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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relationship between changes in central venous pressure and cardiac output&#46; Central venous pressure &#40;CVP&#41; is defined by the relationship between the right ventricular function &#40;red&#41; and venous return curves &#40;blue&#41;&#46; Intersection of both curves &#40;black dot&#41; determines a unique value of CVP and cardiac output&#46; Changes in cardiac output and CVP in the same direction mainly reflect variations in the venous return &#40;peripheral function&#41;&#46; Changes in cardiac output and CVP in opposite directions are usually the result of a variation in cardiac function &#40;central function&#41;&#46; A&#58; cardiac function improvement&#59; B&#42;&#58; cardiac function worsening&#59; C&#58; venous return increase&#59; D&#58; venous return decrease&#46; &#42;In this particular scenario&#44; an increase in extravascular pressure should be also considered &#40;air trapping&#44; intraabdominal hypertension&#44; etc&#46;&#41;&#46; In these circumstances&#44; transmural pressure and cardiac preload could be reduced&#46;</p>"
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Or does it still bring relevant information for the patient assessment&#63; Following&#44; we will describe some principles &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; that might be useful for a correct interpretation of CVP measurements from its physiological meaning to its clinical use&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Why should we stop using CVP&#63;</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">To estimate patient&#39;s preload</span><p id="par0015" class="elsevierStylePara elsevierViewall">Preload is the myocardial tension at the end of diastole&#46; CVP is used as a measure of preload due to the directly proportional relationship between pressure and tension&#46; However&#44; CVP is an intracavitary pressure and preload is defined not only by the intravascular pressure&#44; but also by the pressure surrounding the heart&#46; As pericardial pressure is almost identical to CVP except in pathological states&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> this external pressure is represented mostly by the pleural pressure &#40;Ppl&#41;&#46; Subtracting Ppl from CVP results in the transmural pressure &#40;Ptm&#41;&#46; Transmural pressure is related with the force that distends cardiac cavities and that actually defines the cardiac preload&#46; This is the source of frequent mistakes when measuring intravascular pressures and why CVP should be measured at the end of expiration&#46; In normal conditions&#44; Ppl is close to zero at end-expiration and the effect of surrounding pressure can be then neglected&#44; so the CVP is closest to the right atrial Ptm&#46; However&#44; in pathological situations&#44; Ppl can be significantly increased&#44; making such approach unreliable&#46; This circumstance is particularly evident during pathological conditions such as intra-abdominal hypertension or in presence of pulmonary hyperinsuflation&#46; In these situations&#44; Ppl is increased and transmitted to the cardiac cavities raising CVP&#46; However&#44; the Ptm and cardiac preload could be reduced&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Another factor to consider when using CVP for estimating preload is that end-diastolic ventricular volume &#40;EDV&#41; is not related with pressure in a linear nor unique way&#46; This can be explained by the fact that atrial compliance decreases as EDV increases&#46; So&#44; CVP increases more as EDV increases&#46; Moreover&#44; in some pathological situations&#44; such as myocardial ischemia or septic shock&#44; this relationship is frequently altered&#46; In other words&#44; the same CVP may correspond with different EDVs according with the actual atrial compliance&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally&#44; CVP results from the interaction between the right ventricular &#40;RV&#41; function and the venous return &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Consequently&#44; a single CVP value may involve numerous cardiac function and venous return states&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Therefore&#44; CVP changes may be the consequence of variations in cardiac function&#44; venous return&#44; or both&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">To predict the cardiac output response resulting from fluid administration</span><p id="par0030" class="elsevierStylePara elsevierViewall">Regardless of its limited value as a preload index&#44; CVP is also unable to predict whether the cardiac output &#40;CO&#41; will increase after fluid administration&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Since CO variations do not depend only on preload changes but also on the ventricular function&#44; an isolated preload value&#44; as estimated by CVP&#44; will not reliably predict the CO increase after a fluid challenge&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> It is noteworthy that this is purely a physiological but not technological limitation&#44; so it does not rely on the accuracy of the preload estimation&#44; either measured by the CVP or by any other preload variable&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Why should we still measure CVP&#63;</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Because CVP is a determinant of the venous return</span><p id="par0035" class="elsevierStylePara elsevierViewall">The venous return is determined by the gradient created between the average pressure in the venous system or mean filling pressure &#40;MFP&#41;&#44; and the CVP&#46; Venous resistances oppose to this gradient resulting in a simple relationship that describes venous return as &#40;MFP&#8211;CVP&#41;&#47;venous resistances&#46; Keeping constant other factors&#44; any increase in CVP will reduce the MFP-CVP gradient and hence the venous return&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">When evaluating the influence of CVP on venous return&#44; the intravascular pressure&#44; not the Ptm&#44; must be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Since venous return is usually simplify as a continuous flow returning to heart&#44; the mean value of CVP throughout the entire respiratory cycle has to be used&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Because CVP