NDLI: Effects of plasma expansion with albumin and paracentesis on haemodynamics and kidney function in critically ill cirrhotic patients with tense ascites and hepatorenal syndrome: a prospective uncontrolled trial

Content Provider	Springer Nature : BioMed Central
Author	Umgelter, Andreas Reindl, Wolfgang Wagner, Katrin S Franzen, Michael Stock, Konrad Schmid, Roland M Huber, Wolfgang
Abstract	Introduction Circulatory dysfunction in cirrhotic patients may cause a specific kind of functional renal failure termed hepato-renal syndrome (HRS). It contributes to the high incidence of renal failure in cirrhotic intensive care unit (ICU) patients. Fluid therapy may aggravate renal failure by increasing ascites and intra-abdominal pressure (IAP). This study investigates the short-term effects of paracentesis on haemodynamics and kidney function in volume resuscitated patients with HRS. Methods Nineteen consecutive cirrhotic patients with HRS were studied. Circulatory parameters and renal function were analysed before and after plasma expansion and paracentesis. Haemodynamic monitoring was performed by transpulmonary thermodilution. Results After infusion of 200 ml of 20% human albumin solution, mean arterial pressure (MAP) and central venous pressure remained unchanged. Global end-diastolic volume index (GEDVI) increased from 791 ml m-2 (693 to 862) (median and 25th to 75th percentile) to 844 ml m-2 (751 to 933). Cardiac index (CI) increased from 4.1 l min-1 m-2 (3.6 to 5.0) to 4.7 l min-1 m-2 (4.0 to 5.8), whereas systemic vascular resistance index (SVRI) decreased from 1,422 dyn s cm-5 m-2 (1,081 to 1,772) to 1,171 dyn s cm-5 m-2 (893 to 1,705). Creatinine clearance (CC) and fractional excretion of sodium (FeNa) were not affected. During paracentesis, IAP decreased from 22 mmHg (18 to 24) to 9 mmHg (8 to 12). MAP decreased from 81 mmHg (74 to 100) to 80 mmHg (71 to 89), and CI increased from 4.1 l min-1 m-2 (3.2 to 4.3) to 4.2 l min-1 m-2 (3.6 to 4.7), whereas SVRI decreased from 1,639 dyn s cm-5 m-2 (1,168 to 2,037) to 1,301 dyn s cm-5 m-2 (1,124 to 1,751). CC during the 12-hour interval after paracentesis was significantly higher than during the 12 hours before (33 ml min-1 (16 to 50) compared with 23 ml min-1 (12 to 49)). CC remained elevated for the rest of the observation period. FeNa increased after paracentesis but returned to baseline levels after 24 hours. Conclusion Paracentesis with parameter-guided fluid substitution and maintenance of central blood volume may improve renal function and is safe in the treatment of ICU patients with hepato-renal failure.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc6765.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc6765
Journal	Critical Care
Issue Number	1
Volume Number	12
Language	English
Publisher	BioMed Central
Publisher Date	2008-01-15
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Mean Arterial Pressure Cirrhotic Patient Terlipressin Plasma Expansion Transpulmonary Thermodilution
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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