Determinants of central venous pressure
author: Fiona| Engineer of International Sales | UTECH
2024-04-23
Picture model of the interaction between venous return and cardiac function (contractility).
(a) The intersection of the cardiac function and venous return curves gives cardiac output (CO), venous return, and
Resulting value of CVP.
(b) Maximum venous return with low (negative) CVP in the vertical position ("waterfall" phenomenon) when an increase in contractility does not result in a further increase in CO.
(c) The venous return curve crosses the plateau of the cardiac function curve; therefore, an increase in venous return does not lead to a further increase in CO. Note that based on simultaneous positional shifts in the curve, the resulting CVP values can increase and decrease depending on the individualized response to similar interventions (i.e., fluid loading, vasopressors). CVP central venous pressure, CO cardiac output, PMS mean circulating filling pressure, RV venous return resistance
(a) The intersection of the cardiac function and venous return curves gives cardiac output (CO), venous return, and
Resulting value of CVP.
(b) Maximum venous return with low (negative) CVP in the vertical position ("waterfall" phenomenon) when an increase in contractility does not result in a further increase in CO.
(c) The venous return curve crosses the plateau of the cardiac function curve; therefore, an increase in venous return does not lead to a further increase in CO. Note that based on simultaneous positional shifts in the curve, the resulting CVP values can increase and decrease depending on the individualized response to similar interventions (i.e., fluid loading, vasopressors). CVP central venous pressure, CO cardiac output, PMS mean circulating filling pressure, RV venous return resistance
Central venous pressure depends largely on the tone (and resulting compliance) of the venous reservoir. It is believed that CVP is determined by blood volume
and venous bed capacity, the condition of the cardinal veins and heart valves (to a greater extent the tricuspid valve), and the compliance of right ventricular and pulmonary artery pressures.
determined by the correspondence between them. These numerous factors severely hinder direct clinical interpretation of baseline values and changes in CVP.
and venous bed capacity, the condition of the cardinal veins and heart valves (to a greater extent the tricuspid valve), and the compliance of right ventricular and pulmonary artery pressures.
determined by the correspondence between them. These numerous factors severely hinder direct clinical interpretation of baseline values and changes in CVP.
According to the Guyton circulation model, there are three main determinants of cardiac output—the pumping function of the heart, peripheral blood flow resistance, and the capacity of the circulatory system. Since venous return is equivalent to cardiac output, an increase in the latter can occur by increasing mean systemic pressure and decreasing the response to venous return or CVP
resistance to achieve. This is supported by the observation that cardiac output increases and CVP simultaneously decreases during moderate physical activity.
resistance to achieve. This is supported by the observation that cardiac output increases and CVP simultaneously decreases during moderate physical activity.
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