Respiratory mechanics in patients with tense cirrhotic ascites

Abstract

Lung volumes are decreased by tense ascites and increase after large volume paracentesis (LVP). The overall effect of ascites and LVP on the respiratory function is poorly understood.We studied eight cirrhotic patients with tense ascites before and after LVP. Inspiratory muscle force (maximal transdiaphragmatic pressure (Pdi,max), and the lowest pleural pressure (Ppl,min)) was assessed while the patients were seated. Rib cage and abdominal volume displacements, as well as pleural and gastric pressures were measured during quiet breathing while the patients were supine.Pdi,max and Ppl,min were normal and did not change after LVP (from 84.2±19.7 to 85.2±17.0 cmH 2 O and from 68.3±19.7 to 74±15.9 cmH 2 O, respectively). The abdominal contribution to the generation of tidal volume was greater than that of the rib cage (79 vs 21%), a pattern which did not change after LVP (73 and 27%). We conclude that the strength of the inspiratory muscles is normal or reduced in seated cirrhotic patients. In the supine position, tense ascites results in an increase in lung elastic load and development of positive end-expiratory pressure, with a consequent overload and increased activation of inspiratory muscles. Large volume paracentesis decreases overloading and activation, but does not change the strength of the inspiratory muscles. Eur Respir J 1997; 10: 1622-1630

Dyspnea and respiratory muscle strength in end-stage liver disease

“…We also compared Pemax and Pimax in our patients, stratified according to the presence or absence of ascites (Table 3). Our findings are consistent with a few studies comparing these respiratory muscle indices before and after the removal of the ascitic fluid [8,27] . A possible explanation for the lower values of respiratory muscle strength indices in ascites compared to non-ascites group is that the former group of patients had more severe liver disease and a variable degree of mechanical compromise due to ascites per se.…”

“…In fact, in patients undergoing continuous ambulatory peritoneal dialysis (a situation similar to ascites), Siafakas et al [28] and Prezant et al [29] reported that Pimax, measured in a sitting position, was low during this procedure and increased after the drainage of the fluid. In contrast, Duranti et al [8] found that large volume drainage in patients with tense cirrhotic ascites showed a lack of effect on Pimax, indicating that the cause is not solely mechanical.…”

“…The loss of muscle mass may affect both peripheral and respiratory muscles [3] . However, there are only a few reports on respiratory muscle function [4][5][6][7][8] or pattern of breathing in patients awaiting liver transplantation. These patients frequently report chronic dyspnea, however, its exact prevalence and severity remains unknown.…”

Dysfunction of the canine respiratory muscle pump in ascites

“…Specifically, Prezant et al (29) reported an increase in pressure during maximum static inspiratory efforts in six patients with chronic renal failure receiving 3 liters of peritoneal dialysate. On the other hand, Siafakas et al (32) reported that 2 liters of dialysate in similar patients caused a small reduction in pressure, and Duranti et al (16) found no change in pressure after removal of 3.5-13.0 liters of ascites in eight patients with cirrhosis. However, in most patients, the amount of liquid in the peritoneal cavity was small and unlikely to impact significantly on the respiratory system.…”

Prognostic Implications of Preoperative Aerobic Capacity and Exercise Oscillatory Ventilation After Liver Transplantation

“…controlled plant gain) might be impaired as the result of reductions in lung volumes . Decreases in lung volumes were attributed to the compressive effects of ascites , which were found more severe in patients with EOV, despite equivalent volume of ascite drainage the day before functional testing. Whether ascites would develop more rapidly after paracentesis in EOV patients or other mechanisms of lung volume restriction may be present in EOV patients warrants further studies.…”