By W. J. Russell

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In most clinical circumstances, this means that even the best conditions give a normal range as wide as 6 cm H 2 0 . Any failure to assess the prevailing conditions carefully will broaden this range still further. Interpretation If the cardiac output is insufficient, there are three possible causes: the venous return has reached its limit, the cardiac performance is limiting the cardiac output, or both. Measurement of the central venous pressure can help because it shows whether the right atrial pressure is below or above the point of inflexion on the venous return curve.

G. (1968a). ' Scand, J. Gastroenterol, 3, 113-122. 62 REFERENCES Andersen, D. and Klebe, J. G. (1968b). P. ' Scand. J. Gastroenterol, 3, 267-272. Anderson, R. , James, P. , Bredenberg, C. E. and Hardaway, R. M. (1967). ' Ann. , 165, 341-350. Aubaniac, R. (1952). , 60, 1456. Banet, M. and Guyton, A. C. (1971). ' Am. J. Physiol, 220, 662-666. , Keith, D. and Tesluk, H. (1958). ' /. Amer. med. , 167, 1606-1611. Barrat-Boyes, Β. G. and Wood, Ε. Η. (1957). ' J. Lab. clin. , 50, 93-106. Benchimol, A.

An alternative approach has been to try to improve the cardiac performance with isoprenaline (MacLean and Duff, 1965); in this case a fall in central venous pressure indicates a better cardiac performance and therefore d 0 • • • • • • • 1 0 1 2 3 Time (min) 1 4 1 5 1 6 Figure 28. Diagram of the effect of a fluid load to test different situations. In hypovolaemia the fluid causes a brief rise in central venous pressure. Normally there is a modest rise which has vanished by about six minutes. In hypervolemia the fluid load causes a greater rise in pressure and this rise is more sustained (Reproduced from Sykes (1963), by courtesy of the author and the Editor, Annals of the Royal College of Surgeons) a retrospective diagnosis of some cardiac deficiency can be made.

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Central Venous Pressure. Its Clinical Use and Role in by W. J. Russell
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