Respiratory impact of paracentesis in cirrhotic patients with acute lung injury

Abstract Introduction Ascites may contribute to the loss of lung volume and alter the gas exchange in cirrhotic patients with acute lung injury (ALI). Aim The aim of the study was to evaluate the effects of paracentesis on respiratory parameters in ventilated cirrhotic patients with ALI. Study Desig...

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Bibliographic Details
Published in:Journal of critical care 2011-06, Vol.26 (3), p.257-261
Main Authors: Levesque, Eric, MD, Hoti, Emir, MD, Jiabin, Jin, MD, Dellamonica, Jean, MD, Ichai, Philippe, MD, Saliba, Faouzi, MD, PhD, Azoulay, Daniel, MD, PhD, Samuel, Didier, MD, PhD
Format: Article
Language:English
Subjects:
Abdomen
Abdomen - physiopathology
Acute lung injury
Acute Lung Injury - therapy
Adult
Critical Care
End expiratory lung volume
Female
Gas exchange
Gases
Humans
Hypotheses
Intensive Care Units
Intraabdominal pressure
Liver cirrhosis
Liver Cirrhosis - therapy
Liver diseases
Lungs
Male
Methods
Middle Aged
Mortality
Paracentesis
Paracentesis - methods
Pressure
Prospective Studies
Pulmonary Gas Exchange - physiology
Respiration, Artificial
Respiratory distress syndrome
Statistical analysis
Studies
Treatment Outcome
Ventilation
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Summary:Abstract Introduction Ascites may contribute to the loss of lung volume and alter the gas exchange in cirrhotic patients with acute lung injury (ALI). Aim The aim of the study was to evaluate the effects of paracentesis on respiratory parameters in ventilated cirrhotic patients with ALI. Study Design This was a prospective trial in an intensive care unit of a university hospital. Patients and Methods Thirty-one cirrhotic patients on mechanical ventilation (with ALI) requiring paracentesis were included in this study. Arterial blood gases, intraabdominal pressures, ventilator parameters, and lung volumes were measured before and after the ascitic drainage. Results Following paracentesis, the intraabdominal pressure decreased (24.1 ± 7.0 vs 12.3 ± 8.9 mm Hg, P < .0001) and the Pa o2 /Fi o2 improved significantly (190.0 ± 65.2 vs 284.9 ± 76.1 mm Hg, P < .0001), without hemodynamic disturbances. End-expiratory lung volume, markedly reduced before drainage, increased significantly following paracentesis (Δ end-expiratory lung volume: +463 ± 249 mL, P = .0009). No adverse effects related to the paracentesis were encountered. Conclusion In contrast to ventilatory recruitment maneuvers, paracentesis is a simple and well-tolerated technique able to improve oxygenation and alveolar recruitment without the risk of the lung overdistension in severely hypoxemic cirrhotic patients.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2010.08.020