Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction: A Concise Review

Kulkarni, Anand V.; Kumar, Pramod; Sharma, Mithun; Ravikumar, Sowmya Tirumalige; Talukdar, Rupjyoti; Rao, PN; Reddy, D. Nageshwar

doi:10.14218/jcth.2019.00048

Cited by 21 publications

(25 citation statements)

References 48 publications

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“…To mitigate the risk of paracentesis-induced circulatory dysfunction (PICD), the removed volume is limited to 5 liters(L). 13 Should a patient experience PICD in cases where less than 5 L of ascites are removed, the MPCSS is partnered with an on-call mobile IV service to provide intravenous volume replacement. For patients exhibiting greater than 5 L of ascites, the paracentesis was stopped once 5 L were removed and one 5-0 nylon suture was placed at the catheter insertion site to prevent post-procedure leakage of ascites.…”

Section: Methodsmentioning

confidence: 99%

Palliative Paracentesis in the Home Setting: A Case Series

Ota

Schultz

Segaline

2020

Am J Hosp Palliat Care

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Background: Management of ascites-related symptoms in home hospice and palliative care patients can be challenging. Ultrasound-guided paracentesis is a standard intervention for this indication, but generally requires transfer to a hospital or outpatient interventional-radiology (IR) setting; thus, such interventions are often not practical or attainable for home hospice and palliative care patients. Objective: To describe a mobile, in-home service that provides home-based palliative paracentesis (HBPP) as an interventional palliative option for patients with distressing symptoms related to ascites. Design: Retrospective case series. Setting/Subjects: Thirty patients with ascites, confirmed by portable bedside ultrasound, who underwent HBPP at their residence. Results: Thirty-three patients were referred for HBPP for symptomatic abdominal distention from March 1, 2019 to March 1, 2020. Thirty (91%) patients had ultrasound-confirmed ascites and received HBPP. All 30, verbalized appreciable symptom relief post-intervention. There were no reported post-procedural complications. Conclusion: Home-based palliative paracentesis is a safe, effective, and convenient intervention for hospice and palliative care patients with symptomatic ascites.

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Section: Methodsmentioning

confidence: 99%

Palliative Paracentesis in the Home Setting: A Case Series

Ota

Schultz

Segaline

2020

Am J Hosp Palliat Care

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“…The analysis suggested a lower number of adverse events with noradrenaline 42 . However, noradrenaline has a half‐life of 1‐2 minutes, and noradrenaline infusion requires central line insertion and regular intensive care monitoring, which is a significant disadvantage 43 . Noradrenaline, an economical choice, has efficacy similar to terlipressin and is associated with lower adverse events without any added mortality benefit 27 .…”

Section: Evidence For the Role Of Terlipressin In Liver Diseasementioning

confidence: 99%

“…Paracentesis causes mechanical decompression of the splanchnic vascular bed leading to vasodilation, a further decrease in the arterial filling and activation of neurohormonal systems 43 . These haemodynamic alterations lead to paracentesis‐induced circulatory dysfunction (PICD).…”

Section: Evidence For the Role Of Terlipressin In Liver Diseasementioning

confidence: 99%

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Kulkarni

Arab

Premkumar

et al. 2020

Liver International

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Vasoactive drugs form the mainstay of therapy for two of the most important complications of liver disease: hepatorenal syndrome (HRS) and acute variceal bleed (AVB). With cumulative evidence supporting the use in cirrhosis, terlipressin has been recommended for the management of HRS and AVB. However, owing to the safety concerns, terlipressin was not approved by food and drug administration (FDA) until now. In this review, we discuss the pharmacology and the major practice‐changing studies on the safety and efficacy of terlipressin in patients with cirrhosis particularly focusing on existing indications like AVB and HRS and reviewing new data on the expanding indications in liver disease. The references for this review were identified from PUBMED with MeSH terms such as “terlipressin,” “hepatorenal syndrome,” “varices, esophagal and gastric,” “ascites” and “cirrhosis.” Terlipressin, a synthetic analogue of vasopressin, was introduced in 1975 to overcome the adverse effects of vasopressin. Terlipressin is an effective drug for HRS reversal in patients with liver cirrhosis and acute‐on‐chronic liver failure. There is documented mortality benefit with terlipressin therapy in HRS and AVB. Adverse effects are common with terlipressin and need to be monitored strictly. There is some evidence to support the use of this drug in refractory ascites, hepatic hydrothorax, paracentesis‐induced circulatory dysfunction and perioperatively during liver transplantation. However, terlipressin is not yet recommended for such indications. In conclusion, terlipressin has stood the test of time with expanding indications and clear prerequisites for clinical use. Our review warrants a fresh perspective on the efficacy and safety of terlipressin.

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“…3 It is well known that employing albumin as a volume expander is superior to other crystalloids (saline) or colloids (hydroxyethyl starch or polygeline) to counteract the hypovolemia occurring post-paracentesis. 4 Seventyfour per cent of all patients included in the meta-analysis compared albumin with other volume expanders which is why albumin was found to be superior. 3 Further, a recent Cochrane review of 27 randomised trials concluded that there was neither any benefit nor any adverse effect in using any plasma expanders (including albumin) in patients undergoing paracentesis.…”

Section: Midodrine or Albumin In Paracentesis-induced Circulatory Dysmentioning

confidence: 99%

“…However, we do agree with Kumar and colleagues that large randomised trials (with adherence to CONSORT guidelines) comparing midodrine against albumin is required to confirm the role of midodrine in preventing PICD. We also suggest that future trials should be based on clinical endpoints rather than laboratory (rise in PRA) based 4. …”

mentioning

confidence: 99%

Midodrine or albumin in paracentesis‐induced circulatory dysfunction: Author's reply

Kulkarni

Rao

2020

GastroHep

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We read the current network meta-analysis by Kulkarni et al 1 with great interest. It is the first network meta-analysis suggesting the superiority of vasoactive drug (midodrine) over albumin in preventing paracentesis-induced circulatory dysfunction (PICD) though with low-quality evidence. 1 However, as we know to ensure validity of findings from network meta-analyses, the systematic review must be designed rigorously and conducted carefully. This network meta-analysis included only nine randomised controlled trials (RCTs) out of which only two have midodrine in comparator arm (one even being an open label pilot study of 20 patients). 2 Also the results of this systemic review and network meta-analysis are in contrast from meta-analysis by Bernardi et al (which comprises of 17 RCTs) which showsalbumin reduce the odds of PICD by 30% when compared to vasoactive drugs. 3 We do agree that midodrine is more costeffective as compared to albumin in prevention of PICD. But before recommending sole use of midodrine for prevention of PICD, well-designed double blind RCTs with sufficient power is required.

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Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction: A Concise Review

Cited by 21 publications

References 48 publications

Palliative Paracentesis in the Home Setting: A Case Series

Palliative Paracentesis in the Home Setting: A Case Series

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Midodrine or albumin in paracentesis‐induced circulatory dysfunction: Author's reply

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