Single, total paracentesis for tense ascites: Sequential hemodynamic changes and right atrial size
✍ Scribed by Marios Z. Panos; Kevin Moore; Panayiotis Vlavianos; John B. Chambers; John V. Anderson; Alexander E. S. Gimson; Jeremy D. H. Slater; Lesley H. Rees; David Westaby; Roger Williams
- Book ID
- 102848573
- Publisher
- John Wiley and Sons
- Year
- 1990
- Tongue
- English
- Weight
- 651 KB
- Volume
- 11
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
Hemodynamic changes induced by a single, total paracentesis were evaluated in 21 patients with tense ascites from whom 4 to 16 L of ascites were drained over 2 to 8 hr with no serious complications. At 60 min, compared to baseline, there was an increase in cardiac output (7.7 f 0.5 to 8.6 -+ 0.6 Wmin, p -= 0.02) and a tendency for right atrial pressure to decrease (9.3 * 0.8 to 7.50 f 0.8 mm Hg, NS), with no change in pulmonary capillary wedge pressure (10.9 k 0.9 to 10.7 -c 0.9 mm Hg). Between 3 and 12 hr later, there was a drop in right atrial pressure, pulmonary capillary wedge pressure and cardiac output to 5.6 f 0.6 (p < 0.021, 7.2 f0.8 mm Hg (p < 0.002) and 7.2 f 0.6 L/min (NS) respectively, indicative of the development of relative hypovolemia and suggesting that therapeutic plasma expansion is appropriate at this time. Two-dimensional echocardiography before paracentesis (n = 8) showed a reduction in the right to left atrium area ratio as compared with values in patients with minimal ascites (0.64 f 0.04 vs. 0.82 f 0.02, p c 0.0001). This technique may help in identifying patients with right atrial compression caused by tense ascites. HEPATOLOGY 1990; lk662-667.)
In the 1950s, paracentesis was abandoned as a treatment for cirrhotic ascites largely because of fears that the rapid withdrawal of fluid followed by reaccumulation of ascites would result in plasma volume depletion with life-threatening hypovolemia, hyponatremia and renal impairment as a consequence (1, 2). Previous studies on the hemodynamic effects of paracentesis have yielded somewhat conflicting results, with reports of no change (3), improvement (4) or initial improvement followed by deterioration (5). Albumin infusion during or following paracentesis may protect renal function by preventing hypovolemia (6-101, al-