Improvement in Oxygenation After Large Volume Paracentesis

Rp, Byrd; Tm, Roy; Simons, Martin

doi:10.1097/00007611-199607000-00008

Cited by 12 publications

(13 citation statements)

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“…Regarding the positive impact of paracentesis on respiratory function, an improvement of oxygenation (while PaCO 2 remained unchanged) was also observed in a previous study [18]. These positive effects regarding respiratory function are most likely due to improved respiratory mechanics as a consequence of a paracentesis-induced reduction of intraabdominal pressure [18,21,46].…”

Section: Discussionsupporting

confidence: 68%

“…These positive effects regarding respiratory function are most likely due to improved respiratory mechanics as a consequence of a paracentesis-induced reduction of intraabdominal pressure [18,21,46]. The fact that paracentesis caused a significant improvement of dynamic respiratory system compliance in mechanically ventilated patients is also indicative for a decreased intraabdominal pressure following paracentesis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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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“…In concordance with our findings, most studies in the literature show that FVC, FEV 1 , ERV, and functional residual capacity decrease before and increase after paracentesis. (10,12,14,15,21,24) In some patients, we observed that spirometric results returned to normal after paracentesis or after clinical treatment with diuretics, demonstrating that reduction of ascites improves respiratory parameters.…”

Section: Discussionmentioning

confidence: 85%

“…(10) The hypoxemia and decreased pulmonary volume seen in such cases improves after the ascites has been reduced. (11)(12)(13)(14)(15) The increased intra-abdominal volume and pressure caused by the ascites results in decreased lung expansion, and consequent hypoventilation, mainly in the lung bases. Together with the interstitial edema seen in cirrhotic patients, alveolar collapse and microatelectasis may also occur, a situation which could explain the changes in spirometry and blood gas analysis (10) .…”

Section: Introductionmentioning

confidence: 99%

Influência da ascite na avaliação da função pulmonar em portadores de hipertensão portal

Nitrini¹,

Stirbulov²,

Rolim³

2004

J. bras. pneumol.

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INTRODUÇÃO: A oxigenação inadequada nos pacientes com hipertensão portal pode ser secundária a alterações na mecânica respiratória, determinadas pela presença da ascite. OBJETIVO: Avaliar a função pulmonar de doentes com hipertensão portal antes e após redução do volumeda ascite. Método: Quinze doentes com hipertensão portal e ascite foram submetidos a provas de função pulmonar, constituindo-se de espirometria e gasometria arterial, antes e após redução do volume da ascite. Os parâmetros analisados foram: capacidade vital forçada (CVF); volume expiratório no primeiro segundo (VEF1); fluxo expiratório entre 25 e 75% da CVF (FEF 25-75% ); volume de reserva expiratória (VRE); relação VEF1 / CVF; pressão arterial de oxigênio (PaO2), pressão arterial de dióxido de carbono (PaCO2) e saturação arterial de oxigênio (SaO2). RESULTADOS: Houve melhora significativa dos volumes pulmonares analisados após a diminuição da ascite com o tratamento diurético associado ou não à paracentese. CONCLUSÃO: Concluímos que nos doentes com hipertensão portal e ascite, há diminuição dos volumes pulmonares emrelação aos valores preditos, com melhora significativa após diminuição da ascite. Do mesmo modo, observamos aumento na PaO2 e na SaO2.

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Improvement in Oxygenation After Large Volume Paracentesis

Cited by 12 publications

References 0 publications

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

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

Acute Respiratory Failure Complicating Advanced Liver Disease

Influência da ascite na avaliação da função pulmonar em portadores de hipertensão portal

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