Manipulation of Ascitic Fluid Pressure in Cirrhotics to Optimize Hemodynamic and Renal Function

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Abstract
Intra-abdominal pressure (IAP), measured via a transurethral catheter, hemodynamic, and renal functions were evaluated in 25 cirrhotic patients admitted to ICU with variceal bleeding, tense ascites, and peripheral edema. In patients with an IAP > 25 cm H2O, a paracentesis was performed to decrease the IAP by 10 cm H2O. After paracentesis, a decrease in the IAP from 33.47 to 19.06 cm H2O (p < 0.001) resulted in a decrease in total peripheral resistance (TPR) (p < 0.01) and a significant increase in cardiac index (CI) (p < 0.001), stroke index (p < 0.001), left ventricular stroke work (LVSW) (p < 0.01), and right ventricular stroke work (p < 0.01). The therapeutic effects of paracentesis on renal function were: a decrease in BUN and serum creatinine (p < 0.001) and an increase in the creatinine clearance (Ccr) (p < 0.001), urine volume (p < 0.001), osmolar clearance (Cosm) (p < 0.001), and urine creatinine (p < 0.001) values. The IAP correlated directly with the TPR (r = +0.35, p < 0.01) and inversely with the CI (r = −0.39, p < 0.001) and LVSW (r = −0.37, p < 0.001) in the 126 studies of IAP performed with the 25 patients. IAP also correlated directly with BUN (r = 0.40, p < 0.001), serum creatinine (r = 0.28, p < 0.01), and free water clearance (CH2O) (r = 0.3, p < 0.001); IAP correlated negatively with Ccr (r = −0.54, p < 0.001) and Cosm (r = −0.43, p < 0.001). In critically ill cirrhotic patients, IAP, when measured noninvasively via a bladder catheter, is an accurate and useful method to follow manipulation of ascitic fluid pressure quantitatively in order to optimize hemodynamic and renal function.