Effects of therapeutic paracentesis on systemic and hepatic hemodynamics and on renal and hormonal function

Abstract

Thirteen patients with cirrhosis and tense ascites (six with and seven without peripheral edema) underwent 4- to 15-liter paracentesis without intravenous "colloid" replacement. Cardiac output increased from 6.6 +/- 0.7 liters per min at baseline to 8.2 +/- 0.7 liters per min (p less than 0.003) 1 hr after large-volume paracentesis completion and fell to 7.5 +/- 0.69 liters per min (p less than 0.05 vs. baseline, p less than 0.02 vs. 1 hr) 24 hr after large-volume paracentesis completion. There was no change in mean arterial pressure or mean pulmonary artery pressure. Central venous pressure fell from 9.1 +/- 0.8 mm Hg at baseline to 8.6 +/- 1.4 mm Hg 1 hr post-large-volume paracentesis to 6.8 +/- 1.0 mm Hg (p less than 0.005 vs. baseline, p less than 0.02 vs. 1 hr value) at 24 hr, and pulmonary capillary wedge pressure fell from 13.1 +/- 0.9 to 11.1 +/- 1.3 mm Hg 1 hr after large-volume paracentesis and to 9.89 +/- 1.2 (p less than 0.01 vs. baseline, p less than 0.03 vs. 1 hr after large-volume paracentesis) at 24 hr. Heart rate fell from 90 +/- 3.0 to 85 +/- 2.9 beats per min (p less than 0.01) 1 hr after large-volume paracentesis completion, but increased to 89 +/- 2.5 beats per min (p less than 0.02 vs. 1 hr after large-volume paracentesis) at 24 hr.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomized comparative study of hemaccel vs. albumin infusion after total paracentesis in cirrhotic patients with refractory ascites

“…A transient state of hypovolemia after large-volume paracentesis can be inferred also from the observation of raised levels of PRA and PAC in 11 patients. In almost all cases the raised PRA and PAC had reversed in a few days and were not correlated with an increased risk of recurrent ascites or 19). Therefore adequate expansion of plasma volume is essential to attenuate the hypovolemic effect of large-volume paracentesis.…”

Large-volume paracentesis in nonedematous patients with tense ascites: Its effect on intravascular volume

“…Two recent studies (19,21) have found an increased plasma renin activity (suggesting a decrease in plasma volume) after large-volume paracentesis (8 and 13.2 liters in each study, respectively), but neither study actually measured plasma volume.…”

Paracentesis: A safe and effective form of therapy

“…Paracentesis without albumin infusion was clearly associated with a reduction in effective blood flow and thought to account for the higher incidence of renal and electrolyte disorders occurring in these patients. The effects of therapeutic paracentesis without albumin infusion on cardiovascular and renal function are described by Simon et al (8) in this issue of Hepatology. Thirteen patients (6 with and 7 without peripheral edema) underwent large-volume paracentesis (4 to 15 liters) without intravenous albumin replacement.…”