influence the blood capillary flow</span><p id="par0045" class="elsevierStylePara elsevierViewall">Capillary blood flow depends on the gradient between the mean arterial pressure &#40;MAP&#41; and the CVP&#46; Although&#44; under normal conditions&#44; autoregulatory mechanisms allow to maintain a stable MAP despite highly variable CO&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> CVP increases can affect significantly tissue blood flow&#44; particularly during low MAP states&#46; Therefore&#44; a high CVP value could decrease the MAP-CVP gradient&#44; which in turn&#44; could also result in a reduced capillary and organ blood flow&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Because a high CVP value is always pathologic</span><p id="par0050" class="elsevierStylePara elsevierViewall">In a healthy person&#44; CVP is close to zero&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and for an optimal performance&#44; the heart will always try to keep the CVP as low as possible&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Therefore&#44; in normal conditions&#44; changes in venous return or CO are not usually followed by significant changes in CVP&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> This is explained because CVP results from the interaction between venous return and RV function&#46; As long as RV function is preserved&#44; CVP will be kept as low as possible&#46; In other words&#58; the heart regulates CO modulating the CVP&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Therefore&#44; CVP should be interpreted as a coupling index between RV function and venous return&#44; rather than as a preload variable&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Regardless of its cause&#44; a high CVP will always have a negative impact on venous return and capillary blood flow&#46; This could explain why high CVP values have been associated with increased mortality and higher renal failure incidence&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Accordingly&#44; a high CVP value should be considered an alarm signal and should trigger an urgent diagnostic assessment aimed to determine the underlying cause &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; However&#44; it is important to remember that a high CVP may be the result of several pathological conditions and can be associated with different preload states&#46; Therefore&#44; the therapeutic approach could be quite different according to the situation&#46; An adequate echocardiographic evaluation may be helpful to find out the main mechanism involved&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Because CVP should be considered as a limit rather than a target during fluid administration</span><p id="par0060" class="elsevierStylePara elsevierViewall">Fluid administration aimed to achieve an arbitrary CVP value lacks of physiological rationale&#46; Pursuing a fixed value of CVP&#44; such as 12<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O&#44; can be deleterious in a patient with ventricular dysfunction&#44; whereas for a patient with intra-abdominal hypertension&#44; this CVP could be associated with a decreased preload&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">However&#44; since a healthy heart is associated with low CVP values&#44; a significant CVP raise after fluid administration should be interpreted as an early sign of RV dysfunction&#46; Giving more fluids beyond this point could worsen cardiac function and impair venous return and capillary blood flow&#46; Therefore&#44; the role of CVP for guiding fluid therapy is not for defining how much&#44; but rather when to stop giving fluids&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Because&#44; when analyzed together&#44; cardiac output and CVP changes can provide information about changes in venous return and cardiac function</span><p id="par0070" class="elsevierStylePara elsevierViewall">It has been explained that an isolated CVP value is difficult to interpret&#46; However&#44; assessing CVP and CO together could provide a valuable information about what is happening with the cardiac function and&#47;or the venous return&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">As CVP is defined by the interaction between RV function and the venous return&#44; CVP and CO changes are determined by a unique peripheral &#40;venous return&#41; and central &#40;cardiac function&#41; relationship&#46; Consequently&#44; when CO and CVP change in the same direction&#44; they mainly reflect a change in the venous return &#40;either by an increase in the MFP-CVP gradient or by a decrease in venous resistances&#41;&#46; On the other hand&#44; when changes in CO and CVP are in opposite directions&#44; they usually result from a variation in cardiac function &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">An adequate use of CVP measurements requires a solid knowledge of its physiological basis and limitations&#46; In this regard&#44; we strongly believe that&#44; understanding these physiological boundaries&#44; CVP measurement may still have a role in the hemodynamic assessment&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Authors contribution</span><p id="par0085" class="elsevierStylePara elsevierViewall">Both authors contributed to the original idea and writing of this manuscript&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">A&#46; Santos is M&#43;Vision COFUND Advanced Fellow and has received funding from <span class="elsevierStyleItalic">Consejer&#237;a de Educaci&#243;n&#44; Juventud y Deporte</span> of the Comunidad de Madrid and the People Programme &#40;Marie Curie Actions&#41; of the European Union&#39;s Seventh Framework Programme &#40;FP7&#47;2007-2013&#41; under Research Executive Agency grant agreement n¿ 291820&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest regarding this paper&#46;</p></span></span>"
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          "titulo" => "Why should we stop using CVP&#63;"
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              "titulo" => "To estimate patient&#39;s preload"
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              "titulo" => "To predict the cardiac output response resulting from fluid administration"
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          "titulo" => "Why should we still measure CVP&#63;"
