Respiratory failure & ventilation
Central Venous Pressure Referencing in the Lateral Position: Comparison With Direct Right Atrial Pressure in Mechanically Ventilated ICU Patients
Authors' conclusion
In mechanically ventilated ICU patients, central venous pressure accuracy was position-dependent, and optimal external reference levels differed between lateral positions. Right atrial pressure increased in the right lateral position, suggesting that lateral positioning influences cardiopulmonary physiology beyond hydrostatic measurement effects alone.
Study context
- Population
- Sedated, mechanically ventilated ICU patients with central venous cathetersevery patient in every position
- Participants
- 16 participants
- Exposure
- Central venous pressure (CVP) (transducer 5 cm below mid-sternum) vs direct right atrial pressure (RAP) (solid-state catheter, mid-right atrium) in supine, 45° left lateral and 45° right lateral positions
- Outcome
- Agreement between RAP and CVP (Bland-Altman bias and limits of agreement, ICC, predefined clinical thresholds)
- Follow-up
- End-expiration
Methodological detailsmethod-comparison, Bland-Altman analysis
- Method-comparison
- Bland-Altman analysis
Main finding
As reported in the abstract
Agreement of CVP (5 cm below sternum) with RAP
| Group | Value | ICC |
|---|---|---|
| Right lateral | bias −0.4 (limits of agreement −3.2 to +2.4) mmHg | 0.85 |
| Left lateral | bias −2.2 (limits of agreement −5.0 to +0.7) mmHg | 0.58 |
Value
Right lateralbias −0.4 (limits of agreement −3.2 to +2.4) mmHg
Left lateralbias −2.2 (limits of agreement −5.0 to +0.7) mmHg
ICC
Right lateral0.85
Left lateral0.58
Observational data: associations, not effects.
Further findings
| Outcome | Δ (mmHg) | P value |
|---|---|---|
| RAP change with positionRight lateral vs Supine · RAP increased in right lateral | +2.9 | P < 0.001 |
| RAP change with positionRight lateral vs Left lateral · RAP increased in right lateral | +2.8 | P < 0.001 |
| RAP change with positionLeft lateral vs Supine · no difference | P = 0.78 |
Optimal CVP reference level, left lateral position (hydrostatic adjustment)
- Bias with adjustment to ≈2 cm below the sternum (minimised)
- −0.1 mmHg
- ICC with adjustment to ≈2 cm below the sternum (improved agreement)
- 0.82
Original publication
Central Venous Pressure Referencing in the Lateral Position: Comparison With Direct Right Atrial Pressure in Mechanically Ventilated ICU Patients. Acta Anaesthesiol Scand. Published 12 June 2026. doi:10.
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