Central Venous Pressure Goal

Definition

Studies demonstrating the efficacy of Early Goal Directed Therapy have targeted central venous pressures of between 8-12 mm Hg.  For hypotensive patients who have not responded to fluid resuscitation or for those patients with lactate > 4 mmol/L (36 mg/dL), central venous pressure should be maintained 8 to 12 mm Hg in order to reproduce the mortality reductions cited in the literature.

Note: To remain consistent with the literature, no calculation is provided in the Individual Chart Measurement Tool to account for the effects of positive end-expiratory pressure (PEEP) on central venous pressure.  Clinicians may wish to make note that central venous pressure as an estimate of volume status will be underestimated in patients receiving PEEP.

Compliance with this bundle element is defined as the percent of patients for whom a CVP goal of > 8 mm Hg was achieved within 6 hours following septic shock or lactate > 4 mmol/L (36 mg/dL) identification.

Numerator: The number of patients with severe sepsis with lactate > 4 mmol/L (36 mg/dL) or septic shock for whom a CVP goal > 8 mm Hg was achieved within 6 hours of presentation time

Denominator: The number of patients with severe sepsis with lactate > 4 mmol/L (36 mg/dL) or septic shock

Exclusion: Patients with non-severe sepsis or severe sepsis with lactate < 4 mmol/L (36 mg/dL)

Goal

Increase central venous pressure to > 8 mm Hg within 6 hours in 100 percent of indicated cases.

Data Collection Plan

Data is collected for this measure on each individual patient. Concurrent collection of data is always best as it avoids care memory loss. Fpr more information on the SSC performance improvement database, please click on the top tab of the website labled "Manual & Database."

Related Changes

Maintain Adequate Central Venous Pressure

Sample Graph

Use IHI's Improvement Tracker to enter, save, and graph your team's data.