Factors associated with central venous pressure in children with parallel circulation after the Norwood operation: insights from high resolution hemodynamic data

Introduction: Central venous pressure (CVP) plays a crucial role in guiding clinical management, particularly in critically ill children. However, its applicability in children with parallel circulation after the Norwood operation remains poorly understood. This study aimed to identify clinical factors associated with CVP in mechanically ventilated children with parallel circulation. Methods: This retrospective study analyzed data from nine neonates with functionally univentricular hearts who underwent the Norwood operation. Various clinical variables, including hemodynamic parameters, ventilatory data, and medication doses, were collected using the T3 software with high temporal resolution. Bayesian linear regression was employed to model CVP using these variables. Results: A total of 27,270 data points from 1,338 patient hours were analyzed. The most probable model explained only 32.4% of the variance in CVP. Variables significantly associated with CVP included fluid balance, milrinone dose, vasopressin dose, peak airway pressure, mean airway pressure, positive end expiratory pressure, fraction of inspired oxygen, temperature, mean arterial pressure, renal near infrared spectroscopy, and systemic vascular resistance. However, the clinical significance of some associations was limited due to the magnitude of change required in independent variables to affect CVP. Conclusion: This study demonstrates that modeling CVP in neonates with parallel circulation after the Norwood operation is challenging, and CVP is not strongly associated with routinely monitored variables. Clinicians should interpret CVP cautiously and consider other clinical parameters when assessing fluid balance and circulatory status in these patients. Further research is needed to better understand the factors influencing CVP in this unique population.