Albumin infusion fails to restore circulatory function following paracentesis of tense ascites as assessed by beat-to-beat haemodynamic measurements.
OBJECTIVE
To study whether circulatory changes during large volume paracentesis (LVP) in patients with liver cirrhosis and tense ascites as assessed by novel non-invasive haemodynamic measuring technology are reversed by subsequent albumin infusion.


METHODS
Eleven patients with portal hypertensive ascites secondary to liver cirrhosis of Child's class B or C were studied during LVP (10.7 +/- 4.4 l) and subsequent infusion of albumin. Digital arterial pulse waves were continuously measured by vascular unloading technique providing data for beat-to-beat values of systolic (P(s)), diastolic (P(d)) and mean arterial pressures (P(m)), respectively, as well as for heart rate (F(h)), stroke volume (V(s)), cardiac output (Q(co)) and peripheral resistance (R). Data extrapolated to the end of paracentesis, albumin infusion and follow-up phases were compared with the end of the equilibration phase.


RESULTS
At the end of paracentesis, P(s), P(m) and P(d) changed by -14 +/- 15% (p < 0.05), -16 +/- 11% (p < 0.01) and -17 +/- 11% (p < 0.001), respectively, whereas Q(co) and F(h) did not change substantially. There was a highly significant increase in V(s) by +21 +/- 25% (p < 0.01). The largest change was seen in R which significantly decreased by -29 +/- 24% (p < 0.01). This change was not reversed by infusion of albumin and persisted up to the end of follow-up.


CONCLUSIONS
The haemodynamic changes following LVP appear to be first and foremost controlled by changes in peripheral resistance with insufficient cardiac compensation. Further studies combining albumin with vasopressors for prevention of paracentesis-induced circulatory changes are needed.
Schneditz
D
D
Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria.
Bachler
I
I
Stadlbauer
V
V
Stauber
R E
RE
D000368:Aged; D000418:Albumins / Q000008:administration & dosage*; D001201:Ascites / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods*; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology
D000418:Albumins