This issue was vaguely touched upon in Question 14 from the first paper of 2001, "What are the determinants of central venous pressure? How may its measurement guide patient management?" Some of this is already covered in the chapter on the information derived from the central venous pressure waveform. Those waveform findings are undoubtedly useful (for example, when there is impressive tricuspid regurgitation the abnormal CVP trace is an obvious and memorable feature). But the measurement itself: how may it guide patient management? A more recent Question 8 from the first paper of 2014 asks more directly of the candidates, "Discuss the role of CVP monitoring". This requires a little bit more thinking.
Extensive discussion of central venous pressure measurement and monitoring take place in the Haemodynamic Monitoring section. For the time-poor exam candidate who is untrusting of resources with "Deranged" or "Fast Lane"in the title, an excellent overview exists in this book chapter by Smith, Grounds and Rhodes; one's reading can be safely limited to this single reference.
It is also quite easy to find articles about how bad the CVP is in predicting this or that, but it is much more difficult to find anybody writing anything in its defence. Sheldon Magder's 1998 article in Intensive Care Medicine is probably the best one of those, even if it is almost 20 years old, and slightly off the topic. The same author also produced a similar piece in 2006, arguing that the major limiting factor for the utility of CVP measurement is a failure to acknowledge the potential errors of measurement.
Anyway. First, briefly let us think about the waveform:
The CVP waveform can be a diagnostic aide. It can identify valvular or atrial pathology, and therefore has "utility" in the ICU. The waveform can give information regarding the following physiological features:
Central venous pressure may be reflective of right atrial pressure, which may be elevated in the following settings:
However, CVP is not diagnostic of these pathological states. In recent and not-so-recent history, the CVP has undergone a major change, and is no longer viewed as a particularly useful parameter (whereas previously it was used extensively). In order to render this into a well-organised exam-oriented discussion of CVP, I have formatted my response to Question 8 in the form of a stereotypical "critically evaluate" answer.
Thus:
Arguments from theoretical physiology:
Arguments from experimental physology:
Arguments from clinical evidence:
Most of this material can be found in Bersten and Soni’s” Oh's Intensive Care Manual”, 6th Edition, as well as the CVC section from The ICU Book by Paul L Merino (3rd edition, 2007)
Additionally, I have made use of the amazing Essentials of Critical Care, 8th ed.(ch.3 - Monitoring in the ICU).
For those willing to pay for it, there is a good UpToDate article on this.
For those unwilling to pay, see these free articles:
Magder, S. "More respect for the CVP." Intensive care medicine 24.7 (1998): 651-653.
Pittman, James AL, John Sum Ping, and Jonathan B. Mark. "Arterial and central venous pressure monitoring." International anesthesiology clinics 42.1 (2004): 13-30.
Marik, Paul E., and Rodrigo Cavallazzi. "Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense*." Critical care medicine 41.7 (2013): 1774-1781.
Alzeer A et al. Central venous pressure from common iliac vein reflects right atrial pressure. Can J Anaesth 1998 Aug 45 798-801.
Magder, Sheldon. "Central venous pressure: A useful but not so simple measurement." Critical care medicine 34.8 (2006): 2224-2227.
Smith, T., R. M. Grounds, and A. Rhodes. "Central venous pressure: uses and limitations." Functional Hemodynamic Monitoring. Springer Berlin Heidelberg, 2005. 99-110.
Ishihara, Hironori, et al. "The initial distribution volume of glucose rather than indocyanine green derived plasma volume is correlated with cardiac output following major surgery." Intensive care medicine 26.10 (2000): 1441-1448.
Michard, Frédéric, et al. "Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock." CHEST Journal 124.5 (2003): 1900-1908.
Diebel, Lawrence N., et al. "End-diastolic volume: a better indicator of preload in the critically ill." Archives of surgery 127.7 (1992): 817-822.
Gödje, O., et al. "Central venous pressure, pulmonary capillary wedge pressure and intrathoracic blood volumes as preload indicators in cardiac surgery patients." European journal of cardio-thoracic surgery 13.5 (1998): 533-540.
Magder, Sheldon. "Central venous pressure: A useful but not so simple measurement." Critical care medicine 34.8 (2006): 2224-2227.