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              "titulo" => "Because CVP is a determinant of the venous return"
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              "titulo" => "Because CVP influence the blood capillary flow"
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              "titulo" => "Because a high CVP value is always pathologic"
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              "titulo" => "Because CVP should be considered as a limit rather than a target during fluid administration"
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              "titulo" => "Because&#44; when analyzed together&#44; cardiac output and CVP changes can provide information about changes in venous return and cardiac function"
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          "titulo" => "Conclusion"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relationship between changes in central venous pressure and cardiac output&#46; Central venous pressure &#40;CVP&#41; is defined by the relationship between the right ventricular function &#40;red&#41; and venous return curves &#40;blue&#41;&#46; Intersection of both curves &#40;black dot&#41; determines a unique value of CVP and cardiac output&#46; Changes in cardiac output and CVP in the same direction mainly reflect variations in the venous return &#40;peripheral function&#41;&#46; Changes in cardiac output and CVP in opposite directions are usually the result of a variation in cardiac function &#40;central function&#41;&#46; A&#58; cardiac function improvement&#59; B&#42;&#58; cardiac function worsening&#59; C&#58; venous return increase&#59; D&#58; venous return decrease&#46; &#42;In this particular scenario&#44; an increase in extravascular pressure should be also considered &#40;air trapping&#44; intraabdominal hypertension&#44; etc&#46;&#41;&#46; In these circumstances&#44; transmural pressure and cardiac preload could be reduced&#46;</p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">When not to use CVP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">To evaluate preload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">To evaluate volemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">To predict fluid responsiveness &#40;preload dependence&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Because it is related with the venous return&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Because it affects tissue blood flow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Because a high CVP value is always pathologic&#44; regardless of the cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">To establish a &#8220;limit&#8221; for fluid administration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CVP&#44; when assessed with the cardiac output&#44; provides information about changes in venous return and cardiac function&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Intravascular causes &#40;increased transmural pressure and preload&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypervolemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary embolism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Extravascular causes &#40;decreased transmural pressure and preload&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pericardial effusion&#47;Cardiac tamponade&#47;Constrictive pericarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Air trapping&#47;High PEEP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valsalva maneuver&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumothorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intra-abdominal hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Causes for a high central venous pressure&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
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              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid challenges in intensive care&#58; the FENICE study&#58; a global inception cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Cecconi"
                            1 => "C&#46; Hofer"
                            2 => "J&#46;L&#46; Teboul"
                            3 => "V&#46; Pettila"
                            4 => "E&#46; Wilkman"
                            5 => "Z&#46; Molnar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-015-3850-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "1529"
                        "paginaFinal" => "1537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26162676"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does the central venous pressure predict fluid responsiveness&#63; An updated meta-analysis and a plea for some common sense"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;E&#46; Marik"
                            1 => "R&#46; Cavallazzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e31828a25fd"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "41"
                        "paginaInicial" => "1774"
                        "paginaFinal" => "1781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23774337"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus on circulatory shock and hemodynamic monitoring&#46; Task force of the European Society of Intensive Care Medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Cecconi"
                            1 => "D&#46; De Backer"
                            2 => "M&#46; Antonelli"
                            3 => "R&#46; Beale"
                            4 => "J&#46; Bakker"
                            5 => "C&#46; Hofer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-014-3525-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "paginaInicial" => "1795"
                        "paginaFinal" => "1815"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25392034"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between pericardial pressure and right atrial pressure&#58; an intraoperative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;V&#46; Tyberg"
                            1 => "G&#46;C&#46; Taichman"
                            2 => "E&#46;R&#46; Smith"
                            3 => "N&#46;W&#46; Douglas"
                            4 => "O&#46;A&#46; Smiseth"
                            5 => "W&#46;J&#46; Keon"
                          ]
                        ]
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Point of view
Why should we continue measuring central venous pressure?
