Central Venous Pressure Revisited: Physiology, Pitfalls, Misconceptions, and Modern Clinical Interpretation in Critical Care

Central venous pressure (CVP) has long been a cornerstone of hemodynamic monitoring, traditionally interpreted as a surrogate of intravascular volume and cardiac preload. However, current physiological and clinical evidence clearly demonstrates that CVP does not assess volume status and does not reliably predict fluid responsiveness (FR). Ac-cordingly, its role as a target for guiding fluid therapy has been progressively aban-doned. This narrative review retraces the evolution of CVP interpretation, from its physiological foundations to its role in contemporary clinical practice. While early re-suscitation strategies relied on predefined CVP thresholds, this approach has been abandoned. Despite these limitations, CVP remains widely used due to its simplicity and historical familiarity. Importantly, modern perspectives redefine CVP not as a static in-dicator of volume status, but as a valuable marker of systemic venous congestion and right ventricular load. In this context, CVP retains clinical utility when used for waveform interpretation, assessment of venous congestion, and, most importantly, as part of an integrated, multimodal hemodynamic monitoring strategy.