Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension
Abstract Background Ascites is a major complication of decompensated liver cirrhosis. Intraabdominal hypertension and structural alterations of parenchyma involve decisive changes in hepatosplanchnic blood flow. Clearance of indo-cyanine green (ICG) is mainly dependent on hepatic perfusion and hepat...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2018-07-01
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| Series: | Annals of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13613-018-0422-6 |
| _version_ | 1828175200987906048 |
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| author | Ulrich Mayr Leonie Fahrenkrog-Petersen Gonzalo Batres-Baires Alexander Herner Sebastian Rasch Roland M. Schmid Wolfgang Huber Tobias Lahmer |
| author_facet | Ulrich Mayr Leonie Fahrenkrog-Petersen Gonzalo Batres-Baires Alexander Herner Sebastian Rasch Roland M. Schmid Wolfgang Huber Tobias Lahmer |
| author_sort | Ulrich Mayr |
| collection | DOAJ |
| description | Abstract Background Ascites is a major complication of decompensated liver cirrhosis. Intraabdominal hypertension and structural alterations of parenchyma involve decisive changes in hepatosplanchnic blood flow. Clearance of indo-cyanine green (ICG) is mainly dependent on hepatic perfusion and hepatocellular function. As a consequence, plasma disappearance rate of ICG (ICG-PDR) is rated as a useful dynamic parameter of liver function. This study primarily evaluates the impact of large-volume paracentesis (LVP) on ICG-PDR in critically ill patients with decompensated cirrhosis. Additionally, it describes influences on intraabdominal pressure (IAP), abdominal perfusion pressure (APP), hepatic blood flow, hemodynamic and respiratory function. Methods We analyzed LVP in 22 patients with decompensated liver cirrhosis. ICG-PDR was assessed by using noninvasive LiMON technology (Pulsion® Medical Systems; Maquet Getinge Group), and hepatic blood flow was analyzed by color-coded duplex sonography. Results Paracentesis of a median volume of 3450 mL ascites evoked significant increases of ICG-PDR from 3.6 (2.8–4.6) to 5.1 (3.9–6.2)%/min (p < 0.001). Concomitantly, we observed a raise in “ICG-Clearance” from 99 (73.5–124.5) to 104 (91–143.5) mL/min/m2 (p = 0.005), while circulating blood volume index was unchanged [2412 (1983–3025) before paracentesis vs. 2409 (1997–2805) mL/m2, p = 0.734]. Sonography revealed a significant impact of paracentesis on hepatic blood flow: Hepatic artery resistance index dropped from 0.74 (0.68–0.75) to 0.68 (0.65–0.71) (p < 0.001) and maximum flow velocity in hepatic vein increased from 24 (17–30) to 30 (22–36) cm/s (p < 0.001). Consistent with previous studies, paracentesis caused significant decreases in IAP from 19.0 (15.0–20.3) to 11.0 (8.8–12.3) mmHg (p < 0.001) and central venous pressure from 22.5 (17.8–29.0) to 17.5 (12.8–24.0) mmHg (p < 0.001) with inverse increases in APP from 63.0 (56.8–69.5) to 71.0 (65.5–78.5) mmHg (p < 0.001). Changes in ICG-PDR were concomitant with changes in IAP (r = − 0.602) and APP (r = 0.576). Moreover, we found a substantial improvement in respiratory function. By contrast, hemodynamic parameters assessed by transpulmonary thermodilution, serum bilirubin and international normalized ratio did not change after paracentesis. Conclusion Critically ill patients with decompensated cirrhosis and elevated IAP showed dramatically impaired ICG-PDR. Paracentesis evoked an improvement in ICG-PDR in parallel with a decreased IAP and an increased APP, while conventional parameters of liver function did not change. This effect on ICG-PDR is mainly referable to a relief of intraabdominal hypertension and changes in hepatosplanchnic blood flow. |
| first_indexed | 2024-04-12T04:23:13Z |
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| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-12T04:23:13Z |
| publishDate | 2018-07-01 |
| publisher | SpringerOpen |
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| series | Annals of Intensive Care |
