implant stability

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Physical outcome measures for conductive and mixed hearing loss treatment: A systematic review

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Anterior disc derangement with reduction of the temporomandibular joint: a case report

Temporomandibular dysfunction involving anterior disc derangement with or without reduction, secondary to posterior ligament insufficiency is typically managed conservatively with success in a majority of pati...

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Vertigo in children; a narrative review of the various causes and their management

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): K. Devaraja
Vertigo is a not an uncommon symptom in children, but often the treating doctors are unsure of the diagnosis and the management of these cases. This narrative review of the literature discusses the brief etiopathology, the clinical manifestations and the management algorithm of most of the conditions causing vertigo in children. The relevant information has been condensed into a table for the perusal of the readers, which would assist in the appropriate management of these children.



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Isolated Knee Arthritis as Early and Only Symptom of Whipple’s Disease

We report a case of isolated Whipple's disease involving the knee of a 64-year-old female patient who presented recurrent monoarthritis whose origin was not clear. Initially, the cause of the gradually invalidating symptoms was related to a meniscal lesion and a diffuse minor grade chondropathy, but pain and functional impairment suggested that more exams were needed. Biopsies were performed during arthroscopy. The histology showed highly inflammatory infiltrates with PAS staining negative for Tropheryma while PCR revealed the infection with Tropheryma whipplei. This, following the recommendation of a rheumatologist and infectious disease specialist, led to biopsies of the gastrointestinal tract and analysis of the cerebrospinal fluid that showed no other organ involvement. This confirms the scientific literature that an isolated monoarthritis without involvement of the gastrointestinal tract caused by this bacterium is rare but can occur as an early manifestation of potentially fatal systemic disease. Moreover, a review of the scientific literature showed the uncertainty about epidemiology of this rare disease, suggesting that more and specific data are required.

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High-precision voluntary movements are largely independent from preceding vertex potentials elicited by sudden sensory events

Kilintari, M; Bufacchi, RJ; Novembre, G; Guo, Y; Haggard, P; Iannetti, GD; (2018) High-precision voluntary movements are largely independent from preceding vertex potentials elicited by sudden sensory events. Journal of Physiology 10.1113/JP275715 . (In press).

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Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain

Harris, S; Singer, M; Sanderson, C; Grieve, R; Harrison, D; Rowan, K; (2018) Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain. Intensive Care Medicine 10.1007/s00134-018-5148-2 . (In press). Green open access

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