Effect of large-volume paracentesis on pulmonary function in patients with cirrhosis and tense ascites

Chao, Yee; Wang, Sun Sang; Lee, Shou Dong; Shiao, Guang-Ming; Chang, Huei Ing; Chang, Shi Chuan

doi:10.1016/s0168-8278(05)80474-x

Cited by 25 publications

(13 citation statements)

References 23 publications

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“…Therefore, it is possible that we have underestimated the actual prevalence of COPD in our cohort. On the other hand, some studies have shown that diuresis or large‐volume paracentesis in patients with tense ascites increases FEV1 and FVC in parallel with an unchanged FEV1/FVC ratio 21, 22. Less than 50% of patients in our study had detectable ascites by physical examination, and this makes it less likely that this had a significant impact on our conclusions.…”

Section: Discussioncontrasting

confidence: 54%

Risk factors and impact of chronic obstructive pulmonary disease in candidates for liver transplantation

Rybak¹,

Fallon²,

Krowka³

et al. 2008

Liver Transpl

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Chronic obstructive pulmonary disease (COPD) may cause significant symptoms and have an impact on survival. Smoking is an important risk factor for COPD and is common in candidates for liver transplantation; however, the risk factors for and outcomes of COPD in this population are unknown. We performed a prospective cohort study of 373 patients being evaluated for liver transplantation at 7 academic centers in the United States. COPD was characterized by expiratory airflow obstruction and defined as follows: prebronchodilator forced expiratory volume in 1 second/forced vital capacity Ͻ 0.70. Patients completed the Liver Disease Quality of Life Questionnaire 1.0, which included the Short Form-36. The mean age of the study sample was 53 Ϯ 9 years, and 234 (63%) were male. Sixty-seven patients (18%, 95% confidence interval 14%-22%) had COPD, and 224 (60%) had a history of smoking. Eighty percent of patients with airflow obstruction did not previously carry a diagnosis of COPD, and 27% were still actively smoking. Older age and any smoking (odds ratio ϭ 3.74, 95% confidence interval 1.94-7.23, P Ͻ 0.001) were independent risk factors for COPD. Patients with COPD had worse New York Heart Association functional class and lower physical component summary scores on the 36-Item Short Form but had short-term survival similar to that of patients without COPD. In conclusion, COPD is common and often undiagnosed in candidates for liver transplantation. Older age and smoking are significant risk factors of COPD, which has adverse consequences on functional status and quality of life in these patients.

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Section: Discussioncontrasting

confidence: 54%

Risk factors and impact of chronic obstructive pulmonary disease in candidates for liver transplantation

Rybak¹,

Fallon²,

Krowka³

et al. 2008

Liver Transpl

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“…Fluid retention may cause interstitial and airway oedema, which may reduce alveolar ventilation in some areas 12 31 Finally, in the presence of ascites the basal parts of the lungs may be compressed, leading to hypoventilation 32…”

Section: Discussionmentioning

confidence: 99%

Arterial hypoxaemia in cirrhosis: fact or fiction?

Möller

Hillingsø

Christensen

et al. 1998

Gut

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Background-Although low arterial oxygen tension (PO 2 ) has been claimed to occur in one to two thirds of patients with cirrhosis, hypoxaemia appears to be rare in clinical practice. Aims-To assess the frequency of arterial hypoxaemia in cirrhosis in relation to clinical and haemodynamic characteristics. Patients-One hundred and forty two patients with cirrhosis without significant hepatic encephalopathy (grades 0-I) (41 patients in Child class A, 57 in class B, and 44 in class C) and 21 patients with hepatic encephalopathy. Results-Mean PO 2 in kPa was 11.3 in Child class A, 10.8 in class B, 10.6 in class C, and 10.6 in patients with encephalopathy (p<0.05). The fraction of patients with PO 2 below the lower normal limit of 9.6 kPa was 10%, 28%, 25%, and 43%, respectively in class A, B, C, and in patients with encephalopathy (p<0.05). Oxygen saturation (SO 2 ) in these groups was respectively: 96%, 96%, 96%, and 93% (NS). SO 2 was below the lower limit of 92% in 0%, 9%, 7%, and 24% (p<0.05). In patients without hepatic encephalopathy, a multivariate regression analysis revealed that independent determinants of a low PO 2 were a high arterial carbon dioxide tension, a low systemic vascular resistance, and a low indocyanine green clearance (p<0.0001). Conclusion-The prevalence of arterial hypoxaemia in cirrhosis is about 22% in patients without encephalopathy, but it varies from 10-40% depending on the degree of hepatic dysfunction. Arterial hypoxaemia in patients with cirrhosis of diVering severity seems lower than previously reported, and patients with severe arterial hypoxaemia are rare. (Gut 1998;42:868-874)

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“…Several studies have evaluated the effect of paracentesis in cirrhotic patients with tense ascites and show an improvement in pulmonary function (oxygenation, functional residual capacity, and total lung capacity) after percutaneous abdominal decompression. [143][144][145][146][147] Reducing the ascitic abdominal compression on the lung bases allows caudal displacement of the diaphragm, which in turn results in massive alveolar recruitment. Thus paracentesis is equivalent to a recruitment maneuver according to the OLC.…”

Section: The Impact Of Ascites On Ventilation In Esldmentioning

confidence: 99%

Acute Respiratory Failure Complicating Advanced Liver Disease

Karcz

Bankey

Schwaiberger

et al. 2012

Semin Respir Crit Care Med

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Advanced liver disease is associated with hypoxemia and respiratory failure by various mechanisms. Patients with cirrhosis are especially prone to episodes of decompensation requiring intensive care unit admission and management. Such patients may already be in acute liver failure or have decompensated due to a concurrent illness such as spontaneous bacterial peritonitis, sepsis, encephalopathy, varices, or hepatorenal syndrome. Acute respiratory distress syndrome is one of the main reasons for intensive care unit admission and mortality. Overall, critically ill cirrhotic patients frequently progress to multiorgan failure requiring mechanical ventilation. Caring for such patients is therefore understandably complex and extremely challenging. Patients with end-stage liver disease are especially at risk for developing acute respiratory failure and hypoxemia secondary to hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. They should therefore be screened for these conditions because failure to recognize and adequately treat these serious complications of cirrhosis may have devastating consequences. This article is based on a review of the current literature on how to approach and manage acute respiratory failure in advanced liver disease, which is important to intensivists, anesthesiologists, and physicians as a whole.

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Effect of large-volume paracentesis on pulmonary function in patients with cirrhosis and tense ascites

Cited by 25 publications

References 23 publications

Risk factors and impact of chronic obstructive pulmonary disease in candidates for liver transplantation

Risk factors and impact of chronic obstructive pulmonary disease in candidates for liver transplantation

Arterial hypoxaemia in cirrhosis: fact or fiction?

Acute Respiratory Failure Complicating Advanced Liver Disease

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