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JAMA. 1967;202(12):1099. doi:10.1001/jama.1967.03130250081017.
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Central venous pressure determinations, although an extremely valuable tool in assessing the relationship between blood volume, cardiac competence, and vascular tone,1 often is misleading. This has been demonstrated in a recent study of the hemodynamic status of 20 patients with difficult problems of fluid management, as reported in a recent issue of the Archives of Surgery.2

A prime reason for misinterpretation of central venous pressure determinations is the failure to realize that a "family" of ventricular function curves exists, one for each circulatory state. Each curve expresses a constant relationship between ventricular end-diastolic pressure (central venous pressure) and ventricular stroke work. Thus a given increment in venous return in a failing heart will result in a smaller increment in ventricular stroke work than in a normal or supranormal state of myocardial activity. If the myocardium is compromised, a specific central venous pressure will be associated with a smaller


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