Центральное Венозное Давление Как Показатель Возможной Эффективности Инфузионной Терапии: Систематический Обзор И Метаанализ

INTRODUCTION: Central venous pressure (CVP) has long been considered one of the most reliable methods for assessing volemic status and responsiveness to infusion therapy in patients in intensive care. In recent years, attitudes toward CVP have shifted dramatically, but neither the published data nor the emergence of methods with proven efficacy have significantly changed practicing anesthesiologists' reliance on CVP measurement for diagnostic accuracy. OBJECTIVE: The aim of this study is to assess the existing data on the diagnostic accuracy of CVP in predicting patients' response to infusion therapy and to identify factors that influence these results. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted on prospective cohort studies that examined the diagnostic accuracy of CVP in predicting response to infusion therapy. The primary endpoint was the area under the ROC curve (AUROC). The literature search was performed in the PubMed and CENTRAL databases up to March 2024. Meta-regression was used to assess the impact of covariates, including age, sex, and body mass index (BMI). Risk of bias was evaluated using the QUADAS-2 tool, and the certainty of evidence was assessed by the GRADE approach. RESULTS: A total of 84 studies, comprising data from 3729 patients (4472 observations), were included in the meta-analysis. The overall AUROC for CVP was 0.6 (95% CI [0.57; 0.62]), indicating low diagnostic accuracy (quality of evidence: moderate). The result was consistent in both ICU and perioperative settings. The diagnostic accuracy of CVP did not depend on ICU profile or surgical setting. Pooled sensitivity and specificity were 61 % and 65 %, respectively. Univariate meta-regression showed no significant impact of age, sex, or BMI on the results. Subgroup analysis indicated that mechanical ventilation and infusion load volume did not influence CVP's diagnostic accuracy. CONCLUSIONS: CVP has low diagnostic accuracy for assessing responsiveness to infusion therapy (moderate quality of evidence). Further studies are needed to evaluate the diagnostic accuracy of extreme CVP values, as well as other simple and accessible methods that could potentially replace this measure in clinical practice.