Effects of Large–Volume Paracentesis on Pulmonary Function in Patients With Tense Cirrhotic Ascites

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Abstract
Large–volume paracentesis is an accepted therapeutic modality for the treatment of tense ascites in patients with cirrhosis. Whereas the effects of large–volume paracentesis on the cardiovascular system have been studied in great detail, the effects of tense ascites and large–volume paracentesis on the respiratory system have undergone only limited evaluation. Most patients report symptomatic improvement in breathing after large–volume paracentesis. The aim of our study was to prospectively evaluate the effects of large–volume paracentesis on the pulmonary function of patients with tense ascites. Nine patients with alcoholic cirrhosis and tense ascites underwent large–volume paracentesis (mean, 3,500 ml of ascites removed) followed by intravenous albumin infusion (10 gm/L ascites removed). Pulmonary function tests were performed just before and 2 hr after large–volume paracentesis. The functional residual capacity increased from 2.46 ± 0.92 to 2.99 ± 0.97 L (p = 0.01) and total lung capacity from 5.08 ± 1.18 to 5.72 ± 1.32 L (p = 0.03). The forced vital capacity, expiratory reserve volume and residual volume also increased but were not statistically significant (p = 0.07 for all). We noted no significant improvement in forced expiratory volume in 1 sec, forced expiratory effort 25% to 75%, vital capacity or diffusion capacity. There was marked symptomatic improvement in all patients. We conclude that large–volume paracentesis improves measured lung volumes within hours in patients with tense ascites. (Hepatology 1994;20:825-828).