¿Por qué deberíamos seguir midiendo la presión venosa central?
M.I. Monge Garcíaa,
Autor para correspondencia
ignaciomonge@gmail.com

Corresponding author.
, A. Santos Oviedob,c,d
a Unidad de Cuidados Intensivos, Hospital SAS de Jerez de la Frontera, Jerez de la Frontera, Spain
b Centro de Investigación Biomédica en Red (CIBER), Madrid, Spain
c Surgical Sciences Department, Uppsala University, Uppsala, Sweden
d M+Vision Cofund, Madrid, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relationship between changes in central venous pressure and cardiac output&#46; Central venous pressure &#40;CVP&#41; is defined by the relationship between the right ventricular function &#40;red&#41; and venous return curves &#40;blue&#41;&#46; Intersection of both curves &#40;black dot&#41; determines a unique value of CVP and cardiac output&#46; Changes in cardiac output and CVP in the same direction mainly reflect variations in the venous return &#40;peripheral function&#41;&#46; Changes in cardiac output and CVP in opposite directions are usually the result of a variation in cardiac function &#40;central function&#41;&#46; A&#58; cardiac function improvement&#59; B&#42;&#58; cardiac function worsening&#59; C&#58; venous return increase&#59; D&#58; venous return decrease&#46; &#42;In this particular scenario&#44; an increase in extravascular pressure should be also considered &#40;air trapping&#44; intraabdominal hypertension&#44; etc&#46;&#41;&#46; In these circumstances&#44; transmural pressure and cardiac preload could be reduced&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Central venous pressure &#40;CVP&#41; is still the most frequent hemodynamic variable for deciding when to administer fluids&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This is interesting regarding numerous trials demonstrating that CVP is not a reliable index for predicting fluid responsiveness&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and most of the clinical guidelines in which CVP is no longer recommended for such a purpose&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite its current discredit&#44; should we exclude CVP from our usual hemodynamic evaluation&#63; Or does it still bring relevant information for the patient assessment&#63; Following&#44; we will describe some principles &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; that might be useful for a correct interpretation of CVP measurements from its physiological meaning to its clinical use&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Why should we stop using CVP&#63;</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">To estimate patient&#39;s preload</span><p id="par0015" class="elsevierStylePara elsevierViewall">Preload is the myocardial tension at the end of diastole&#46; CVP is used as a measure of preload due to the directly proportional relationship between pressure and tension&#46; However&#44; CVP is an intracavitary pressure and preload is defined not only by the intravascular pressure&#44; but also by the pressure surrounding the heart&#46; As pericardial pressure is almost identical to CVP except in pathological states&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> this external pressure is represented mostly by the pleural pressure &#40;Ppl&#41;&#46; Subtracting Ppl from CVP results in the transmural pressure &#40;Ptm&#41;&#46; Transmural pressure is related with the force that distends cardiac cavities and that actually defines the cardiac preload&#46; This is the source of frequent mistakes when measuring intravascular pressures and why CVP should be measured at the end of expiration&#46; In normal conditions&#44; Ppl is close to zero at end-expiration and the effect of surrounding pressure can be then neglected&#44; so the CVP is closest to the right atrial Ptm&#46; However&#44; in pathological situations&#44; Ppl can be significantly increased&#44; making such approach unreliable&#46; This circumstance is particularly evident during pathological conditions such as intra-abdominal hypertension or in presence of pulmonary hyperinsuflation&#46; In these situations&#44; Ppl is increased and transmitted to the cardiac cavities raising CVP&#46; However&#44; the Ptm and cardiac preload could be reduced&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Another factor to consider when using CVP for estimating preload is that end-diastolic ventricular volume &#40;EDV&#41; is not related with pressure in a linear nor unique way&#46; This can be explained by the fact that atrial compliance decreases as EDV increases&#46; So&#44; CVP increases more as EDV increases&#46; Moreover&#44; in some pathological situations&#44; such as myocardial ischemia or septic shock&#44; this relationship is frequently altered&#46; In other words&#44; the same CVP may correspond with different EDVs according with the actual atrial compliance&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally&#44; CVP results from the interaction between the right ventricular &#40;RV&#41; function and the venous return &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Consequently&#44; a single CVP value may involve numerous cardiac function and venous return states&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Therefore&#44; CVP changes may be the consequence of variations in cardiac function&#44; venous return&#44; or both&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">To predict the cardiac output response resulting