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


METHODS
Observational 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.


RESULTS
Median 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.


CONCLUSIONS
Paracentesis in critically ill patients is safe regarding circulatory function and is related to immediate and sustained improvement of respiratory function.
Veit
V
Phillip
Bernd
B
Saugel
Christina
C
Ernesti
Alexander
A
Hapfelmeier
Caroline
C
Schultheiß
Philipp
P
Thies
Ulrich
U
Mayr
Roland M
RM
Schmid
II, Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany. wolfgang.huber@lrz.tum.de.
Wolfgang
W
Huber
D000368:Aged; D001201:Ascites / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure; D016638:Critical Illness; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D019152:Paracentesis / Q000009:adverse effects*; D010313:Partial Pressure; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D014655:Vascular Resistance
D010100:Oxygen