| spelling | doaj.art-5f75ef2e9a8842c1ab4a7802a97d1ff82022-12-22T03:48:09ZengSpringerOpenAnnals of Intensive Care2110-58202018-07-018111010.1186/s13613-018-0422-6Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertensionUlrich Mayr0Leonie Fahrenkrog-Petersen1Gonzalo Batres-Baires2Alexander Herner3Sebastian Rasch4Roland M. Schmid5Wolfgang Huber6Tobias Lahmer7Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität MünchenKlinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität MünchenKlinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität MünchenKlinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität MünchenKlinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität MünchenKlinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität MünchenKlinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität MünchenKlinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität MünchenAbstract Background Ascites is a major complication of decompensated liver cirrhosis. Intraabdominal hypertension and structural alterations of parenchyma involve decisive changes in hepatosplanchnic blood flow. Clearance of indo-cyanine green (ICG) is mainly dependent on hepatic perfusion and hepatocellular function. As a consequence, plasma disappearance rate of ICG (ICG-PDR) is rated as a useful dynamic parameter of liver function. This study primarily evaluates the impact of large-volume paracentesis (LVP) on ICG-PDR in critically ill patients with decompensated cirrhosis. Additionally, it describes influences on intraabdominal pressure (IAP), abdominal perfusion pressure (APP), hepatic blood flow, hemodynamic and respiratory function. Methods We analyzed LVP in 22 patients with decompensated liver cirrhosis. ICG-PDR was assessed by using noninvasive LiMON technology (Pulsion® Medical Systems; Maquet Getinge Group), and hepatic blood flow was analyzed by color-coded duplex sonography. Results Paracentesis of a median volume of 3450 mL ascites evoked significant increases of ICG-PDR from 3.6 (2.8–4.6) to 5.1 (3.9–6.2)%/min (p < 0.001). Concomitantly, we observed a raise in “ICG-Clearance” from 99 (73.5–124.5) to 104 (91–143.5) mL/min/m2 (p = 0.005), while circulating blood volume index was unchanged [2412 (1983–3025) before paracentesis vs. 2409 (1997–2805) mL/m2, p = 0.734]. Sonography revealed a significant impact of paracentesis on hepatic blood flow: Hepatic artery resistance index dropped from 0.74 (0.68–0.75) to 0.68 (0.65–0.71) (p < 0.001) and maximum flow velocity in hepatic vein increased from 24 (17–30) to 30 (22–36) cm/s (p < 0.001). Consistent with previous studies, paracentesis caused significant decreases in IAP from 19.0 (15.0–20.3) to 11.0 (8.8–12.3) mmHg (p < 0.001) and central venous pressure from 22.5 (17.8–29.0) to 17.5 (12.8–24.0) mmHg (p < 0.001) with inverse increases in APP from 63.0 (56.8–69.5) to 71.0 (65.5–78.5) mmHg (p < 0.001). Changes in ICG-PDR were concomitant with changes in IAP (r = − 0.602) and APP (r = 0.576). Moreover, we found a substantial improvement in respiratory function. By contrast, hemodynamic parameters assessed by transpulmonary thermodilution, serum bilirubin and international normalized ratio did not change after paracentesis. Conclusion Critically ill patients with decompensated cirrhosis and elevated IAP showed dramatically impaired ICG-PDR. Paracentesis evoked an improvement in ICG-PDR in parallel with a decreased IAP and an increased APP, while conventional parameters of liver function did not change. This effect on ICG-PDR is mainly referable to a relief of intraabdominal hypertension and changes in hepatosplanchnic blood flow.http://link.springer.com/article/10.1186/s13613-018-0422-6Indo-cyanine green (ICG)Plasma disappearance rate (PDR)Large-volume paracentesis (LVP)Intraabdominal hypertension (IAH)Intraabdominal pressure (IAP)Decompensated liver cirrhosis |
| spellingShingle | Ulrich Mayr Leonie Fahrenkrog-Petersen Gonzalo Batres-Baires Alexander Herner Sebastian Rasch Roland M. Schmid Wolfgang Huber Tobias Lahmer Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension Annals of Intensive Care Indo-cyanine green (ICG) Plasma disappearance rate (PDR) Large-volume paracentesis (LVP) Intraabdominal hypertension (IAH) Intraabdominal pressure (IAP) Decompensated liver cirrhosis |
| title | Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension |
| title_full | Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension |
| title_fullStr | Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension |
| title_full_unstemmed | Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension |
| title_short | Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension |
| title_sort | large volume paracentesis effects plasma disappearance rate of indo cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension |
| topic | Indo-cyanine green (ICG) Plasma disappearance rate (PDR) Large-volume paracentesis (LVP) Intraabdominal hypertension (IAH) Intraabdominal pressure (IAP) Decompensated liver cirrhosis |
| url | http://link.springer.com/article/10.1186/s13613-018-0422-6 |
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