Abstract
BackgroundAscites is a major and common complication of liver cirrhosis. Large or refractory ascites frequently necessitates paracentesis. The aim of our study was to investigate the effects of paracentesis on hemodynamic and respiratory parameters in critically ill patients.MethodsObservational study comparing hemodynamic and respiratory parameters before and after paracentesis in 50 critically ill patients with advanced hemodynamic monitoring. 28/50 (56%) required mechanical ventilation.Descriptive statistics are presented as mean ± standard deviation for normally distributed data and median, range, and interquartile range (IQR) for non-normally distributed data. Comparisons of hemodynamic and respiratory parameters before and after paracentesis were performed by Wilcoxon signed-rank tests. Bivariate relations were assessed by Spearman’s correlation coefficient and univariate regression analyses.ResultsMedian amount of ascites removed was 5.99 L (IQR, 3.33-7.68 L). There were no statistically significant changes in hemodynamic parameters except a decrease in mean arterial pressure (-7 mm Hg; p = 0.041) and in systemic vascular resistance index (-116 dyne·sec/cm5/m2; p = 0.016) when measured 2 hours after paracentesis. In all patients, oxygenation ratio (PaO2/FiO2; median, 220 mmHg; IQR, 161–329 mmHg) increased significantly when measured immediately (+58 mmHg; p = 0.001), 2 hours (+9 mmHg; p = 0.004), and 6 hours (+6 mmHg); p = 0.050) after paracentesis. In mechanically ventilated patients, lung injury score (cumulative points without x-ray; median, 6; IQR, 4–7) significantly improved immediately (5; IQR, 4–6; p < 0.001), 2 hours (5; IQR, 4–7; p = 0.003), and 6 hours (6; IQR 4–6; p = 0.012) after paracentesis.ConclusionParacentesis in critically ill patients is safe regarding circulatory function and is related to immediate and sustained improvement of respiratory function.
Highlights
Introduction to the revised AmericanAssociation for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis
Ascites is a major and frequent complication of liver cirrhosis that is associated with high mortality [1,2,3,4,5]
The vast majority of studies on the subject of paracentesis were not performed in critically ill patients with advanced hemodynamic monitoring or mechanical ventilation
Summary
Introduction to the revised AmericanAssociation for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis. Large or refractory ascites frequently necessitates paracentesis. The aim of our study was to investigate the effects of paracentesis on hemodynamic and respiratory parameters in critically ill patients. Ascites is a major and frequent complication of liver cirrhosis that is associated with high mortality [1,2,3,4,5]. The vast majority of studies on the subject of paracentesis were not performed in critically ill patients with advanced hemodynamic monitoring or mechanical ventilation. Estimation of volume status based on physical examination in critically ill patients is difficult [22]. This problem might be even more pronounced in patients with ascites. Advanced hemodynamic monitoring might help to accurately assess the fluid status and hemodynamic changes in critically ill patients with ascites
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