This study is designed to evaluate the various physiologic maneuvers (Valsalva, humming, breath-hold) for the potential prevention of air embolism during central venous catheter placement. Central venous pressure measurements were prospectively obtained in 40 patients undergoing central venous catheter placement. The average central venous pressure at baseline was 3.275 mm Hg (range = -4 to 16, SD = 5.99). The average central venous pressure during breath hold was 6.1 mm Hg (range = -6 to 24, SD = 7.99). The average central venous pressure during humming was 5.1 mm Hg (range = -4 to 20, SD = 6.4) The average central venous pressure during the Valsalva maneuver was 18.43 (range = -3 to 48, SD = 14.73). Forty percent of patients (16 of 40) had negative central venous pressures at rest, 25% (10 of 40) had negative pressures during breath hold, 20% (8 of 40) had negative pressures during humming, and 2.5% (1 of 40) had negative pressures during Valsalva maneuver. The average increases in central venous pressure during breath hold, humming, and Valsalva were 2.85, 1.82, and 15.2 mm Hg, respectively. The difference between pressures during Valsalva and other maneuvers was statistically significant (P <.05). The conclusion is that the Valsalva maneuver is superior to breath-hold and humming for increasing central venous pressure during central venous catheter placement and, therefore, it is more likely to prevent air embolism in cooperative patients.

译文

本研究旨在评估各种生理动作 (Valsalva,嗡嗡声,屏气),以预防中央静脉导管放置过程中空气栓塞的可能性。前瞻性地获得了40例接受中心静脉导管放置的患者的中心静脉压测量值。基线时的平均中心静脉压为3.275毫米Hg (范围 = -4至16,SD = 5.99)。屏气期间的平均中心静脉压为6.1毫米Hg (范围 = -6至24,SD = 7.99)。嗡嗡声期间的平均中心静脉压为5.1毫米Hg (范围 = -4至20,SD = 6.4)。Valsalva动作期间的平均中心静脉压为18.43 (范围 = -3至48,SD = 14.73)。40% 的患者 (40例中的16例) 在休息时中心静脉压力为负,25% 例 (40例中的10例) 在屏气期间有负压,20% 例 (40例中的8例) 在嗡嗡声期间有负压,2.5% 例 (40例中的1例) 在Valsalva操作期间有负压。屏气,嗡嗡声和Valsalva期间中心静脉压的平均升高分别为2.85,1.82和15.2毫米Hg。Valsalva期间的压力与其他动作之间的差异具有统计学意义 (P <.05)。结论是,在中心静脉导管放置过程中,Valsalva动作优于屏气和嗡嗡声,可提高中心静脉压,因此,在合作患者中,它更有可能预防空气栓塞。

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