from fluid administration</span><p id="par0030" class="elsevierStylePara elsevierViewall">Regardless of its limited value as a preload index&#44; CVP is also unable to predict whether the cardiac output &#40;CO&#41; will increase after fluid administration&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Since CO variations do not depend only on preload changes but also on the ventricular function&#44; an isolated preload value&#44; as estimated by CVP&#44; will not reliably predict the CO increase after a fluid challenge&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> It is noteworthy that this is purely a physiological but not technological limitation&#44; so it does not rely on the accuracy of the preload estimation&#44; either measured by the CVP or by any other preload variable&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Why should we still measure CVP&#63;</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Because CVP is a determinant of the venous return</span><p id="par0035" class="elsevierStylePara elsevierViewall">The venous return is determined by the gradient created between the average pressure in the venous system or mean filling pressure &#40;MFP&#41;&#44; and the CVP&#46; Venous resistances oppose to this gradient resulting in a simple relationship that describes venous return as &#40;MFP&#8211;CVP&#41;&#47;venous resistances&#46; Keeping constant other factors&#44; any increase in CVP will reduce the MFP-CVP gradient and hence the venous return&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">When evaluating the influence of CVP on venous return&#44; the intravascular pressure&#44; not the Ptm&#44; must be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Since venous return is usually simplify as a continuous flow returning to heart&#44; the mean value of CVP throughout the entire respiratory cycle has to be used&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Because CVP influence the blood capillary flow</span><p id="par0045" class="elsevierStylePara elsevierViewall">Capillary blood flow depends on the gradient between the mean arterial pressure &#40;MAP&#41; and the CVP&#46; Although&#44; under normal conditions&#44; autoregulatory mechanisms allow to maintain a stable MAP despite highly variable CO&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> CVP increases can affect significantly tissue blood flow&#44; particularly during low MAP states&#46; Therefore&#44; a high CVP value could decrease the MAP-CVP gradient&#44; which in turn&#44; could also result in a reduced capillary and organ blood flow&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Because a high CVP value is always pathologic</span><p id="par0050" class="elsevierStylePara elsevierViewall">In a healthy person&#44; CVP is close to zero&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and for an optimal performance&#44; the heart will always try to keep the CVP as low as possible&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Therefore&#44; in normal conditions&#44; changes in venous return or CO are not usually followed by significant changes in CVP&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> This is explained because CVP results from the interaction between venous return and RV function&#46; As long as RV function is preserved&#44; CVP will be kept as low as possible&#46; In other words&#58; the heart regulates CO modulating the CVP&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Therefore&#44; CVP should be interpreted as a coupling index between RV function and venous return&#44; rather than as a preload variable&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Regardless of its cause&#44; a high CVP will always have a negative impact on venous return and capillary blood flow&#46; This could explain why high CVP values have been associated with increased mortality and higher renal failure incidence&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Accordingly&#44; a high CVP value should be considered an alarm signal and should trigger an urgent diagnostic assessment aimed to determine the underlying cause &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; However&#44; it is important to remember that a high CVP may be the result of several pathological conditions and can be associated with different preload states&#46; Therefore&#44; the therapeutic approach could be quite different according to the situation&#46; An adequate echocardiographic evaluation may be helpful to find out the main mechanism involved&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Because CVP should be considered as a limit rather than a target during fluid administration</span><p id="par0060" class="elsevierStylePara elsevierViewall">Fluid administration aimed to achieve an arbitrary CVP value lacks of physiological rationale&#46; Pursuing a fixed value of CVP&#44; such as 12<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O&#44; can be deleterious in a patient with ventricular dysfunction&#44; whereas for a patient with intra-abdominal hypertension&#44; this CVP could be associated with a decreased preload&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">However&#44; since a healthy heart is associated with low CVP values&#44; a significant CVP raise after fluid administration should be interpreted as an early sign of RV dysfunction&#46; Giving more fluids beyond this point could worsen cardiac function and impair venous return and