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Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension

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 hepatocellula...

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Autores principales: Mayr, Ulrich, Fahrenkrog-Petersen, Leonie, Batres-Baires, Gonzalo, Herner, Alexander, Rasch, Sebastian, Schmid, Roland M., Huber, Wolfgang, Lahmer, Tobias
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035121/
https://www.ncbi.nlm.nih.gov/pubmed/29980962
http://dx.doi.org/10.1186/s13613-018-0422-6
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author Mayr, Ulrich
Fahrenkrog-Petersen, Leonie
Batres-Baires, Gonzalo
Herner, Alexander
Rasch, Sebastian
Schmid, Roland M.
Huber, Wolfgang
Lahmer, Tobias
author_facet Mayr, Ulrich
Fahrenkrog-Petersen, Leonie
Batres-Baires, Gonzalo
Herner, Alexander
Rasch, Sebastian
Schmid, Roland M.
Huber, Wolfgang
Lahmer, Tobias
author_sort Mayr, Ulrich
collection PubMed
description 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/m(2) (p = 0.005), while circulating blood volume index was unchanged [2412 (1983–3025) before paracentesis vs. 2409 (1997–2805) mL/m(2), 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.
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spelling pubmed-60351212018-07-24 Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension Mayr, Ulrich Fahrenkrog-Petersen, Leonie Batres-Baires, Gonzalo Herner, Alexander Rasch, Sebastian Schmid, Roland M. Huber, Wolfgang Lahmer, Tobias Ann Intensive Care Research 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/m(2) (p = 0.005), while circulating blood volume index was unchanged [2412 (1983–3025) before paracentesis vs. 2409 (1997–2805) mL/m(2), 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. Springer International Publishing 2018-07-06 /pmc/articles/PMC6035121/ /pubmed/29980962 http://dx.doi.org/10.1186/s13613-018-0422-6 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Mayr, Ulrich
Fahrenkrog-Petersen, Leonie
Batres-Baires, Gonzalo
Herner, Alexander
Rasch, Sebastian
Schmid, Roland M.
Huber, Wolfgang
Lahmer, Tobias
Large-volume paracentesis effects plasma disappearance rate of indo-cyanine green in critically ill patients with decompensated liver cirrhosis and intraabdominal hypertension
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 Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035121/
https://www.ncbi.nlm.nih.gov/pubmed/29980962
http://dx.doi.org/10.1186/s13613-018-0422-6
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