Introduction: Femoral vein catheterization provides an alternative route of access to central veins, is technically easy and relatively safe. There is good evidence of a general agreement between intrathoracic central venous pressure (CVP) and CVP measured in the iliofemoral veins or inferior vena cava in critically ill patients. This agreement is not well documented when intra-abdominal pressure is raised.
Methods: Intra-abdominal and intrathoracic venous pressures were measured in two cases of abdominal compartment syndrome (ACS), who both had intrathoracic and femoral central venous catheters in place for clinical management. A PUBMED search was conducted to identify relevant studies or reports documenting the relationship between intrathoracic and intra-abdominal CVP, with special reference to conditions of raised intraabdominal pressure or ACS.
Results: There are several sources of data confirming that under conditions of normal to moderately raised intra-abdominal pressure there is a close relationship between intrathoracic CVP and intraabdominal CVP in critically ill patients, even during mechanical ventilation. There is little data documenting the relationship under conditions of raised intra-abdominal pressure, and no data under conditions of ACS. The two cases reported suggest that the normal close relationship is completely lost under conditions of ACS.
Conclusions: Vascular catheters inserted via the femoral route can be routinely used to measure CVP in most critically ill patients with normal or moderately raised intra-abdominal pressure (<15-20 mmHg), but should not be used to measure CVP in patients with abdominal compartment syndrome.
Gavin M. Joynt, Charles D. Gomersall, Gordon Choi, Po T. Chui