capillary blood flow&#46; Therefore&#44; the role of CVP for guiding fluid therapy is not for defining how much&#44; but rather when to stop giving fluids&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Because&#44; when analyzed together&#44; cardiac output and CVP changes can provide information about changes in venous return and cardiac function</span><p id="par0070" class="elsevierStylePara elsevierViewall">It has been explained that an isolated CVP value is difficult to interpret&#46; However&#44; assessing CVP and CO together could provide a valuable information about what is happening with the cardiac function and&#47;or the venous return&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">As CVP is defined by the interaction between RV function and the venous return&#44; CVP and CO changes are determined by a unique peripheral &#40;venous return&#41; and central &#40;cardiac function&#41; relationship&#46; Consequently&#44; when CO and CVP change in the same direction&#44; they mainly reflect a change in the venous return &#40;either by an increase in the MFP-CVP gradient or by a decrease in venous resistances&#41;&#46; On the other hand&#44; when changes in CO and CVP are in opposite directions&#44; they usually result from a variation in cardiac function &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">An adequate use of CVP measurements requires a solid knowledge of its physiological basis and limitations&#46; In this regard&#44; we strongly believe that&#44; understanding these physiological boundaries&#44; CVP measurement may still have a role in the hemodynamic assessment&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Authors contribution</span><p id="par0085" class="elsevierStylePara elsevierViewall">Both authors contributed to the original idea and writing of this manuscript&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">A&#46; Santos is M&#43;Vision COFUND Advanced Fellow and has received funding from <span class="elsevierStyleItalic">Consejer&#237;a de Educaci&#243;n&#44; Juventud y Deporte</span> of the Comunidad de Madrid and the People Programme &#40;Marie Curie Actions&#41; of the European Union&#39;s Seventh Framework Programme &#40;FP7&#47;2007-2013&#41; under Research Executive Agency grant agreement n¿ 291820&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest regarding this paper&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relationship between changes in central venous pressure and cardiac output&#46; Central venous pressure &#40;CVP&#41; is defined by the relationship between the right ventricular function &#40;red&#41; and venous return curves &#40;blue&#41;&#46; Intersection of both curves &#40;black dot&#41; determines a unique value of CVP and cardiac output&#46; Changes in cardiac output and CVP in the same direction mainly reflect variations in the venous return &#40;peripheral function&#41;&#46; Changes in cardiac output and CVP in opposite directions are usually the result of a variation in cardiac function &#40;central function&#41;&#46; A&#58; cardiac function improvement&#59; B&#42;&#58; cardiac function worsening&#59; C&#58; venous return increase&#59; D&#58; venous return decrease&#46; &#42;In this particular scenario&#44; an increase in extravascular pressure should be also considered &#40;air trapping&#44; intraabdominal hypertension&#44; etc&#46;&#41;&#46; In these circumstances&#44; transmural pressure and cardiac preload could be reduced&#46;</p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">When not to use CVP</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Because it affects tissue blood flow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Because a high CVP value is always pathologic&#44; regardless of the cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">To establish a &#8220;limit&#8221; for fluid administration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CVP&#44; when assessed with the cardiac output&#44; provides information about changes in venous return and cardiac function&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Intravascular causes &#40;increased transmural pressure and preload&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypervolemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary embolism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Extravascular causes &#40;decreased transmural pressure and preload&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pericardial effusion&#47;Cardiac tamponade&#47;Constrictive pericarditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Air trapping&#47;High PEEP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valsalva maneuver&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumothorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intra-abdominal hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid challenges in intensive care&#58; the FENICE study&#58; a global inception cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Cecconi"
                            1 => "C&#46; Hofer"
                            2 => "J&#46;L&#46; Teboul"
                            3 => "V&#46; Pettila"
                            4 => "E&#46; Wilkman"
                            5 => "Z&#46; Molnar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-015-3850-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "1529"
