Effects of paracentesis on hemodynamic parameters and respiratory function in critically ill patients

BMC Gastroenterology

Research Article

Wolfgang Huber¹  Bernd Saugel¹  Roland M Schmid¹  Philipp Thies¹  Veit Phillip¹  Ulrich Mayr¹  Christina Ernesti¹  Caroline Schultheiß¹  Alexander Hapfelmeier² 

[1] II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Germany;Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Germany;

关键词: Ascites;    Dynamic respiratory system compliance;    Hemodynamics;    Transpulmonary thermodilution;    Hemodynamic monitoring;   

DOI  :  10.1186/1471-230X-14-18

 received in 2013-10-11, accepted in 2014-01-25,  发布年份 2014

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Phillip et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.