title: Point-of-Care Echocardiography Improves Assessment of Volume Status in Cirrhosis and Hepatorenal Syndrome.
abstract: The management of patients with cirrhosis along with acute kidney injury is complex and depends in large part on accurate assessment of intravascular volume status. Assessment of intravascular volume status by point-of-care echocardiography often relies solely on inferior vena cava size and variability evaluation; however, this parameter should be interpretated with an understanding of right ventricular function integrated with stroke volume and flow. Attempts to optimize intra-abdominal hemodynamics favorably are clearly problematic when physical examination findings or rudimentary assessments of central venous pressure or change in central venous pressure are used. Here, we have demonstrated the potential utility of point-of-care echocardiography to optimize the hemodynamic state in patients with decompensated cirrhosis along with acute kidney injury. This case is very unique and describes how this technique may have great promise in optimizing the intra-abdominal hemodynamics and predict the timing of large-volume paracentesis in patients with decompensated cirrhosis, which in turn can aid in promoting favorable renal recovery.
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: hugginjt@musc.edu.
authors.forename: John Terrill
authors.initials: JT
authors.lastname: Huggins
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Doelken
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Chet
authors.initials: C
authors.lastname: Walters
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
mesh_terms: D058186:Acute Kidney Injury / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000368:Aged; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006530:Hepatorenal Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019152:Paracentesis; D019095:Point-of-Care Systems
keywords: Acute kidney injury; Ascites; Hepatorenal syndrome; Liver failure; Point-of-care echocardiography