                        "paginaFinal" => "1537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26162676"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does the central venous pressure predict fluid responsiveness&#63; An updated meta-analysis and a plea for some common sense"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;E&#46; Marik"
                            1 => "R&#46; Cavallazzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e31828a25fd"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "41"
                        "paginaInicial" => "1774"
                        "paginaFinal" => "1781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23774337"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus on circulatory shock and hemodynamic monitoring&#46; Task force of the European Society of Intensive Care Medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Cecconi"
                            1 => "D&#46; De Backer"
                            2 => "M&#46; Antonelli"
                            3 => "R&#46; Beale"
                            4 => "J&#46; Bakker"
                            5 => "C&#46; Hofer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-014-3525-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "paginaInicial" => "1795"
                        "paginaFinal" => "1815"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25392034"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between pericardial pressure and right atrial pressure&#58; an intraoperative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;V&#46; Tyberg"
                            1 => "G&#46;C&#46; Taichman"
                            2 => "E&#46;R&#46; Smith"
                            3 => "N&#46;W&#46; Douglas"
                            4 => "O&#46;A&#46; Smiseth"
                            5 => "W&#46;J&#46; Keon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1986"
                        "volumen" => "73"
                        "paginaInicial" => "428"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3948353"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central venous pressure is a stopping rule&#44; not a target of fluid resuscitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;R&#46; Pinsky"
                            1 => "J&#46;A&#46; Kellum"
                            2 => "R&#46; Bellomo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Resusc"
                        "fecha" => "2014"
                        "volumen" => "16"
                        "paginaInicial" => "245"
                        "paginaFinal" => "246"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25437216"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bench-to-bedside review&#58; an approach to hemodynamic monitoring &#8211; Guyton at the bedside"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Magder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc11395"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2012"
                        "volumen" => "16"
                        "paginaInicial" => "236"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23106914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central venous pressure monitoring"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Magder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ccx.0000224866.01453.43"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2006"
                        "volumen" => "12"
                        "paginaInicial" => "219"
                        "paginaFinal" => "227"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16672781"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Personalizing blood pressure management in septic shock"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Kato"
                            1 => "M&#46;R&#46; Pinsky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13613-015-0085-5"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Intensive Care"
                        "fecha" => "2015"
                        "volumen" => "5"
                        "paginaInicial" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26573630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding central venous pressure&#58; not a preload index&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Magder"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCC.0000000000000238"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "paginaInicial" => "369"
                        "paginaFinal" => "375"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26348416"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid resuscitation in septic shock&#58; a positive fluid balance and elevated central venous pressure are associated with increased mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;H&#46; Boyd"
                            1 => "J&#46; Forbes"
                            2 => "T&#46;A&#46; Nakada"
                            3 => "K&#46;R&#46; Walley"
                            4 => "J&#46;A&#46; Russell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3181feeb15"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "39"
                        "paginaInicial" => "259"
                        "paginaFinal" => "265"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20975548"
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                    ]
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                ]
              ]
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