Abstract
Introduction: Ascites is a common complication of liver cirrhosis and results in increased intra-abdominal pressure. Paracentesis is a commonly used symptomatic treatment. Hypothesis: Paracentesis might have beneficial as well as harmful effects on circulation and mechanical ventilation. Methods: We prospectively investigated the effects of paracentesis in 50 patients (27 m, 23 f; 58+/-10 years, APACHE-II 22+/-7) with cirrhosis and equipped with PiCCO-monitoring (Pulsion Medical Systems, Germany) for transpulmonary thermodilution (TPTD). 27 patients were under mechanical ventilation. A mean of 6193+/-3422ml of ascites were removed by paracentesis within 140+/-58min. TPTD was performed immediately before and after paracentesis as well as after 2h and 6h. In mechanically ventilated patients simultaneously blood gas analyses were determined, main ventilation data were recorded and Murray-Score without points for X-ray was calculated. Results: In mechanically ventilated patients, paracentesis had a marked and persisting effect on respiratory parameters: Murray score (composed of pO2/FiO2, compliance and PEEP) improved immediately (p<0.001), 2h (p=0.03) and 6h (p=0.012) after paracentesis. Similarly oxygenation index (mean airway pressure * FiO2/pO2) improved immediately (p=0.001), 2h (p<0.001) and 6h (p=0.02) after paracentesis. Compliance increased by 5.5 (p=0.03) and 5.6ml/cmH2O immediately and 2h after paracentesis. pO2/FiO2 increased immediately, 2h and 6h after paracentesis by 40+/-67 (p=0.001) 30+/-58 (p=0.004) and 28+/-55 mmHg (p=0.05). By contrast, we did not observe any changes in hemodynamics except a decrease in CVP immediately (-2.6+/-5.1mmHg; p=0.002) and after 2h (-2.8+/-7.1mmHg; p=0.044) as well as a decrease in diastolic blood pressure immediately (-4.6+/-10.6mmHg; p=0.018) and after 2h (-5.4+/-9.1mmHg; p=0.005). There were no changes in cardiac output, stroke volume, global end-diastolic volume (GEDV), extravascular lung water (EVLW), MAP and heart rate at any time. Conclusions: Paracentesis in critically ill results in marked and sustained improvement in key respiratory parameters without impairment of advanced circulatory parameters. Paracentesis might help to limit ventilator associated lung injury.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
